1. Global 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.

2. Strategic Advisory Group of Experts (SAGE), November 2010
Measles can and should be eradicated
Measurable progress towards 2015 global targets and existing regional elimination goals is required before establishing a target date
Requested frequent updates on progress

3. World Health Assembly, May 2011
2015 Global Targets as milestones towards eradication
Vaccination coverage of 90% national level and 80%
in every district
Reported incidence of <5 cases of measles per million
Mortality reduction of 95% vs. year 2000
 Targets aligned with the 2015 Millennium Development Goal of reducing child mortality by 2/3
WHA 2010 endorsed 3 global measles targets as milestones towards eradication

4. What is New? The plan includes: rubella and CRS control/elimination
activities to strengthen routine immunization and disease surveillance systems.
outbreak preparedness and response
research 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 & surveillance
Builds 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

5. A world without measles, rubella and congenital rubella syndrome
Vision
A world without measles, rubella and congenital rubella syndrome
Reaching this vision will most likely happen beyond 2020

6. Goals
By end 2015:
Reduce global measles mortality by >95% compared to level
Achieve regional measles and rubella/CRS elimination goals
By end 2020:
Achieve measles elimination in at least 5 WHO regions
Achieve & sustain measles elimination in at least four WHO regions. – PAHO, EURO, EMRO & WPRO
Achieve rubella and CRS elimination in at least 2 WHO regions – PAHO & EURO
These are in line with the current regional measles & rubella targets

7. Measles and Rubella Elimination Goals by WHO Region, August 2011
World Health Organization
Measles and Rubella Elimination Goals by WHO Region, August 2011
1 April, 2017
Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals
Americas and Europe have rubella elimination goals
SEARO 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 2015
2015
2012
2020
SEAR: 95% Measles Mortality Reduction by 2015 7

8. Milestones By end 2015
Achieve > 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 million
Achieve rubella/CRS elimination in at least 2 WHO Regions
Establish a rubella control/CRS prevention goal in at least 1 additional WHO region
Establish a global measles eradication goal

9. Milestones By 2020 Sustain the achievement of the 2015 targets
> 95% coverage with MCV1 & MCV2 (and RCV) in each district and nationally
Achieve > 95% coverage with M, MR or MMR during SIAs in every district.
Establish a global rubella and CRS eradication goal.

10. Strategies
High vaccination coverage with two doses of measles and rubella vaccines
Effective surveillance, monitoring and evaluation
Outbreak preparedness and response
Case management
Research and development
Emphasize text in blue.
Under the research section, mention the following:
Essential to provide the scientific underpinnings of the strategies and shaping evidence based policy
2011 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.

11. Guiding Principles Country ownership and sustainability
Routine immunization and health systems strengthening
Equity
Linkages
1. Country ownership and sustainability
Co-financing an indicator of political commitment and progress towards financial sustainability
Capacity building towards technical sustainability
2. Routine immunization and health systems strengthening
Using measles activities to strengthen routine immunization
SIAs
1st and 2nd routine doses
Develop global indicators to track improvement in routine
Disease/lab surveillance strengthening
3. Equity
ALL 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. Linkages
Link measles and rubella more closely
With polio through joint activities (e.g. SIAs, surveillance)
With other child health interventions (Vit A, deworming tablets, bed nets, etc.)

12. Priorities Reach the 2015 measles mortality reduction goal
Continue to improve routine coverage
Key countries
Countries with high measles disease burden
Countries that have not introduced RCV into routine
Low resource countries
These are the MI priorities up to 2015, after which epidemiological-based evidence will be used to reprioritize activities to reach the 2020 goal
Strategic plan covers All countries, however MI focuses on key countries.

13. Addressing Key Risks

15. 1. India: Highest Disease Burden Country
Risk
largest # of measles cases and deaths worldwide
Determining the vaccination coverage needed to stop transmission in large, densely populated states
No RCV except in private sector
Tactics
Intensified advocacy
Conduct operational research to address key questions prior to setting an eradication target
Enhance support to GoI (TA, M&E, etc)
Introduce RCV into national EPI
Continued advocacy with GoI to ensure measles mortality redcution remains high on the immunization agenda

16. 2. Weak routine immunization and reporting systems
Tactics
Expansion of best practices for SIAs
Support regular data validation activities
Research on best approach for using SIAs to strengthen routine
Research on innovative ways to improve coverage monitoring
Focus on weakest countries
Risk
Resurgence in measles due to:
weak health systems resulting in missed children
low quality of administrative coverage data
Insufficient resources leading to low quality/delayed measles SIAs
Resurgence in measles due to:
weak health systems & low (actual vs. reported) vaccination coverage
Low quality of administrative coverage data leading to miscalculation of interval between SIAs and unexpected outbreaks.

17. 3. Funding Gap Risk Tactics
Competition with funding with PEI and other health initiatives
Reduced political commitment
The price of success!
No RCV funding for low-income countries (most GAVI-eligible)
Tactics
Enhance linkages with PEI, GAVI
Increase # staff for advocacy/resource mobilization
Communicate contribution of measles mortality reduction to reaching MDG4 + continued risk of resurgence
Bring in new partners/donors
The 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.

18. 4. Resistance to Immunization and Anti-Vaccination Lobbies
Risk
Measles and rubella are not perceived as serious problems
Strong anti-vaccine groups
Highly publicized and unfounded vaccine safety concerns
Decreased coverage in western Europe leading to increased outbreaks and exportation to other regions
Tactics
Conduct operational research on communication strategies and develop communication tool kits
Specific 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 vaccines
Measles 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 trends
Specific efforts to target the population at risk and health care professionals, e.g. through advocacy and outreach via the annual European Immunization Week

19. 5. Conflict and emergency settings
Risk
Conflicts and natural disasters causing displacement of populations
Reduced access to health facilities
Increased cross border transmission
Tactics
Immediate vaccination of all children affected by humanitarian emergencies
Coordination of funding with humanitarian partners
Use PEI lessons learned, e.g.
Negotiating access
Synchronization of cross boarder SIAs

20. Management and coordination
Clearly defined roles and responsibilities
countries, MI and immunization partners
Clearly defined monitoring and evaluation indicators and process
Regular coordination through:
Weekly calls with regions and key countries
Two annual meetings
Reporting of annual progress
Evidence-based planning and budgeting
This 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 partners
2. Clearly defined monitoring and evaluation indicators and process- will address these in next slide
3. 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 meetings
3. Streamlined reporting mechanism of annual progress, implementation challenges. Annual MI report, reports back to SAGE and the WHA
4. Evidence-based planning and budgeting

21. Monitoring and Evaluation Indicators
Process indicators
Impact indicators
Guiding principles indicators
The 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 measles
Guiding 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.

22. Measles 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 estimates
Modelled estimates using method of Wolfson et al, 2007

23. Anne Ray Charitable Trust