Accelerated Measles Control:
Highlights and priorities for South East
Asian Region
Anindya Bose, IVD/FHR, SEARO
Global Measles and Rubella Management Meeting
Salle B, WHO Headquarters, Geneva, Switzerland
15-17 March, 2011
1
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
1
Overview
Regional Measles and Rubella Goals
Progress towards the Goals:
Immunization coverage
Surveillance data
Linkages with other programme interventions
Strengths in SEA Region
2011: plans and budgets
Major challenges in the region and barriers to
achieving the goals
Advocacy plans and opportunities
2
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
2
Regional consultative processes for accelerated
measles control and Current regional goals
High level preparatory (HLP) meeting proposal for
consideration of 63rd Regional Committee
Interim goals approved by the 63rd World Health Assembly
(May 2010) should be adopted
By 2015
– MCV1 coverage >90% nationally and >80% in all districts
– Measles incidence <5/million and maintain that level
– Reduce mortality by 95% compared to 2000
63rd Regional Committee in Sept 2010
Endorsed the recommendations made by the HLP
meeting
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
3
SEAR: Rubella goals (Immunization TAG 2008)
Noted that
4 countries (Bhutan, Maldives, Sri Lanka and Thailand)
include RCV in their routine EPI.
Recommendations:
Remaining countries should strengthen/establish
rubella and CRS surveillance.
Countries should review burden of rubella and CRS,
build the political and financial commitment to
introduce Rubella containing Vaccine (RCV)
according to WHO guidelines
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
4
1st dose measles vaccine coverage (MCV1) by
country*, SEAR, 2009
(Minimum Target 90%)
100
MCV1 Coverage (%)
80
60
40
89
98
98
98
71
82
87
INO
MAV
Country
MMR
96
98
79
70
20
0
BAN
BHU
*WHO/ UNICEF Estimate
5
DPRK
IND
NEP
SRL
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
THA
TLS
5
46%
Estimated measles mortality (2000-08), MCV1 coverage and SIA
Reduction
achievements SEAR, 2000 to 2010
2000-2010: Over
153 million
childrenvaccinated
immunized through
through MEASLES
SIA
120 million
SIA
6.3
1.5
5.2
10
10.4
42.4
40.7
3.6
2.0
30.7
250000
100
42 % reduction of mortality, 2000 - 2007
200000
95
90
150000
80
75
100000
70
MCV1 Coverage (%)
Estimated deaths
85
65
50000
60
55
0
50
2000
2001
2002
2003
Estimated Measles Deaths
6
2004
2005
2006
2007
2008
WHO/UNICEF estimated MCV 1 coverage
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
2009
2010
SIA achievement in millions
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SEAR: Type of vaccine in MCV2 and SIA by 2010
Measles vaccine
MMR vaccine
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
7
Measles Incidence per million population 2009
(as reported through JRF)
Countries
with
Incidence
<5 per
million
(2009)
Maldives
8
Reporting rate of
discarded measles
cases per 100,000
(2009) –(Target 2
per 100,000)
BAN
9.90
DPK
Not known
MMR
0.18
SRL
1.15
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
8
Linkages & Collaboration with Other Programmes (integration)
Impact on the routine immunization programme
Some countries (e.g. India took a policy decision to
keep RI days undisturbed during campaign weeks)
India program looking at effect of measles catch-up
activity on RI programme
Integration with polio, other child health programmes
Most countries in SEA Region combine other
interventions (OPV, Vit-A) with measles mass
campaigns)
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
9
SEAR Strengths… 1/2
Strong and visible political commitment.
National Governments funding measles in RI and
catch-up campaign
Major contributions from Govts. Of Bangladesh, Bhutan,
DPR Korea, Maldives, Myanmar and Sri Lanka
India: All costs for MCV2 and SIA borne by National Govt.
Vaccine supply and security
At least two countries in the Region have measles vaccine
production capacities
Can be scaled up to match additional demand
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
10
SEAR Strengths and opportunities … 2/2
Excellent community acceptance and safety profile
of catch-up campaigns
Support from Polio eradication infrastructure in five
priority countries
Bangladesh, India, Indonesia, Myanmar and Nepal
Laboratory support to measles surveillance
adequate and can be scaled up
Built on Polio laboratories infrastructure plus
Inclusion of new labs for laboratory supported surveillance for
measles
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
11
Overview
Regional Measles and Rubella Goals
Progress towards the Goals:
Immunization coverage
Surveillance data
Linkages with other programme interventions
Strengths in SEA Region
2011: plans and budgets
Major challenges in the region and barriers to
achieving the goals
Advocacy plans and opportunities
12
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
12
Measles SIA plans for 2011
2011: SEAR Plans to immunize 56 million children in
3 countries *
India: catch-up campaign targeting 38 million covering
whole of 9 states
Indonesia: Follow-up targeting 12 million in 17
provinces
MMR: Follow-up targeting 6 million in two phases
covering whole country
* Provisional
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
13
Budget to support measles SIA and surveillance in 2011
Contributions from National Govts. for measles SIA and
surveillance for 2011
$ 78 million (IND, INO and MMR)
Does not take into account moneys spent by Govt. in RI
systems and services
Budget for WHO and UNICEF support to measles SIA and
surveillance (in USD million)
Bundled
vaccines
WHO
14
Ops costs
Tech
support
4.0
3.7
UNICEF
2.4
3.2
2.2
Total
2.4
7.2
5.9
Surveillanc Total (net
e
of PSC)
5.0
12.7
7.8
5.0
Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
20.5
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Challenges for the Region … 1/2
Large Target population and MCV1 coverage
5 countries (IND, INO, MMR, NEP, TLS) with nearly 83% of the
population will need to increase MCV1 coverage by 8-20% to
reach 90% level nationally
Building strong political commitment and full country
ownership when there are competing health priorities
Adequate resource (equipment, staff, training and supervision)
commitment to ensure
Safe injection practices and waste disposal.
System for monitoring and responding to Adverse Events
Following Immunization (AEFI)
Establishing a high quality surveillance system that meets
surveillance performance indicators
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
15
Challenges: Funding support for SIA and surveillance in
2011 (2/2)
2011 SIA plans in Region for 56 million children
INO (12 mln), IND (38 mln), MMR (6 mln)
Support needed (in order of priority)
1. Myanmar for vaccines, operational costs, surveillance and
2.
3.
4.
5.
technical support (USD 5.2 million)
WHO regional office for surveillance and technical support. (USD
0.5 million)
Technical support for India (USD 5 million)
Surveillance Costs (Bangladesh, India, Indonesia and Nepal)
(USD 4.2 million)
Support for Indonesia towards operational costs for campaigns
and technical support. (USD 5.4 million)
Total requirement: ~ USD 20.5 million
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
16
Summary
63rd Regional Committee has recommended that countries work
towards the interim milestones towards measles elimination
At least 8 out of 11 countries (except IND, INO and TLS) have
reached or can reach these milestones on current program
performance
In 2010, India has introduced 2nd dose of measles (state
specific strategies) and has launched a campaign to immunize
134 million children
Funding shortfall remains an immediate challenge
Continued advocacy and support needed for countries to
sustain gains and take the next step towards and beyond
elimination milestones
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Bose: SEAR Highlights and Priorities
Global Measles & Rubella Management Meeting
Geneva, 15-17 March 2011
17