Measles, Rubella and CRS Elimination
Region of the Americas
Engaging Government and Civil Society
to Achieve the Elimination
12th Annual Meeting of the Measles and Rubella Initiative
Washington, 10-11 September 2013
Dr. Carlos Castillo Solórzano
Ms. Katri Kontio
Dr. Carolina Danovaro
Presentation Outline
• Progress to achieve regional measles, rubella and
congenital rubella syndrome (CRS) elimination
goals
• Engaging government and civil society
to achieve and maintain the elimination
• Challenges for maintaining the Regional elimination
• Next steps
Milestones: Measles, Rubella and CRS Elimination
in the Region of the Americas
1994: Resolution to eliminate measles by 2000
2012: Resolution to maintain the elimination
2003: Resolution to eliminate rubella by 2010
2002: LAST
ENDEMIC
MEASLES CASE
1999
1994
1995
1997
2002
2001
First mass
campaigns
against rubella
First Ladies
as Ambassadors for
the measles elimination
2012
2007
2003
Sucre
Agreement
in Bolivia
2013: 4th IEC*
meeting
2007: Resolution on
documentation and
verification process
1th IEC*
meeting
2009
2013
2009: LAST
ENDEMIC
RUBELLA AND
CRS CASES
Largest measles
outbreaks: Canada and
Ecuador 2011-2012
* IEC=International Expert Committee for the documentation and verification process
Measles Vaccination Coverage among Children <1 Year of Age* and
Reported Measles and Rubella Cases, the Americas, 1980-2013*
Measles
Catch-up campaigns
300,000
Rubella speed-up
campaigns
80
200,000
Measles Follow-up campaigns
60
150,000
Last case of
endemic
measles
100,000
40
Last case of
endemic
rubella
20
50,000
0
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13
Measles cases
Rubella cases
Coverage Measles
Coverage MMR
* MMR in children 1 year of age by vaccine introduction
Source: country reports to FCH-IM/PAHO
* Data as of September 4, 2013
Catch-up
(<15yr)
Follow-up
(1-4 yr)
Speed-up
(adol/adult)
140 million
80 million
260 million
% Vaccination coverage
Confirmed cases
250,000
100
Where are We Now with the Regional
Verification Process?
•
All National
Commissions
have submitted
the reports.
IEC field visits
2013
PER (Feb)*
ECU (Jul)*
NIC (Aug)
CARIBBEAN (Nov)
BRA (Nov)
Final reports and
amendments
Final reports
Draft report/Ongoing activities
Source: Country reports to PAHO/WHO
*Data as of September 9, 2013
•
Final and
amendment
reports due to
December 2013.
2014
GUT
VEN
PAR
URU
Fourth Annual International Expert Committee (IEC)
Meeting, May 2013
Main recommendations
for Member States:
•Provide a plan for
sustainability of program and
strengthening of regular
immunization program.
•Implement the 2012
Resolution (CSP 28.R14):
 To provide evidence
(critical analysis of data)
that supports that endemic
measles and rubella virus
transmission has been
interrupted, and
 To maintain elimination.
July 2013 – PAHO’s Technical Advisory Group (TAG)
endorsed the IEC recommendations
Engaging Government and Civil
Society to Achieve
Elimination in the Americas
6
Technical Feasibility
for Measles and Rubella Elimination
USA:
•Measles
(1997)
•Rubella
(2001)
Served as strong evidence for the
operational feasibility of
measles elimination and
rubella/CRS control among the
Member States of the Region
Source: Ministries of Health, Departments of Statistics and Epidemiology.
English Speaking Caribbean:
•Measles (1991)
•Rubella (2001)
Cuba:
•Measles (1993)
•Rubella (2004)
Costa Rica:
•Measles
(1999)
•Rubella
(2001)
Lessons from Implementation of Rubella Campaigns Served
as a Model for Other Countries to Eliminate Rubella and CRS
Caribbean countries carried out vaccination
campaign against MR during 1998-2001
•Persons aged 20--39 years
Nationwide Campaign for Vaccination of
Women Against Rubella, Chile, 1999
•Non-pregnant women 10-29 years
120
119
116
104
101
95
% cobertura
100
Nationwide Campaign for Vaccination of
Adults Against Rubella and Measles
Costa Rica, 2001
•Persons aged 15--39 years
80
Post partum
MR coverage
(March 2002)
= 98%
60
40
20
0
15 a 19
20 a 24
25 a 29
Edad
30 a 34
35 a 39
Strong Political Decision
− Pan American Sanitary
Conference, 1994
To set a goal to eliminate
measles from the Region by
2000
−Pan American Sanitary
Conference, 2003
To eliminate rubella and
congenital rubella syndrome
from their countries by 2010
1990s: Early Advocates
for the Regional Measles Elimination Goal
The support of the First
Ladies was critical to
provide greater
dissemination of the
measles eradication
initiative at the national
and international level
Establishments of National and
International Expert Committees
President of Costa Rica,
Oscar Árias Sánchez,
signed an executive
decree creating a
national expert
commission to verify the
elimination of measles,
rubella and CRS in the
country, 2008
National and Sub-national Initiatives
for Supporting Achievements of the
Regional Elimination Goals:
Social Mobilization
12
High Level Advocacy with Government and
Civil Society
With key
decision makers
and opinion
leaders
Lobby
• Based on the leadership
and spokesman with
technical expertise
• Flexible/adaptive to the
reality of each country
• Take advantage of
windows of opportunity
Multisectorial and
participatory
Advocacy
•
•
•
•
•
•
Pro-Active
Planned with measurable objectives (SMART)
Multi level (National, sub- national and local)
Use of collaborative networks and
Key persons to diffuse information
Actively seeking for collaborative partners
High Level Advocacy
with Government and Civil Society
Pediatric
Societies,
Schools of
Medicines
Private
Sector
Lobby
Advocacy
Community
Organization
Elimination
campaign
Media
NGOs
Church/
Religious
inst.
Donors
Education
System
State Dignitaries as Vaccination Leaders
• Political priority
• Financial resources
(budgetary and extrabudgetary)
• Active participation in
public events
National and Sub-National Level
Financial Contributions
Total Cost US$ 8,600,000
42%
Local resource mobilization
PAHO/WHO
57%
Ministry of Health and
Social Services
1%
Example, Paraguay, 2007
Source: country reports to FCH-IM/PAHO
Joint and Collaborative Action:
Strategic alliances and Partners in the Field
Participate in implementation of
vaccination program and plans:
the micro-macro-programming,
financing and operations
Scientific Societies and Medical Associations
Independent observers that contributes in creating
confidence and trust in vaccines among the public
Church:
Partners of Cooperation and
Enablers
National Communication Plans During the
Elimination Phase
Holistic
approach:
multimedia
Interaction with
journalist/press
Multiple
voices with
uniform
messages
Campaign
planning by
stages
Resource pack
and
communication
materials
Events and
public
demonstrations
Audience
segmentation
Vaccination
safety
workshops
Famous
people and
opinion
leaders
• Political
support
• Investments
• Early
planning and
production of
material
Created
demand for
vaccination
services
Example of Communications and Social
Mobilization: Brazilian National Vaccination
Campaign to Eliminate Rubella and CRS
• Situation analysis showed that
94% of those surveyed would
receive vaccine to help
eliminate rubella. As a result,
the communication strategy
focused on disease elimination.
• The slogan was (Vaccination
has become a family program)
• Television and radio spots
reminded audiences that Brazil
had eliminated polio and now
the country was eliminating
rubella.
21
Regional and Sub-regional Initiatives
to Achive the Elimination Goals:
Pan Americanism and Solidarity
22
The Sucre Agreement (2002):
Strategy to Prevent the Regionalization of the
Measles Outbreak
Decision to
coordinate a
simultaneous
vaccination week
initiatives
in the Andean subregion.
Project of Technical Cooperation among Countries (TCC):
Vaccination against Measles and Rubella in Border Areas
of Argentina and Brazil
Participating Countries:
(~ 20,000 vaccinated)
Argentina
Bolivia
Brazil
Chile
Colombia
French Guiana
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
This TCC is powerful communication
mechanism between the two subregional
integration systems of South America:
the Andean Community of Nations (CAN)
and the Southern Common Market
(MERCOSUR).
Challenges for Maintaining
the Region Free of Endemic
Measles and Rubella:
Post-elimination Era
25
Interruption of Measles & Rubella/CRS
Endemic Transmission in the Americas
CONTROL
ACCELERATED
CONTROL
ELIMINATION
MEASLES:
Venezuela / NOV 16, 2002
CRS:
Brazil/ AUG 26, 2009
RUBELLA
Argentina/ FEB, 2009
DOCUMENTATION
AND
VERIFICATION
27th Pan American
Sanitary Conference,
DC, 2007:
To document endemic
measles, rubella and
congenital rubella
elimination in the
Region
Towards Regional Certification:
The Last Inch?
Continued Dedication to Measles & Rubella
Elimination from the Western Hemisphere
28th Pan American Sanitary Conference, DC, 2012:
To maintain the regional elimination in the Americas
•Continuing measles and rubella virus transmission anywhere in the world
will continue to pose a risk to the Region of the Americas and cause possible
virus importations and outbreak
•Challenges in immunization programs, such as weak surveillance and
heterogeneous coverage, that put at risk the elimination of measles and
rubella
A Continuing Struggle for the Americas for Maintaining
Elimination Achievement: Main Challenges (1)
• Risk of introduction of endemic transmission due to virus importations
• Heterogeneous vaccination coverage
− Outbreak occur among unvaccinated population groups
• High cost of containing outbreaks in the post-elimination ere
− Small outbreaks with high cost per case; large-scale or/and sustained
outbreaks (e.g. Canada in 2011 (n=803 cases, cost estimate $9,5
million)
• Weak surveillance system to detect sporadic imported cases of
measles and rubella in some countries
A Continuing Struggle for the Americas for Maintaining
Elimination Achievement: Main Challenges (2)
• High volume of international tourism and
international events and mass gatherings
Need to keep in mind large international events to be held
in the Region such as the World Cup and the 2016
Olympics
• Resource mobilization for the elimination of
SR in the context of low incidence
• Maintaining immunization within the
political and social agenda at the country
and Regional level
Program Plans (2014)
•Provision of technical support for countries in
implementation of the plan of action for maintaining
the elimination of measles, rubella and CRS in the
Americas
•Publish technical guidelines & operational
research
•Documentation and Verification Process
Thank you!
¡gracias!