Measles CDC Partnership

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Opportunities to better align GAVI and
Sustainable
Measles
Mortality Reduction Activities 12th GAVI
Board meeting, Geneva, 10 December 2003
Francisco F. Songane, M.D., M.P.H.
Minister of Health, Mozambique Edward J.
Hoekstra, M.D., M.Sc. UNICEF HQ, New York
Bradley S. Hersh, M.D., M.P.H. WHO HQ,
Geneva
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Leading killer of children We know WHERE . . .
94 of all measles deaths in 2000
No second opportunity for measles immunization (
45 )
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Global Targets
2000 - Millennium Development Goals Indicator
of 1 year - old children immunised against
measles 2002 - UN Special Session on Children
World Fit for Children 2003 -
World Health Assembly Measles
Resolution
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• Overriding global goal is sustainable measles
  mortality reduction

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We know HOW . . .
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Strategy for sustainable measles mortality
reduction
4. Improved case management
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Projected impact of different measles vaccination
strategies on measles deaths in 45 WHO UNICEF
Priority Countries 2000 - 2025
Annual measles deaths
Catch-up Constant routine
Constant routine
Strengthen routine only
Strengthen routine catch-up second
opportunity
Year
Note routine strengthening assumes 2.5 annual
improvement in routine immunization
coverage until 95
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Mean Routine Measles Coverage in 45 Priority
Countries 1999 - 2002
Percent
Notes (1) Source WHO / UNICEF Joint Reporting
Forms (2) Liberia had no coverage
data for 1999
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Second Measles Opportunity45 UNICEF / WHO
Priority Countries 2001 - 2003
Nation - wide second opportunity 2003 ( 21
) Partial implementation of second opportunity
2003 ( 8 ) No second opportunity 2003 ( 16 )
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Percent reduction in estimated measles deaths by
WHO region between 1999 and 2002
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Global ProgressMeasles Mortality Reduction by
50 by 2005 (compared to 1999 875,000 deaths)
Estimated Measles Mortality by Year
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Measles Initiative Partnership

• Established in 2001
• Mobilised gt 60 million
• Supported in 23 African countries
• Over 120 million African children vaccinated
• gt 90 coverage in each country
• Combined with TT, OPV, Insecticide Treated Nets
  (ITNs), vitamin A, mebendazole

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Estimated Annual Doses of Measles Vaccine
Required for SIAs in 45 Priority Countries 2001
- 2015
Millions Of Doses
Source World Population
Prospects The 2002 Revision, UN Population
Division, Feb. 2003
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Funding for Estimated Annual Doses of Measles
Vaccine Required for SIAs in 45 Priority
Countries 2001 - 2015
Millions Of Doses
Shortfall
Pledges
GAVI ?
Source World Population
Prospects The 2002 Revision, UN Population
Division, Feb. 2003
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WHO / UNICEF Global Meeting for Sustainable
Measles Mortality Reduction and Immunization
System Strengthening
15-17 October 2003 Capetown, South Africa

• gt 200 meeting participants
• Senior MOH representatives from 45 priority
  countries
• 14 partner agencies
• WHO and UNICEF staff
• Consensus on need for comprehensive strategy
• Financial sustainability a priority
• High demand from countries

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How measles mortality activities can add value
to achieve GAVI goals

• Advocacy
• Strengthening immunization systems
• Improving injection safety
• Promoting the fully immunized child
• Comprehensive approach
• Implement the RED strategy for SIAs and routine
  services
• Integration of other priority interventions
• Strengthen linkages
• Periodic replenishment of cold chain
• Build capacity of EPI staff
• Improved partner coordination
• Synergistic resource mobilization efforts

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How GAVI can add value to achieve and sustain
measles mortality reduction (1)

• Advocacy and Communications
• Advocate at policy level how measles mortality
  reduction activities can help strengthen routine
  immunization systems
• Advocate for sustainable financing
• Monitoring of global targets
• Add monitoring of measles vaccination coverage
  for 1st and 2nd opportunity
• Add number of annual estimated measles deaths to
  monitor 2005 goal

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How GAVI can add value to achieve and sustain
measles mortality reduction (2)

• Funding for bundled measles vaccine
• Provide 10 million per year for two to five
  years ( 35 million bundled doses per year )
• Innovation
• Operationalize the transition from periodic SIAs
  to routine two - dose schedule
• Increase complementary interventions during the
  second routine measles contact
• Missed antigens
• Vitamin A
• Insecticide treated bed nets
• Mebendazole
• Coordination consensus building
• Improve coordination among partners

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Obrigado
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Different estimates of lt 5 measles mortality