Role of the National Technical Advisory
Group NITAG in Supporting
Immunization
Najwa Khuri-Bulos MD,CIC,FIDSA
Chairman of the Jordan NITAG
Immunization Week, April 29, 2013
Immunization Week, EPI Jordan 2013
Outline
•
•
•
•
Why Immunization and the EPI
Tools for Decision Making in Immunization
Role of the NITAG
Moving forward together for the future
Immunization Week, EPI Jordan 2013
EPI, case study Jordan
• 1979, EPI started with DTP,OPV,BCG
• 1982 Measles
• 1995 HBV
• 2000 MMR
• 2001 HIB
• 2005 IPV
• Uptake more than 85% for all vaccines
• In private sector, a different agenda
– MMR since 1990, HIB since 1993, Pneumo,Rota,Hep
A and VZV since 2006
Vaccination Coverage for Infants
1990 - 2005 Jordan
120
100
Measles
OPV 3
80
OPV 4
DPT 3
HBV 3
Hib 3
60
MMR
40
20
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Vaccines don’t prevent disease
Vaccination prevents disease
April 27, 2013
Immunization Week, EPI Jordan 2013
Immunization can save money
• Immunization is
one of the most
cost-effective
health
interventions.
• Investing in
vaccines SAVES
more money than it
costs.
The vaccines pipeline
HIV/AIDS
Future
Malaria
Dengue
Mening (conj)
HPV
Rotavirus
Pneumo (conj)
Cholera
Underutilized
Vaccines
Typhoid
YF
Influenza
JE Rubella
Hib (conj)
HepB
Measles
Traditional EPI
Tetanus
Polio
Pertussis
Diphtheria
//
//
1960
1980
TB
2000
Challenges and the decade of vaccines
• Maintain current immunization level for all
vaccines and ALL groups
• Keep both measles eliminated and work for
polio eradication
• Introducing new vaccines into the EPI
• Expand the benefit of immunization to ALL
AGE Groups
• Maintain Public Confidence in Immunization
Immunization Week, EPI Jordan 2013
Guiding Principles
Country ownership
– Countries have primary ownership and responsibility for establishing good governance
and for providing effective and quality immunization services for all.
Shared responsibility and partnership
– Immunization is an individual, a community and a governmental responsibility that
transcends borders and sectors
Equitable access
– Equitable access to immunization is a core component of the right to health
Integration
– Strong immunization systems, which are part of the broader health systems and closely
coordinated with other primary health care delivery programmes
Sustainability
– Informed decisions and implementation strategies, appropriate levels of financial
investments, and improved financial management and oversight
Innovation
– The full potential of immunization realized only through learning, continuous
improvement, and innovation across all aspects of immunization.
7.4
7.1
6.2
4.6
3.0
2.8
0.9
0.6
0.2
0.2
0.0
0.0
0.0
Saudi Arabia
Morocco
Tunisia
Egypt
Iran
Oman
Syria
Iraq
Lebanon
Palestine
Bahrain
Jordan
0
8.1
Kuwait
16.2 14.6 11.6
Djibouti
UAE
South Sudan
Somalia
Libya
82.5
Pakistan
Qatar
Afghanistan
100
Yemen
Sudan
Incidence rate/million
Measles incidence rate/million in
EMR 2012
250
220.6
200
150
99.8 99.1
75.1
55.1
50
Immunization Week, EPI Jordan 2013
New and under-used vaccines
Leading causes of vaccinepreventable death in children under New vaccines:
5 years old:
– Hepatitis B
– Hib
– Pneumococcal disease
– Rotavirus diarrhoea
– HPV
– Meningitis
– Hepatitis a
– Chickenpox
Tools for Decision Making
Vaccine Introduction Preparedness
Policy decision
Programme issues
Financing
Priority
Cost-effectiveness
Burden
Immunization Week, EPI Jordan 2013
Challenges
for the
Jordan EPI
and
Introduction
of New
Vaccines
• Convincing high-level decision
makers
• Regulation and public
procurement laws and procedures
• Financial constraints
• Competing priorities for the same
resources
Immunization Week, EPI Jordan 2013
Role of NITAGS in strengthening Immunization
programmes
• Independent
technical input with broad expertise: allow
for an evidence-based review and decision for an
increasingly complex area
• Adaptation
of global policy recommendations with
consideration of local epidemiology and social contexts
• Way
to demonstrate country ownership and important
element of other DoV - GVAP guiding principles e.g.
•
•
sustainability, shared responsibility and partnership,
equity, integration, sustainability and even innovation
Promotes sustainability of programmes and local
investments in the programme
Facilitates the monitoring of GVAP implementation at
country level
Immunization Week, EPI Jordan 2013
Role of the Jordan NITAG in strengthening the
National Immunization Program
• Advocacy
• Help in upgrading knowledge of all health care
workers about vaccines and immunization
• Help in upgrading knowledge of the public
about value of vaccines and immunization
• Help in maintaining public confidence by acting
as a resource of local expertise on vaccines and
investigate adverse events
• Advocate for the value of the EPI for Jordan
Immunization Week, EPI Jordan 2013
Immunization Week, EPI Jordan 2013
Diseases Preventable by New Vaccines
Proportion of <5 years deaths attributed to Hib, Pneumococcal and
rotavirus diseases in the EMR before vaccine introduction
(WHO estimates)
24
22
20.5
19.4
20
17.5
18
16.9
16.5
15.5
16
% <5 years deaths
20.0
14
12.5
12
11.1
11.5
12.2
16.6
16.1
11.6
10.2
10
9.4
8
6.3
6
4
2.7
1.3
2
0
2.7
0.0
Immunization Week, EPI Jordan 2013
MIC
GAVI supported
HIC
17.1
Thank you
Immunization Week, EPI Jordan 2013