Accelerating Progress towards Measles and Rubella Elimination

1. Accelerating Progress towards Measles and Rubella Elimination Eastern Mediterranean Region 21 June 2016 Geneva, Switzerland

2. Regional Measles and Rubella Goals Measles elimination from all countries of the EMR by 2020 • Resolution EM/RC44/R.6 – 1997 (elimination by 2010) • Revised by Resolution EM/RC58/R.5 – 2011 (elimination by 2015) • Revised target EMVAP to achieve elimination by 2020 • No regional target for rubella/CRS elimination • Thirteen countries have developed national targets for rubella/CRS elimination • RTAG recommended establishing regional target for rubella elimination by 2020

3. Measles and rubella reported cases and MCV1/MCV2coverage in EMR 1980-2014

4. Comparison of EMR MCV1 coverage WHO UNICEF estimates, and number of countries reaching MCV1 coverage ≥90%2000 – 2014 (N=21) EMR MCV1 coverage No. Countries MCV1 ≥90%

5. Reported coverage of MCV1 and MCV2 by country 2015 (JRF data) MCV1/MCV2 coverage

6. MCV1 coverage by WHO UNICEF estimates in EMR countries Number of Countries

7. Measles SIA coverage by country 2015-2016 % Coverage

8. SIAs 2015-2016 in EMR

9. Local funding for measles SIAs in EMR 2015 A total of 48.25 million USD raised locally by these countries in 2015

10. MCV2 introduction into routine EPI in EMR Palestine Bahrain MCV2 introduced in Routine prior to 2015 No MCV2 introduction plans currently

11. Rubella containing vaccine introduction in EMR Palestine Bahrain Rubella introduced prior 2011 Rubella introduced 2011-2014 Rubella introduction date after 2016 or not yet set 4 countries may introduce RCV by end of 2020

12. Indicators of Progress Towards Measles (and Rubella) Elimination EMR Region 2000-2016* ¹ Data as of May 2016

13. Measles Incidence by country EMR 2015 (Confirmed measles cases/million, target < 1/million)

14. Distribution of confirmed measles cases by age and vaccination status EMR 2015 Number of confirmed measles cases

15. Distribution of confirmed measles cases in outbreaks in Egypt and Sudan 2015 Egypt 2015 confirmed cases = 5431 Sudan 2015 confirmed cases = 3585

16. Measles incidence by countryEMR Jan-Mar 2016(Confirmed measles cases/million, target < 1/million) *Djibouti and Libya did not submit report

17. Age distribution of confirmed measles cases in countries of EMR Jan-Mar 2016 Number of confirmed measles cases

18. Rubella incidence by countryEMR Jan-Mar 2016(Confirmed rubella cases/million, target < 1/million) *Djibouti and Libya did not submit report

19. Age distribution of confirmed rubella cases in countries of EMR Jan-Mar 2016 Number of confirmed rubella cases

20. Routine strengthening activities in EMR • Stand alone activities to increase MCV1 coverage • Implementation of RED approach: Afghanistan, Iraq, Pakistan, Somalia, Sudan and Yemen • Acceleration activities: CHDs in Somalia, catch-up activities in Syria and surrounding countries, integrated interventions in Yemen,.. • Programme strengthening: EPI reviews, EVM assessment and improvement plan, improving data quality • Activities as part of ongoing measles activities (SIAs or MSD introduction) • Human resource capacity building • Improving reporting system and data quality • Improving microplanning capacity • Meetings/Communication • Country implementation of Immunization Week • Inter-country meeting on Measles/Rubella elimination, Amman, November-December 2015

21. Regional and National Verification • RVC in process of being established • National verification committee: • Established in 8 countries: Afghanistan, Bahrain, Iran, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria • Other countries in process of establishing

22. Challenges to achieving regional goals • Security situation: deteriorating in the EMR over a prolonged period • Inaccessibility of population • Unclear or multiple lines of authority • Delayed implementation of planned activities • Funding scarcity: for follow-up SIAs and surveillance • Delayed implementation of the follow up SIAs • Slow progress in improving surveillance sensitivity • Competing priorities: • Emergency relief in conflict countries • Polio eradication

23. Programme Plans 2017-2018

24. Priorities for 2017 • Increase MCV1 / MCV2 coverage and ensure uniformity of coverage within the country • Expand measles case based surveillance to all countries and increase the overall quality of surveillance in all countries • Improve quality of SIA with better planning and intra campaign monitoring • Establish CRS surveillance • Verification of measles elimination in Bahrain, Palestine, and Oman

25. 2017-2018 SIA plans and budget

26. 2017-2018 GAVI application and introduction plans for MR

27. 2016-2017 measles and rubella/CRS surveillance plans and budget • Regional training for MR surveillance guidelines in elimination phase – early 2017 • MR/VPD surveillance review – 4 countries of EMR in 2017 • Establish CRS surveillance – Sudan, Pakistan, Afghanistan, Yemen

28. Technical Assistance needs 2017 • TA needs for SIA planning • Afghanistan and Sudan • TA needs for surveillance • Establishing CRS surveillance in Sudan, Afghanistan, Pakistan and Yemen • TA needs for GAVI applications • Application for MR introduction Afghanistan and Sudan

29. Resource gaps 2017-2018 • Financial resources to support the strengthening and maintenance of MR case based surveillance • Financial resources to maintain high quality lab surveillance • Financial resources for follow up MR campaigns in non GAVI countries, especially those with acute/chronic armed conflict

30. Thank you