Experience with the measles outbreak response fund

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Presentation transcript:

Experience with the measles outbreak response fund Accelerating Progress towards Measles and Rubella Control/Elimination Goals 21 June 2016 Kaushik Banerjee

In this presentation Background How it has worked so far Lessons learned 2 country examples Suggested actions

Background June 2012 – GAVI Board approved USD 55m to be managed by MRI Feb 2013 – UN Foundation concluded the MOU with GAVI on behalf of the MRI Current funding goes up to 2017 Purpose To enable countries experiencing measles or/and rubella outbreaks to rapidly respond to these while they are still relatively small and localized, to prevent them from developing into large and widespread outbreaks.

Management The MR Initiative founding partners* are responsible for decision on allocation of the outbreak response funds The WHO headquarters, Expanded Programme of Immunization functions as the secretariat for management and reporting of the use of outbreak response funds * MRI founding partners are ARC, CDC, UNF, UNICEF and WHO

How has it worked so far Funded 4 countries in 2013, >$ 7 million provided 5 countries in 2014, >$ 7 million provided 8 countries in 2015, >$15 million provided 3 countries so far in 2016, $2.05 million provided outbreak responses wide age group SIAs

Funds disbursed

Response in DRC Age targeted 6m – 9y Cost USD 6.1 million

436 villages in 4 districts and Lao Cai city Response in Vietnam 436 villages in 4 districts and Lao Cai city Cost USD 39,000

Lessons learned Outbreaks reported late (surveillance issues) Political considerations Delays in labelling it as an outbreak Inappropriate small scale responses Proposal often lacking in details, coherence Report Often delayed Short on details

Lessons learned Immunization response Too much, too late Quality suffers Cases continue after response Investigation of outbreaks sub-optimal Data not used to identify gaps in immunity Basic issues need fixing Surveillance, outbreak investigation Immunization systems strengthening

Constraints Fund cannot be used in non-GAVI countries We could not fund Republic of Georgia Syria The Philippines Mongolia Countries graduating out of GAVI support

2 country examples Strong routine with one SIA to fill immunity gap: Republic of Korea Strong routine offering MCV1 and SIAs: Malawi

Reported measles cases and measles vaccination coverage, 1990-2013*, Republic of Korea Approach: MCV1+2+SIAx1 Birth rate: <11/1000 Pop: 48,391,343 MCV1: 99% *2013 data through 20.08.2013

Proportion of persons aged 7–18 yr Proportion of persons aged 7–18 yr* with measles susceptibility,† by age — Republic of Korea, 2000 2000 serosurvey N = 18,139 Sample by age group (7-18y), region Residual sera from 36 hospital laboratories Enzygnost IgG ELISA measles *N = 18,139. † Defined as not having anti-measles immunoglobulin G antibody. § 95% confidence interval. Source: MMWR 2007; 56:304-307

Incidence rate* of reported measles cases, by patient age — Republic of Korea, 2000–2001 * Per 100,000 population Source: MMWR 2007; 56:304-307

Reported measles cases and measles vaccination coverage, 1990-2013*, Republic of Korea *2013 data through 20.08.2013 29.11.2018 SAGE MR WG 25/09/2013

Reported measles cases and measles vaccination coverage, 1996-2013*, Malawi 107% admin *2013 data through 10.09.2013 29.11.2018 SAGE MR WG 25/09/2013

Measles cases by epidemiological week, Malawi, 2009 – 2010

Confirmed measles cases by age, Malawi, 2010 Adapted from Minetti, Emerg Infect Dis 2013; 19(2):202-9

Reported measles cases and measles vaccination coverage, 1996-2013*, Malawi 107% admin *2013 data through 10.09.2013

Country experience shows that… Rep of Korea: SIAs targeted age groups involved in the outbreak; very low incidence after SIA Malawi: gaps in routine not recognized; age range cases in 2010 matched the age groups covered in 1998 SIA (<90% coverage) Initial outbreak responses with narrow age range, narrow geographic focus, worked locally

Suggested actions Outbreaks should be investigated to better define the susceptibility profile of the population Outbreak investigations should aim to uncover the underlying reasons why outbreaks are occurring (e.g. who is transmitting to whom; what are the exposure settings) Resources to be mobilized for a similar fund in non-Gavi eligible countries

Thank you! Merci !