1. State of Measles Initiative Financing Partners for Measles Advocacy Meeting Washington, D.C. September 22, 2008 Andrea Gay

2. Investing in the Measles Initiative What Dividends Has It Paid?
Current investment of $635 million ( ) has paid high dividends in mortality and morbidity reduction
Extremely cost effective with high impact:
equity,
meet (exceed) UN targets on time,
vaccinate over 600 million children (by end 2008),
prevent 2.3 million deaths (end 2006) at cost of $184/death averted
Contribute to achievement of MDG # 4
Expand and strengthen polio surveillance system – useful for new vaccine introduction
Equity: only criteria is age; Exceed UN targets on time: % mortality reduction-PAHO,AF,EM,EU,WP[no SE]

3. Dividends continued Good future for measles mortality reduction &
Enable scale-up coverage with preventive health interventions: vitamin A, deworming, ITNs and other vaccines (OPV, Rubella)
Countries financial commitments are increasing for sustainability: experience with follow-up campaigns
31 countries contributed to operational costs up to 50% with upward trend
Good future for measles mortality reduction &
elimination if sufficient finances available

4. Components of campaigns that strengthen health systems: Micro-planning
Investing in Measles Initiative Entry Point to Strengthening Health Systems
Components of campaigns that strengthen health systems:
Micro-planning
Training – injection safety
Cold chain improvement
Logistics
Increase community demand for immunizations with social mobilization
Waste management improvement
Disease surveillance and data management

5. Immunization Strengthening Support
WHO AFRO
2007: 6 countries received $348,575 (range $6,000 – 184,704)
2008: 9 countries received $1,050, (range $80,000 – 250,000)

6. * Excluding country contributions for catch-up and follow-up SIAs
Measles Initiative Annual Donations and Estimated Financial Resource Requirements, Contributions, Funding Gap 2009*
2009: Funding gap US$ 35 million
Excluding India
* Excluding country contributions for catch-up and follow-up SIAs

7. Resource Requirements 2009
Total required for at least 26 follow-up campaigns (plus possible India catch-up), surveillance, minimal routine strengthening: approximately $55 million (plus India)
Total pledged by existing donors: approximately $20 million (CDC, ARC, UNF, Merck, LDS, Vodafone Fdn)
Gap: approximately $35 million

8. Options to Address Funding Gap for 2009
Decrease number of countries conducting SIAs
Shorten age range of target populations
Cease specific support for routine immunization
Increase countries’ share of budget beyond 50% ops costs (ex: Nigeria)
Rather than proactively conduct SIAs to prevent outbreaks, simply respond to outbreaks when they occur (without donor support)

9. Annual Donor Expenditure and Financial Resource Requirements (FRR)
103
Slide used in April 2008 – in process of updating for 2008 (no gap), 2009 and India is wild card

10. Financial Strategy (Banker)
Support follow-up SIAs and improve routine coverage
Avoid collapse of gains, resurgence of measles
Use smaller age range when possible & appropriate
Increase sustainability with increased country financial responsibility (shift costs)
Increase separate financing for surveillance (as global public good?)
Increase number/type of donors
Improve cost sharing with added interventions

11. Financial Challenges
Consistent immunization donors are limited: bilaterals [notably CDC], GAVI, ARC, UNF, Vodafone Fdn., LDS, Gates Fdn., Rotary International, BD, and most recently, Merck
How broaden this base?
Countries can use SWAP, country multi-year plan (CMYP) funds for measles, but compete with newer vaccines being introduced
How involve measles staff in CMYP process to access funds?

12. Should global measles elimination be considered??
WHO Executive Board consideration for elimination 1/09
4 of 6 WHO regions have elimination targets: PAHO – 2002, EURO & EMRO – 2010, WPRO – 2012
1 WHO region has “pre-elimination” target: AFRO – 2012
1 WHO region has no target: SEARO
Measles goals have been met on time
Political will currently exists in countries
For sustainability and elimination goals need more predictable multi-year financing
Potential donor support (appetite for large scale activities not evident)
Late to ask question but relevant to financing issues

13. Questions to Ponder
Why donors reluctant to continue support when innovative strategy proven to work?
When is proven strategy no longer “innovative”?
What is time frame for innovation?
What is the value of innovation/catalytic?
Pilot / lessons learned / lessons lost