Global Issues in Comparing Vaccination Strategies
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Global Issues in Comparing Vaccination Strategies . Dr Lara Wolfson Vaccine Assessment & Monitoring Department of Immunization, Vaccines & Biologicals. Vaccination Strategies: WHO. Overview of work at WHO Examples of current work Unmet needs.

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Global Issues in Comparing Vaccination Strategies

Dr Lara Wolfson

Vaccine Assessment & Monitoring

Department of Immunization, Vaccines & Biologicals

Vaccination strategies who l.jpg
Vaccination Strategies: WHO

  • Overview of work at WHO

  • Examples of current work

  • Unmet needs

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Estimates of current disease burden for vaccine-preventable diseases

Forecasts of future disease burden & cost-effectiveness under different vaccination scenarios

Methods and Materials to assist RO’s and countries in estimation and forecasting of disease burden, introduction of new vaccines, cost-effectiveness assessments

Support to users of burden of disease data, technical assistance for cost-effectiveness


Accelerated Disease Control

Immunization Systems

Measuring Mortality and Morbidity

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Independent studies / reports / models

Complete vital



Incomplete vital

mortality rates


Epidemiological data from studies, verbal autopsies, WHO programme estimates (child, maternal, injuries, non-communicable, TB, HIV/AIDS)

Sample registration





DHS and other surveys

No recent data


UN population

UN estimates

mortality patterns


All-cause mortality

Country level age, sex and cause specific mortality estimates

envelope by age and sex

Estimating (Total) Mortality at WHO

Life tables

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Primary data


Sensitivity analysis

Looking at all the sources of data

Method 1

Best estimate

Method 2

Method 3

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General Approach

  • Get best data/information (literature/grey literature review)

    • Primary data

    • Secondary data

  • Seek expert advise/opinion

    • natural history of the disease

    • methods/models

    • context

  • Develop consultative process with ROs/countries

  • Develop best methods/models

  • Use best assumptions/probabilities

  • Conduct sensitivity analysis

  • Validate/check consistency & coherence

  • Document (explicit & transparent)

  • Subject to in-house review, then expert review

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    Expected Outputs

    • Burden of Disease Estimates

      • By country, age group, sex, year

      • With estimates of uncertainty, document methods

      • Country consultation, continuous update of inputs (?!?)

    • "Scenarios" (aka Comparing Strategies)

      • Recommendations for best practice

      • Tools for use at country level

      • Provide support to advocacy efforts

    • Cost-Effectiveness

      • Tools and guidelines, training, support

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    Publish methods, database

    Of results, inputs

    Country clearance

    HQ produces burden

    of disease estimates




    Develop scenario models

    And database of inputs

    Develop costing tools and


    Publish tools






    Country for




    Publish tools


    Collaborate with country

    On CEA

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    GAVI and the Vaccine Fund

    • 75 out of 192 member states with GNI <$1000 eligible for support

    • Immunization Systems Strengthening (ISS) support –performance/reward based system

    • New Vaccine Support (NVS) – vaccine provided for 1st five years

    • "Next Window" – 2005-2009

    • ICF (Investment Case Framework)

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    The Example: Measles

    • Need to develop a method for estimating measles mortality and morbidity

    • Measure progress towards Measles Mortality Reduction Goal (50% reduction in measles deaths from 1999-2005)

    • Evaluate the impact of supplemental immunization activities (SIA’s) and routine coverage

    • Develop a tool for countries to use to estimate their own disease burden and monitor progress

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    SIR Model for 192 Member States Countries, 2005-2015

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    How to calculate R Countries, 2005-20150?

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    Looking at Scenarios Countries, 2005-2015

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    Work that is needed (urgently!!) Countries, 2005-2015

    High Priority/Some Work Started

    • Pneumococcal Disease (Meningitis, Pneumonia)

    • Rotavirus

    • Yellow Fever

    • Rubella/CRS

    • Diphtheria

    Lower Priority/Not Started

    • Meningoccocus A/C

    • Japanese Encephalitis

    • Mumps

    • Dengue

    • Typhoid

    • Cholera

    • ETEC

    • Papillomavirus

    • RSV

    • Shigella

    • Streptococcus group A

    • Infant TB

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    CEA Countries, 2005-2015

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    Mixed Bag of Needs Countries, 2005-2015

    • Simple tools for use in country to make policy decisions – but validated compared to complex methods.

    • Valid assessments of current burden of disease (MDG!!)

    • Guidance on plugging "data holes"

    • Introduction of new vaccines