GAVI Support for
Measles and Rubella Immunisation
Helen Evans
Deputy CEO, GAVI Alliance
11th Annual Meeting
Measles & Rubella Initiative
Washington D.C
18 September 2012
Overview
1. About the GAVI Alliance
2. GAVI support to Measles & Rubella immunisation
3. Communicating with Countries
4. Advocacy
1
The GAVI Alliance: an innovative partnership
2
GAVI’s mission and four strategic goals
Mission: To save children’s lives and protect
people’s health by increasing access
to immunisation in poor countries
 Accelerate the uptake and use of underused
and new vaccines
 Contribute to strengthening the capacity of integrated
health systems to deliver immunisation
 Increase the predictability of global financing and improve
the sustainability of national financing for immunisation
 Shape vaccine markets
3
What Countries have achieved with GAVI
Alliance support
 Supported the immunisation
of 326 million children
Future deaths averted
 Contributed to preventing
over 5.5 million future
deaths
 Accelerated vaccine
introductions in over 70
countries
 Strengthened health
systems to deliver
immunisation
Source: These estimates and projections are produced by the WHO
Department of Immunization, Vaccines and Biologicals, based on the most
up-to-date data and models available as of 30 September 2011.
*Includes deaths averted by GAVI-supported vitamin A supplementation
programmes.
 Helped shape the market
for vaccines
4
Key GAVI policies
 Country eligibility policy:
 Threshold for 2012 is $1,520 GNI per capita (World
Bank, Atlas method) – updated annually
 Catalytic new vaccine introduction grant and
operational support for campaigns policy – not
recurrent operational support
 Co-financing policy geared to programme ownership &
financial sustainability
In development:

Country-by-Country Approach: introducing more flexibility

Access to acceptable vaccine prices for lower middle income
countries
5
GAVI vaccines support
Vaccines currently supported
2013 and later
Pentavalent
Pneumococcal conjugate
Rotavirus
Measles second dose
Meningococcal A conjugate (campaigns)
Yellow Fever (routine & campaigns)
Japanese
encephalitis
New in 2012:
•
•
•
•
•
HPV (national introduction & demo project)
Rubella (MR campaigns)
Measles SIAs in selected countries and
outbreak response
Also: meningitis and yellow fever vaccine
stockpiles
6
Typhoid
Future decisions
Malaria
IPV
Cholera
Dengue
Others
GAVI supports the world’s poorest countries
Type and value of support, 2000–2011
Source: GAVI Alliance , 2012
7
GAVI cash-based support
 GAVI supports health system strengthening (HSS) through
the Health System Funding Platform
 Focus on strengthening the capacity of integrated
health systems to deliver immunisation outcomes
 Resolve major constraints to delivery
 Increase equity in access to services
 Strengthen civil society engagement
 New performance based approach being introduced
 Countries and partners will be updated by end 2012
8
GAVI vaccine introduction grant and operational
support for campaigns policy – revised amounts from
1 Sept 2012
 Facilitate timely, effective implementation of critical activities:


Preparing for new vaccine introductions: US$ 0.80 per target
(for HPV: US$ 2.40 per girl)
Supporting delivery of campaigns: US$ 0.65 per target
 One-time investments, covering a share of the cost. Does
not cover recurrent costs

Driven by country needs
 Flexible, simple, separate from other cash support, not to be
used for co-financing
9
Overview
1. About the GAVI Alliance
2. GAVI support to Measles & Rubella immunisation
3. Communicating with Countries
4. Advocacy
10
GAVI’s integrated commitents to prevent
rubella and measles
 US$ 176 million from 2004-2008 through Measles Initiative
to support campaigns
 Investments in health systems to improve immunisation
coverage
 Routine measles second dose (11 countries receiving
support, 3 more applied this year)
 Measles-rubella through wide-age campaigns and adoption
of routine (9 countries have applied this year)
 Performance-based funding with measles coverage indicator
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Background and aim of increased GAVI
engagement
 Estimated measles mortality has plateaued around 140,000
deaths
 Increased routine coverage critical to sustainably preventing
measles
 Outbreaks possible (e.g. every 3–5 years) unless coverage
is high
 GAVI support:
 Long-term strategy to prevent deaths in six countries through
high routine coverage
 Bridging: help avoid further measles resurgence before and
during the MR vaccine roll-out
 Outbreak prevention
12
June 2012 GAVI Board decision on GAVI
support for measles
The GAVI Alliance will provide additional funding to
control and prevent measles outbreaks
 US$ 55 million of this support will be for outbreaks and other
emerging needs requiring rapid responses
 Six large countries at high risk of measles outbreaks
(Afghanistan, Chad, DR Congo, Ethiopia, Nigeria and
Pakistan) can exceptionally apply for GAVI support for
preventive measles vaccination campaigns
 This support comes in addition to GAVI’s existing support for
introducing the second dose of measles into routine
immunisation
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GAVI support for rubella and measles vaccines
Measles-Rubella
Measles Second Dose
All GAVI eligible countries: GNI < US$ 1,520
Routine MCV1 ≥ 80% (or)
Last measles SIA ≥ 90% (admin) (or)
Survey of acceptable methodology
coverage ≥ 80%
Catch-up
campaigns with a
wide age range
(9 mth-14 yo boys
and girls)
Introduction
into routine
programme
GAVI covers
vaccine costs,
operational costs
GAVI covers one
time introduction
grant
Country covers
vaccine &
operational costs
Combines measles vaccination with
rubella to prevent CRS and
reinvigorate measles campaigns
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Measles SIAs
GAVI support for rubella and measles vaccines
Measles-Rubella
Measles Second Dose
All GAVI eligible countries: GNI < US$ 1,520
Routine MCV1 ≥ 80% (or)
Last measles SIA ≥ 90% (admin) (or)
Survey of acceptable methodology
coverage ≥ 80%
MCV1 > 80%
DTP3 ≥ 70%
Catch-up
campaigns with a
wide age range
(9 mth-14 yo boys
and girls)
Introduction
into routine
programme
Introduction into routine
programme
GAVI covers
vaccine costs,
operational costs
GAVI covers one
time introduction
grant
Country covers
vaccine &
operational costs
GAVI covers
vaccine costs for 5 years and
introduction grant
Country covers operational costs &
all vaccine costs after 5 years
Combines measles vaccination with
rubella to prevent CRS and
reinvigorate measles campaigns
On-time delivery of the first dose
remains the highest priority, but
reaching all children with two
doses of measles vaccine should
become standard for all
immunisation programmes
15
Measles SIAs
GAVI support for rubella and measles vaccines
Measles-Rubella
Measles Second Dose
Measles SIAs
All GAVI eligible countries: GNI < US$ 1,520
Routine MCV1 ≥ 80% (or)
Last measles SIA ≥ 90% (admin) (or)
Survey of acceptable methodology
coverage ≥ 80%
MCV1 > 80%
DTP3 ≥ 70%
For six large countries at risk of measles
outbreaks: Afghanistan, Chad, DR Congo,
Ethiopia, Nigeria, Pakistan
Catch-up
campaigns with a
wide age range
(9 mth-14 yo boys
and girls)
Introduction
into routine
programme
Introduction into routine
programme
Bridging: SIAs until MR implemented or
2017, whichever is earlier
GAVI covers
vaccine costs,
operational costs
GAVI covers one
time introduction
grant
Country covers
vaccine &
operational costs
GAVI covers
vaccine costs for 5 years and
introduction grant
Country covers operational costs &
all vaccine costs after 5 years
Support determined following country
discussions, with the maximum as per the
GAVI policy on campaigns costs
Combines measles vaccination with
rubella to prevent CRS and
reinvigorate measles campaigns
On-time delivery of the first dose
remains the highest priority, but
reaching all children with two
doses of measles vaccine should
become standard for all
immunisation programmes
To strengthen the impact of
comprehensive GAVI support to prevent
measles deaths through a country
specific and integrated focus, including
HSS, financial sustainability, routine
delivery of MSD and introduction of MR
16
The GAVI application and reporting cycle
17
Overview
1. About the GAVI Alliance
2. GAVI support to Measles & Rubella immunisation
3. Communicating with Countries
4. Advocacy
18
Overview of GAVI country communication
 Maintaining an ongoing dialogue around GAVI
policy, processes and vaccine evidence base
 Information dissemination and feedback loops
adapted to the content, context and audience
 Written documents: guidelines, FAQs, briefs, letters, etc.
Available at: http://www.gavialliance.org/support/apply/
 With countries and partners:
 WHO/UNICEF in country and regional GAVI Alliance members
 GAVI Secretariat CROs responsible for specific countries
 Discuss new policy and technical developments
 Consult and coordinate to resolve implementation bottlenecks
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Contact points for information
www.gavialliance.org
GAVI Country
Responsible Officers
GAVI Alliance Partners
(WHO, UNICEF, CDC,..)
Access to information
on:
Contact for country
specific detail on:
Contact for technical
support on:
How to apply for GAVI
support
Implications of GAVI
policy and processes
Assistance in preparing
applications to GAVI
GAVI guidelines, policy
and processes
Information and follow
up on the review of
applications and reports
Implementation of GAVI
support
Vaccine impact
Links to partner sites for
more information:
WHO, UNICEF, MRI, etc
Updates on existing
approved support
>> Contact country officer at
GAVI or info@gavialliance.org
or proposals@gavialliance.org
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Technical resources and
vaccine evidence base
Overview
1. About the GAVI Alliance
2. GAVI support to Measles & Rubella immunisation
3. Communicating with Countries
4. Advocacy
21
What role does the GAVI Alliance play in
advocating for immunisation?
Objectives:
 Position immunisation, global health and
development in public policy agenda – value of
investing in immunisation, new vaccines is
understood amongst key influencers and
stakeholders
 Mobilize network of advocates and policy partners in
countries and globally to inform policies, support
fundraising and help achieve strategic goals of the
Alliance
 GAVI Alliance’s aim to be catalytic
22
Advocacy building blocks
Champions
• Southern
advocates
• Civil society
• Donor country
advocates
Evidence
• Results
• Economic
evidence
GAVI Alliance became named partner of Measles & Rubella Initiative (August 2012)
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Policy
• Health and
Development
• Equity
• Global Vaccine
Action Plan
The immunisation landscape
Synergies and shared learnings
Polio
eradication
Traditional
vaccines
Measles
elimination
R&D: vaccine
improvements
New
vaccines
Regional
vaccines
25
R&D: future
vaccines
Thank you
www.gavialliance.org
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Communication around the application cycle
Dissemination of
application guidelines,
forms, other supporting
information to
countries and partners
via email and web site,
with specific follow up
Dialogue with
countries and
partners to inform
decision-making
Updates on GAVI Alliance
Board decisions and
deliberations by email,
The Board
media and multiple
considers and
other channels.
approves IRC
recommendations
28
Coordination with
partners for technical
assistance and support
in completing forms
Countries
contacted with
information on IRC
recommendations
and any required
clarifications
The Global Vaccine Action Plan
Guiding Principles
Strategic objectives of the Decade of Vaccines
1
Country ownership
All countries commit to immunizations as a priority
Individuals and communities
understand the value of vaccines and
demand immunization as both their
right and responsibility
5
Equity
Integration
Immunization
programs have
sustainable access
to predictable
funding, quality
supply and
innovative
technologies
4
Strong immunization systems
are an integral part of a
well-functioning health system
3
The benefits of immunization are
equitable extended to all people
Sustainability
6
Innovation
• Achieve a world free of
poliomyelitis
• Meet global and regional
elimination targets
2
Shared responsibility
and partnership
Goals
Country, regional and global research and development
innovations maximize the benefits of immunization
Source: Bill & Melinda Gates Foundation
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• Meet vaccination
coverage targets in every
region, country and
community
• Develop and introduce
new and improved
vaccines and
technologies
• Exceed the Millennium
Development Goal 4
target for reducing child
mortality
June – Dec 2012 key events at a glance
JUN
JUL
AUG
SEPT
OCT
NOV
Child Survival
Financing for Health:
Event. DC, 14-15 Health & Finance
June
Ministers AFDB
Meeting, Tunis, 4-5
July
UNGA – UNSG
EWEC MCH , New
York and
Clinton Global
Initiative (CGI)
Sept 23-25,
Finance Ministers
12 Nov-Meeting GAVI/WB (at World Pneumonia
Annual IMF/WB
Day 2012
meeting ) Tokyo, 1214 Oct
Pledging
Conference first
anniversary
WEF, Tianjin,
11-13 Sept
Africa – French
parliamentarian visit
BOARD
MEETING
Djibouti-PCV
introduction
Moldova- Rota
introduction
Madagascar,
Pakistan, Congo
Rep, Zambia,
Zimbabwe-PCV
introduction
Nigeria-Penta
introduction
Yemen-Rota
introduction
Bangladesh,
Cambodia, Eritrea,
Gambia- MSD
introduction
Armenia-Rota
introduction
High-Level
Meeting of Asian
Health Ministers
Jakarta, 3-5
September
Georgia-Rota
introduction
Sao Tome and Zambia-MSD
Principe-MSD introduction
introduction
Timor-LestePenta
introduction
Senegal/Sudan –
MEP visit
AFRO Regional
Meeting, Luanda, 2226 Oct
Angola, Sao TomePCV introduction
Malawi-Rota
introduction
Sudan, Senegal,
Benin, Ghana- MenA
introduction
Korea DPR,
Myanmar-Penta
introduction
30
DEC
TBD
Partners’
Forum
& DoV, Dar es
Salaam, 5-7
Dec
Burma- Australian/NZ Tanzania –
parliamentarian visit German parlt
visit
BOARD
MEETING
Tanzania-PCV
(and Rota?)
introduction
Burundi-MSD
introduction
EthiopiaRota intro
Draft Session
Session
ChartChart
Wednesday
Wednesday
9:00 – 13.00
Consultations
GAVI Board
Mtg
Consultations
and
Satellite
andEvents
Satellite Events
GAVI
Board
Mtg
Thursday
Thursday
8:00 –
9:30
Friday
Friday
Plenary 1
Plenary
1
10:00
–
11:30
Plenary 2
Plenary
2
Panel
Panel
Symposia
Symposia
Lunch
Lunch
12:30 – 14:00
12:30 – 14:00
Special
Special
Sessions
Sessions
Lunch
Lunch
Special
Special
Sessions
Sessions
15:00
13:30 – 15:30
Workshops
Workshops
14:30
14:30
–
–
16:00
16:00
Symposia
Panel
14:30
14:30
–
–
16:00
16:00
Workshops
Workshops
15:30– 17:00
16:00 – 18:00
Workshops
Workshops
17:30– 18:00
16:30--17:30
17:30
16:30
GM-NM Dialogue
NM-GM Dialogue
Opening Plenary
18:30 – 20:30
Transport to State House
Welcoming Ceremony
by
Tanzania government
Welcoming
Ceremony
18:30 – 21:00
18:30 – 21:00
18:30 – 21:00Award Dinner
Award Dinner
by Tanzania government
31
310
16:00
16:00 –
– 17:30
17:30
Closing Session
Closing Session
Aligning advocacy efforts
 Partners’ Forum – themes focused around GVAP –
measles and rubella sessions
 World Immunisation Week
 World Health Assembly and Regional Committees –
reporting on progress
 IPA Congress in Australia
 GAVI Alliance mid-term review
32