Presentation on theme: "Global Measles and Rubella Strategic Plan"— Presentation transcript:
1Global Measles and Rubella Strategic Plan 2011-2020 This strategic plan is a work in progress, and the final plan will be available before the end of the year.
2Strategic Advisory Group of Experts (SAGE), November 2010 Measles can and should be eradicatedMeasurable progress towards 2015 global targets and existing regional elimination goals is required before establishing a target dateRequested frequent updates on progress
3World Health Assembly, May 2011 2015 Global Targets as milestones towards eradicationVaccination coverage of 90% national level and 80%in every districtReported incidence of <5 cases of measles per millionMortality reduction of 95% vs. year 2000 Targets aligned with the 2015 Millennium Development Goal of reducing child mortality by 2/3WHA 2010 endorsed 3 global measles targets as milestones towards eradication
4What is New? The plan includes: rubella and CRS control/elimination activities to strengthen routine immunization and disease surveillance systems.outbreak preparedness and responseresearch and development– reduction & eventual elimination of cases of rubella and CRS- renewed commitment from MI partners to allocate resources and provide technical assistance to strengthen routine immunization & surveillanceBuilds on > 10 years of experience implementing previous strategic plans.Incorporates the 2009 and 2010 guidance and recommendations from the WHO SAGE and the WHO Ad Hoc Global Measles Advisory Group.R&D is now one of the components of the strategy
5A world without measles, rubella and congenital rubella syndrome VisionA world without measles, rubella and congenital rubella syndromeReaching this vision will most likely happen beyond 2020
6GoalsBy end 2015:Reduce global measles mortality by >95% compared to levelAchieve regional measles and rubella/CRS elimination goalsBy end 2020:Achieve measles elimination in at least 5 WHO regionsAchieve & sustain measles elimination in at least four WHO regions. – PAHO, EURO, EMRO & WPROAchieve rubella and CRS elimination in at least 2 WHO regions – PAHO & EUROThese are in line with the current regional measles & rubella targets
7Measles and Rubella Elimination Goals by WHO Region, August 2011 World Health OrganizationMeasles and Rubella Elimination Goals by WHO Region, August 20111 April, 2017Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goalsAmericas and Europe have rubella elimination goalsSEARO RC in Sept 2009 endorsed a resolution to mobilize support towards eliminate measles, 2010 RC meeting adopted the global 2015 measles targets (95% mortality reduction).Note: EURO changed target to 2015, EMRO is in process of changing target to 2015201520122020SEAR: 95% Measles Mortality Reduction by 20157
8Milestones By end 2015Achieve > 90% coverage with MCV1 (and RCV) nationally and > 80% in every district.Achieve > 90% coverage with M, MR or MMR during SIAs in every district.Reduce global measles incidence to < 5 per millionAchieve rubella/CRS elimination in at least 2 WHO RegionsEstablish a rubella control/CRS prevention goal in at least 1 additional WHO regionEstablish a global measles eradication goal
9Milestones By 2020 Sustain the achievement of the 2015 targets > 95% coverage with MCV1 & MCV2 (and RCV) in each district and nationallyAchieve > 95% coverage with M, MR or MMR during SIAs in every district.Establish a global rubella and CRS eradication goal.
10StrategiesHigh vaccination coverage with two doses of measles and rubella vaccinesEffective surveillance, monitoring and evaluationOutbreak preparedness and responseCase managementResearch and developmentEmphasize text in blue.Under the research section, mention the following:Essential to provide the scientific underpinnings of the strategies and shaping evidence based policy2011 CDC/WHO meeting: highlighted critical research areas needed to address risks and facilitate elimination.The WHO SAGE Working group on measles and rubella will help identify the highest priorities for research.
11Guiding Principles Country ownership and sustainability Routine immunization and health systems strengtheningEquityLinkages1. Country ownership and sustainabilityCo-financing an indicator of political commitment and progress towards financial sustainabilityCapacity building towards technical sustainability2. Routine immunization and health systems strengtheningUsing measles activities to strengthen routine immunizationSIAs1st and 2nd routine dosesDevelop global indicators to track improvement in routineDisease/lab surveillance strengthening3. EquityALL people have a right to needed vaccines.Outreach activities and SIAs ensure equity as they are specifically targeted towards reaching children missed by routine services.4. LinkagesLink measles and rubella more closelyWith polio through joint activities (e.g. SIAs, surveillance)With other child health interventions (Vit A, deworming tablets, bed nets, etc.)
12Priorities Reach the 2015 measles mortality reduction goal Continue to improve routine coverageKey countriesCountries with high measles disease burdenCountries that have not introduced RCV into routineLow resource countriesThese are the MI priorities up to 2015, after which epidemiological-based evidence will be used to reprioritize activities to reach the 2020 goalStrategic plan covers All countries, however MI focuses on key countries.
151. India: Highest Disease Burden Country Risklargest # of measles cases and deaths worldwideDetermining the vaccination coverage needed to stop transmission in large, densely populated statesNo RCV except in private sectorTacticsIntensified advocacyConduct operational research to address key questions prior to setting an eradication targetEnhance support to GoI (TA, M&E, etc)Introduce RCV into national EPIContinued advocacy with GoI to ensure measles mortality redcution remains high on the immunization agenda
162. Weak routine immunization and reporting systems TacticsExpansion of best practices for SIAsSupport regular data validation activitiesResearch on best approach for using SIAs to strengthen routineResearch on innovative ways to improve coverage monitoringFocus on weakest countriesRiskResurgence in measles due to:weak health systems resulting in missed childrenlow quality of administrative coverage dataInsufficient resources leading to low quality/delayed measles SIAsResurgence in measles due to:weak health systems & low (actual vs. reported) vaccination coverageLow quality of administrative coverage data leading to miscalculation of interval between SIAs and unexpected outbreaks.
173. Funding Gap Risk Tactics Competition with funding with PEI and other health initiativesReduced political commitmentThe price of success!No RCV funding for low-income countries (most GAVI-eligible)TacticsEnhance linkages with PEI, GAVIIncrease # staff for advocacy/resource mobilizationCommunicate contribution of measles mortality reduction to reaching MDG4 + continued risk of resurgenceBring in new partners/donorsThe price of success – the perception that measles mortality reduction/elimination taken care of. It's an old problem and already solved!Enhance linkages with PEI leading to increased efficiency and cost savings.
184. Resistance to Immunization and Anti-Vaccination Lobbies RiskMeasles and rubella are not perceived as serious problemsStrong anti-vaccine groupsHighly publicized and unfounded vaccine safety concernsDecreased coverage in western Europe leading to increased outbreaks and exportation to other regionsTacticsConduct operational research on communication strategies and develop communication tool kitsSpecific efforts to target the population at risk and health care professionals.Tracking of children to ensure they are immunized on time with 2 doses of M & R vaccinesMeasles not perceived as a serious problem, mostly in Western Europe.Research needed to better understand how anti-vaccine lobbies operate and how to intervene/counteract their messages.Conduct operational research on communication strategies and develop communication tool kits aimed at reaching vulnerable and high-risk populations as well as to address culture and belief systems. Look into role of civil society in addressing the anti-vaccination trendsSpecific efforts to target the population at risk and health care professionals, e.g. through advocacy and outreach via the annual European Immunization Week
195. Conflict and emergency settings RiskConflicts and natural disasters causing displacement of populationsReduced access to health facilitiesIncreased cross border transmissionTacticsImmediate vaccination of all children affected by humanitarian emergenciesCoordination of funding with humanitarian partnersUse PEI lessons learned, e.g.Negotiating accessSynchronization of cross boarder SIAs
20Management and coordination Clearly defined roles and responsibilitiescountries, MI and immunization partnersClearly defined monitoring and evaluation indicators and processRegular coordination through:Weekly calls with regions and key countriesTwo annual meetingsReporting of annual progressEvidence-based planning and budgetingThis will be further elaborated by Athalia and Andy on the governance and financing presentation.Effective management and coordination are ensured through having the following:1. Clearly defined roles and responsibilities for countries, MI and immunization partners2. Clearly defined monitoring and evaluation indicators and process- will address these in next slide3. Regular and flexible coordination through:Weekly calls with regions and key countries- additional coordination calls are organized when needed (e.g. in outbreak situations)Two annual meetings3. Streamlined reporting mechanism of annual progress, implementation challenges. Annual MI report, reports back to SAGE and the WHA4. Evidence-based planning and budgeting
21Monitoring and Evaluation Indicators Process indicatorsImpact indicatorsGuiding principles indicatorsThe MI partners have established 3 sets of indicators – process, impact, and guiding principles.Process indicators:- No. countries with national MCV1 coverage >90% and % of districts in each country with coverage >80%- No. additional countries introducing a RCV into their routine EPI- Surveillance performance indicators (quality of surveillance and data reliability)Impact indicators:- Measles incidence. (Number of countries having an annual measles incidence of less than five cases per million.)- Estimated number of deaths attributable to measlesGuiding principles indicators:- No. and proportion of countries contributing > 50% of the operational cost of SIAs funding.- No. and proportion of M, MR or MMR SIAs that include additional child health interventions.- No. countries including routine immunization and AEFI surveillance system strengthening training as part of SIA training activities.
22Measles Deaths Averted, 2000-2010 Provisional Estimates. -- 15 Measles Deaths Averted, Provisional Estimates* Million Deaths Averted !: 5.0 million deaths averted (32%): 10.8 million deaths averted (68%)*Not official WHO estimatesModelled estimates using method of Wolfson et al, 2007