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GAVI Hib Vaccine Strategy

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GAVI Hib Vaccine Strategy

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    1. GAVI Hib Vaccine Strategy A Review of WHO Experience in Decision-Making and Implementation at Country Level

    2. Global Coverage with Hib Vaccine 1997 – 2003*

    3. Main Challenges for Hib Vaccine Introduction Decision making Is this disease really a problem in my country? Is it worth the money spent on it? Is it really my highest priority at this time? Implementation Are the vaccine characteristics suitable for health workers handling it? Will I receive enough vaccine to meet my need? Will I have enough money in the future to continue buying this vaccine? Does this vaccine really make a difference?

    4. Countries Eligible for Hib Vaccine Introduction

    5. Burden of Hib Diseases

    7. Country-specific incidence, by quartile, of Hib meningitis per 100 000 children < 5 years of age in the pre-vaccine era, 46 countries Available data from each country were average to obtain mean <5 yr Hib meninigitis incidence. These averages excluded high risk groups and studies with <15 cases. Mean Hib meningitis incidence rates were available for 46 countries. These data were divided into quartiles & mapped.Available data from each country were average to obtain mean <5 yr Hib meninigitis incidence. These averages excluded high risk groups and studies with <15 cases. Mean Hib meningitis incidence rates were available for 46 countries. These data were divided into quartiles & mapped.

    8. "WHO should assist countries that are considering the adoption of Hib vaccination (…) to strengthen their surveillance and diagnostic capacity for clinical and laboratory-confirmed meningitis".

    9. Cost Effectiveness of Hib Vaccination Cost per life year saved: $17 - $54 000 (Brinsmead et al. Pediatr Inf Dis J 2004) Variable methodologies Most studies only include meningitis Costing not standardized Only 3 published studies from developing countries (South Africa, Chile, Philippines)

    10. Pentavalent Vaccine Characteristics and Supply Combination vaccine Large storage required Liquid-lyophilized Price ($3.60/dose until 2006) Supply Single manufacturer Demand exceeds availability until 2004

    11. Program Costs*

    12. Financing of Immunization Programs by Source*

    13. Three Countries Experience

    14. Tanzania Pre-decisions on Hep B Serological data available early 1990s Hib rapid assessment (September 2001) No cases found in lab records Indirect estimation: 3300 – 3450 annual deaths Consensus meeting (December 2001) Burden of Hib disease not convincing compared to cost of vaccination Future EPI programme interested in Hib vaccine Need to convince senior Ministry officials about long-term financial sustainability

    15. Uganda Consensus and introduction Initial application for HepB only (October 2000) GAVI partners lobby for pentavalent Pentavalent vaccine launched by President (June 2002) Lessons 6 months stock-out in 2003 affected public and political confidence Internal cost-effectiveness study finds HepB superior to Hib Financial sustainability remains the main concern and country indicated possible discontinuation

    16. South Africa Pre-decisions and burden data HepB introduced in 1995 Several studies on Hib meningitis and other invasive infections Consensus and introduction Extensive financial analysis Political lobbying at national and provincial levels DTP-Hib introduced in June 1999 with open tender Factors in favour of introduction Clear disease burden data Personal conviction of decision-makers Impact data from USA, Finland and The Gambia Ability to use internal financing resources

    17. Lessons from Countries Even with demonstrated and convincing disease burden, this relatively expensive vaccine will not necessarily be taken / maintained, unless: Supply is sufficient and 100% assured Prices will reduce substantially Decision-makers are personally interested in introducing and sustaining this vaccine

    18. Summary of Issues Collaborate with countries to strengthen evidence-based decision-making Burden Demonstration in Asia and Eastern Europe Awareness in Africa Cost-effectiveness Consolidate implementation Improved product characteristics including pricing Increased number of suppliers Revised financing strategies Impact data assembled and communicated

    19. Acknowledgement Regional Office for Africa Rose Macauley Tarande Manzila Deo Nshimirimana Regional Office for the Americas Salvador Garcia Jon Andrus Regional Office for Eastern Mediterranean Ezzedine Mohsni Said Youssouf Regional Office for Europe Andrei Lobanov Nedret Emiroglu Regional Office for South-East Asia Pem Namgyal Brent Burkholder Regional Office for Western Pacific Yang Baoping Headquarters Marie-Paule Kieny Peter Carrasco Thomas Cherian Jos Vandelaer Ulla Griffiths Lara Wolfson Chris Nelson Marta Gacic-Dobo Maureen Birmingham Miloud Kaddar Patrick Lydon Lidija Kamara Alejandro Costa Michel Zaffran Oya Afsar Tracey Goodman Julian Bilous

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