1. Conclusions of the meeting and closing remarks

2. Chronology 1981Hepatitis B vaccine becomes available 1991World Health Assembly resolution call for the inclusion of hepatitis B Immunisation of infants in all national immunization programmes 1996Conference on prevention and control of hepatitis B in countries of central and eastern Europe and the Newly Independent States, Siofok, Hungary 2000Global Alliance for Vaccines and Immunization launched 2001GAVI Board decision on fourth round of proposals to the Vaccine Fund 2001Conference on strengthening immunisation systems and introduction of hepatitis B vaccine in central and eastern Europe, St Petersburg

3. Emerging themes and results Progress since Siofok –better country specific epidemiological picture –broad range of partners –GAVI/The Vaccine Fund –Multi-year plans –21 countries with HB immunisation programmes

4. Coordination and planning Inter-Agency Coordinating Committee Tools for financial planning Vaccine procurement Increasing recognition of hepatitis C Clinical diagnosis and serological testing

5. Programmatic aspects (1) Immunization schedules/birth dose Programmes for adolescents/risk groups Integrated programmes Evaluation of immunisation programmes

6. Programmatic aspects (2) Nosocomial transmission Safe injections Cold chain Surveillance

7. Cross-cutting themes Political commitment Advocacy and education Media/anti-vaccine groups Safety of hepatitis B vaccine Build on existing systems and create networks Feedback from the country workshops

8. Global health context New, broad partnerships Health rising up the political agenda Increasing international attention to strengthening health systems Viral hepatitis must be on those agendas

9. Issues (1) Several countries still do not have universal infant or adolescent immunization programmes Unclear strategies for HB vaccine use in some countries Severe resource constraints still present in the region Ineffective procurement leads to relatively high and inconsistent HB vaccine prices Financial sustainability of immunization big issue in this region

10. Issues (2) Lack of effective advocacy for this region at the global level Relatively small pool of donors interested in immunization National level ICC’s not common in region Anti-vaccination ideas are beginning to spread in parts of the region Cold chain upgrading required in certain countries

11. Technical Issues (1) Epidemic of HBV, HCV and HIV among injecting drug users in many countries in region Nosocomial transmission of HBV, HCV and HIV huge problem in region Safe immunization, injection safety (need to transition to autodisable syringes in most countries) Medical waste management big problem Information systems need to become much more effective management tools

12. Technical Issues (2) Surveillance for hepatitis (with standard definitions and procedures) needs strengthening Laboratory support for hepatitis diagnosis lacking Huge need for training (and documents) at all levels for immunization and surveillance Burden of Hib disease not well established in region

13. Next Steps (1) Next meeting in 2 years to ensure GAVI resources well used and plans for sustainability progressing Regional GAVI Working Group should coordinate provision of technical support Regional Working Group should be a liaison to the Regional ICC for mobilization of additional resources All countries, even non-Fund-eligible should undergo process of assessment, multi-year plan and establishment of ICCs

14. Next Steps (2) The options for more rational procurement of vaccines such as HB and Hib should be explored (focus low population countries). These should include investigation of innovative procurement (a PAHO like revolving fund) mechanism for the region The limited funding and partner support in the region should be presented and discussed at a meeting of the GAVI Board

15. Next Steps (3) Financial sustainability of immunization including HB and Hib vaccines is of highest priority in the region, and all countries and partners should be working on these issues. The region, working with the SIGN, and other partners, should work to reduce nosocomial transmission. This should include transition to auto-disable syringes, training, and social mobilization issues

16. Next Steps (4) Information systems in the region should be used as more effective management tools, including vaccine management. The region should study the possibility of expanding the Ukraine Information System to other countries in the region

17. Next Steps (5) Transparent district level monitoring of immunization coverage should be reviewed monthly and immediate action should be taken if reports are missing or inconsistent with previous reports. Similarly surveillance data should also be used for active management of the programme The region should support countries for Hib burden assessments, and coordinate the work with the GAVI R&D group

18. Next Steps (6) Advocacy –Support to countries to counter the activities of anti-vaccine groups seminars information on a website –Countries should engage in social mobilisation