1. GAVI/Vaccine Fund Support to Improve Injection Safety On behalf of the Injection Safety sub-group

2. GAVI is an Alliance The Bill & Melinda GatesFoundation TheWorldBank UNICEF WHO Technical health institute CDC, USA Researchinstitute NIH, USA Health Ministries BhutanMali BilateralagenciesCanada The Netherlands Norway FoundationRockefellerFdtn. Industry- OECD country Aventis Pasteur, France Industry-Developing Country Country CIGB, Cuba NGO Gates Children’s Vaccine Program at PATH, USA GAVI Board

3. GAVI Structure

4. Initial steps taken: Injection Safety (IS) plan required as part of application Member of WHO SC on Immunization Safety participates on independent review team Established IS established as a top priority of the Advocacy Task Force Conceptually “Bundling” each dose of vaccine supplied by Vaccine Fund with an AD syringe and means for disposal

5. Unmet need: Support countries in their transition to use of AD syringes for all vaccines National and local ownership of problem and means for addressing it Support for governments and partners to develop implement long-term multifaceted plans to increase awareness and stimulate necessary behavior change Guidance and options for disposal of health care wastes (HCW) resulting from immunization efforts

6. GAVI commitments Based on the principle of “first do no harm” commit to focusing special attention on Injection Safety Commit to “The Joint WHO/UNICEF/UNFPA/IFRC Joint Statement on the Use of AD syringes in Immunization Services” Request WHO finalize a statement on medical waste disposal Commit to using the Aide Memoires on Injection Safety and Healthcare Waste Management to guide investments and actions

7. Vaccine Fund support for transition to ADs Support for three years, all countries that receive awards from the Vaccine Fund Countries currently without means for obtaining ADs and means for disposal for all traditional routine EPI vaccines will be provided these supplies.

8. Vaccine Fund support Countries with means to obtain safety supplies will be provided the equivalent amount of grant funds for use on injection safety and waste disposal related activities. Proposal has to indicate: source and amount of funding for the AD syringes and safety boxes, areas to be financed by the Vaccine Fund

9. Vaccine Fund Support Support can be applied for either as part of a proposal for immunization services or new vaccine support. Countries that have previously been approved for immunisation services or new vaccine support must resubmit injections safety portion of application.

10. Vaccine Fund support Syringes/funds awarded based on review of IS plan component of country application. Plans must include process for establishing national policies documentation of national commitment plans of actions

11. Plans of action Assure compliance with the WHO/UNICEF/UNFPA statement of 1999 both now and after the resources provided by the Vaccine Fund are no longer available; provide training and support the necessary behavior change among health care providers; provide, appropriate information, education and communication to clients on the risks resulting from unsafe injections and poor sharps waste management;

12. Plans of action plan for monitoring programme progress (including specific indicators that will be used, and annual targets for these indicators); steps that will be taken to improve safety of the disposal of medical waste (especially sharps) resulting from immunization activities. formulation of policy, assessment of the waste management system, and, selection of appropriate waste disposal systems for all levels of health care facilities.

13. Additional Actions Support implementation of Vaccine Fund assistance (i.e., number of safety boxes, source of safety boxes) Monitor improvement in the safety in a manner that encourages safety to serve as a “counterbalance” to coverage as GAVI priorities (TFCC) Commit to support long-term communication effort (Advocacy Task Force, WHO, UNICEF)

14. Additional Actions Based on the principle of “polluter pays” support countries in immediate action to use best options available for safely disposing of HCW. Support R & D of environmentally sound and reasonably priced methods for HCW disposal

15. Summary Focus special attention on IS and commit to follow existing policies and guidelines Through the Vaccine Fund provide temporary assistance to countries in their transition to full use of AD syringes Support long-term efforts which are crucial to sustainability Commit to support efforts to improve the safety of HCW disposal

16. Problem/Opportunity Available data suggest that injection overuse and unsafe injection practices result in: 22.5 million Hep B virus infections 2.7 million Hep C virus infections 98,000 HIV infections Injections provided by immunization programs represent roughly 5% of global injections widely considered the safest Immunization programs can be the leaders in improving the safety/quality of health service delivery