Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum

1. Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum Philadelphia, USA Political Will, Public Confidence, and Immunization Impact: Insights from the WHO European Region Member States Rebecca Martin WHO European Regional Office CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum. Philadelphia, USA

2. WHO European Region 2010: 53 Member States (~890 million) • WHO/Europe role: • Policy development & implementation • Normative guidance • Expert technical assistance

3. Current Landscape in the European Region • Strong history of collaboration for immunization • Progress made towards regional goals • National routine immunization coverage levels are overall high across the Region • Vaccine-preventable disease incidence is variable and generally low • Increasing momentum of vaccine refusals • Marginalized and vulnerable groups require attention, general complacency in absence of disease (low risk perception), variable public trust • Cannot afford to jeopardize progress made towards goals

4. Countries with a standing national immunization technical advisory group on immumnization, 2009 No response (BLR, RUS, UKR, LUX, SMR, MON) No (KAZ, UZB, TKM, AZE, SRB, MNE) No, but ad hoc committee (TJK, ARM, MDA, ROM, CRO, SVN, NOR) Yes (n= 34)

5. Platform for: Improving information on vaccine benefits and safety driving demand for vaccines advocating for political support and financial commitment 2011: ”Shared solutions to common threats” European Immunization Week

6. GAVI eligibility based on Gross National Income (GNI) per capita - Atlas method Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

7. Country Co-financing Needed (2011-2015)GEORGIA – Graduating Country 2 dose schedule for rotavirus vaccine and, reserve stock at start and wastage rate included for all vaccines From 2011 to 2015, estimated GNI growth in US$: 32.0%; US$ inflation: 12.5% Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

8. Projected co-financing as a percentage of operational budget for routine immunization(2009) Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

9. Financial sustainability analysis on revised GAVI co-financing Eligible countries(KGZ, TJK, UZB) Additional co-payment burden may be absorbed by resource allocation changes within MoH budget Increased advocacy needed Graduating countries (ARM, AZE, GEO, MDA) Additional co-payment burden may/can not be absorbed by resource allocation changes within MoH budget In need of external advocacy support Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

10. Measles-containing vaccine 1st dose coverage by World Bank income category

11. Vaccine safety, adverse events following immunization and anti-vaccine movement Immunization programmes more complex Role of health care workers, particularly paediatricians, specialists and academicians AEFIs and trust narcolepsy with pandemic influenza vaccine adverse events with tick-borne encephalitis Suspension of supply of vaccines (Bulgaria) Anti-vaccine and response Deaths following vaccination in Bosnia and Herzegovina HPV vaccine introduction in Netherlands

12. Building political will and public confidence • Public confidence and communication • EIW 2011 Round Table with Belgium ,Switzerland, Germany and France: political, providers, public • Collaborative work WHO, UNICEF, ECDC, EC • European immunization coalition • European communication working group • National regulatory authorities • Behaviour change communication models • Social media activities CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum. Philadelphia, USA

13. Introduction of new vaccinesWHO European Region 2010 Hib PCV Rotavirus HPV

14. Influenza A(H1N1) 2009 vaccine implementation WHO European Region • 45/48 countries reported having a vaccination plan (94%) • 41/45 of countries implemented A(H1N1) 2009 vaccination (91%) 48/53 countries completed the survey (91%)

15. Availability of pandemic influenza A(H1N1) vaccine relative to epidemic peak (n=41) Pre-epidemic Epidemic Post-epidemic 22% received vaccine during peak trans- mission (4 wks) 41% received vaccine at least 2 weeks before epidemic peak 37% received vaccine 2 weeks or more after epidemic peak

16. Principal reasons for refusing pandemic vaccine % N=39

17. Summary • Strengthen political commitment at all levels • Ensure equitable and affordable access to vaccines, including vaccine manufacturing, for all countries • Align immunization plannning with national health plans and budgetary cycles to sustain immunization programmes • Advocate for funding – national/international • Collaborative work ongoing CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum. Philadelphia, USA

18. Thank you CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum. Philadelphia, USA

19. WHO European Region Immunization programmatic goals • Immunization Systems Strengthening • Stewardship/ sustainable financing • Quality-assured vaccines, supply and safety • Access to and utilization of immunization services • Use of new and under-utilized vaccines • Accelerated Disease Control • Diseases with eradication & elimination goals • Priority bacterial and viral diseases • Enhanced Surveillance & Monitoring • Communication and advocacy CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum. Philadelphia, USA