1. 1 1 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Accelerated Measles Control: Highlights and priorities for South East Asian Region Anindya Bose, IVD/FHR, SEARO Global Measles and Rubella Management Meeting Salle B, WHO Headquarters, Geneva, Switzerland 15-17 March, 2011

2. 2 2 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Overview Regional Measles and Rubella Goals Progress towards the Goals: Immunization coverage Surveillance data Linkages with other programme interventions Strengths in SEA Region 2011: plans and budgets Major challenges in the region and barriers to achieving the goals Advocacy plans and opportunities

3. 3 3 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Regional consultative processes for accelerated measles control and Current regional goals High level preparatory (HLP) meeting proposal for consideration of 63 rd Regional Committee Interim goals approved by the 63 rd World Health Assembly (May 2010) should be adopted By 2015 –MCV1 coverage >90% nationally and >80% in all districts –Measles incidence <5/million and maintain that level –Reduce mortality by 95% compared to 2000 63 rd Regional Committee in Sept 2010 Endorsed the recommendations made by the HLP meeting

4. 4 4 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 SEAR: Rubella goals (Immunization TAG 2008) Noted that 4 countries (Bhutan, Maldives, Sri Lanka and Thailand) include RCV in their routine EPI. Recommendations: Remaining countries should strengthen/establish rubella and CRS surveillance. Countries should review burden of rubella and CRS, build the political and financial commitment to introduce Rubella containing Vaccine (RCV) according to WHO guidelines

5. 5 5 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 (Minimum Target 90%) 1 st dose measles vaccine coverage (MCV1) by country*, SEAR, 2009 *WHO/ UNICEF Estimate Country

6. 6 6 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Estimated measles mortality (2000-08), MCV1 coverage and SIA achievements SEAR, 2000 to 2010 2000-2010: 153 million children immunized through MEASLES SIA 46% Reduction

7. 7 7 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 SEAR: Type of vaccine in MCV2 and SIA by 2010 Measles vaccine MMR vaccine

8. 8 8 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Measles Incidence per million population 2009 (as reported through JRF) Countries with Incidence <5 per million (2009) Reporting rate of discarded measles cases per 100,000 (2009) –(Target 2 per 100,000) BAN9.90 DPKNot known MMR0.18 SRL1.15 Maldives

9. 9 9 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Linkages & Collaboration with Other Programmes (integration) Impact on the routine immunization programme Some countries (e.g. India took a policy decision to keep RI days undisturbed during campaign weeks) India program looking at effect of measles catch-up activity on RI programme Integration with polio, other child health programmes Most countries in SEA Region combine other interventions (OPV, Vit-A) with measles mass campaigns)

10. 10 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 SEAR Strengths… 1/2 Strong and visible political commitment. National Governments funding measles in RI and catch-up campaign Major contributions from Govts. Of Bangladesh, Bhutan, DPR Korea, Maldives, Myanmar and Sri Lanka India: All costs for MCV2 and SIA borne by National Govt. Vaccine supply and security At least two countries in the Region have measles vaccine production capacities Can be scaled up to match additional demand

11. 11 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 SEAR Strengths and opportunities … 2/2 Excellent community acceptance and safety profile of catch-up campaigns Support from Polio eradication infrastructure in five priority countries Bangladesh, India, Indonesia, Myanmar and Nepal Laboratory support to measles surveillance adequate and can be scaled up Built on Polio laboratories infrastructure plus Inclusion of new labs for laboratory supported surveillance for measles

12. 12 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Overview Regional Measles and Rubella Goals Progress towards the Goals: Immunization coverage Surveillance data Linkages with other programme interventions Strengths in SEA Region 2011: plans and budgets Major challenges in the region and barriers to achieving the goals Advocacy plans and opportunities

13. 13 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Measles SIA plans for 2011 2011: SEAR Plans to immunize 56 million children in 3 countries * India: catch-up campaign targeting 38 million covering whole of 9 states Indonesia: Follow-up targeting 12 million in 17 provinces MMR: Follow-up targeting 6 million in two phases covering whole country * Provisional

14. 14 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Budget to support measles SIA and surveillance in 2011 Contributions from National Govts. for measles SIA and surveillance for 2011 $ 78 million (IND, INO and MMR) Does not take into account moneys spent by Govt. in RI systems and services Budget for WHO and UNICEF support to measles SIA and surveillance (in USD million) Bundled vaccines Ops costsTech support Surveillanc e Total (net of PSC) WHO4.03.75.012.7 UNICEF2.43.22.2 7.8 Total2.47.25.95.020.5

15. 15 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Challenges for the Region … 1/2 Large Target population and MCV1 coverage 5 countries (IND, INO, MMR, NEP, TLS) with nearly 83% of the population will need to increase MCV1 coverage by 8-20% to reach 90% level nationally Building strong political commitment and full country ownership when there are competing health priorities Adequate resource (equipment, staff, training and supervision) commitment to ensure Safe injection practices and waste disposal. System for monitoring and responding to Adverse Events Following Immunization (AEFI) Establishing a high quality surveillance system that meets surveillance performance indicators

16. 16 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Challenges: Funding support for SIA and surveillance in 2011 (2/2) 2011 SIA plans in Region for 56 million children INO (12 mln), IND (38 mln), MMR (6 mln) Support needed (in order of priority) 1. Myanmar for vaccines, operational costs, surveillance and technical support (USD 5.2 million) 2. WHO regional office for surveillance and technical support. (USD 0.5 million) 3. Technical support for India (USD 5 million) 4. Surveillance Costs (Bangladesh, India, Indonesia and Nepal) (USD 4.2 million) 5. Support for Indonesia towards operational costs for campaigns and technical support. (USD 5.4 million) Total requirement: ~ USD 20.5 million

17. 17 Bose: SEAR Highlights and Priorities Global Measles & Rubella Management Meeting Geneva, 15-17 March 2011 Summary 63 rd Regional Committee has recommended that countries work towards the interim milestones towards measles elimination At least 8 out of 11 countries (except IND, INO and TLS) have reached or can reach these milestones on current program performance In 2010, India has introduced 2 nd dose of measles (state specific strategies) and has launched a campaign to immunize 134 million children Funding shortfall remains an immediate challenge Continued advocacy and support needed for countries to sustain gains and take the next step towards and beyond elimination milestones