The Expanded Programme on
Immunization in Thailand
The implications
for
The border provinces
And
The Displace Person
Tempolary Shelter
Pornsak Yoocharoen, MD.
Bureau of General Communicable Disease, DDC, MOPH
Administrative system for EPI in Thailand
Ministry of Public Health
National Vaccine Com.
Immunization policy
Advisory Com. On
Immunization Practice (ACIP)
Technical support
Dept of Disease Control
• BoE
• Bogcd Monitoring, Supervision
• 12 Reg. Technical support
Off. DPC
National Health
Security Office : NHSO
Budget Planning and Procurement
GPO
Vaccine storage and supply (VMI)
Permanent Secretary Office
Administrative monitoring & control
Provincial Health Office
monitoring & control
Hospital, Health Center
Immunization
Services
Immunization Policy
• Immunization is the basic health need
• All people have the right to be
prevented from VPDs
• The service must be provided with
equality and free of charge
• The service must be safe and in good
quality
Immunization Target and Strategies
Polio Eradication
Measles Elimination
Neonatal Tetanus Elimination
• Maintain high vaccine coverage (> 90%)
• Keep good quality in vaccine administration
& cold chain management
• Assessment Immunization Standard
and Accreditation
• AEFI surveillance & management
Current vaccines in EPI
Vaccine
 BCG
 HB
 OPV
 DTP-HB
 DTP
 JE
 dT
 MMR
20 – 25 M.
US$
Current National Immunization Schedule
Age
At Birth
Vaccine
BCG, HB1
2 Month
OPV1, DTP-HB1
4 Month
OPV2, DTP-HB2
6 Month
OPV3, DTP-HB3
9 Month
Measles ---- > MMR1*
18 Month
OPV4, DTP4, JE1, JE2#
21/2 Year
JE3
4 Year
OPV5, DTP5
7 Year (School gr.1)
MMR2
12 Year (School gr.6)
dT
Pregnant woman
dT3 (depend on immunization history)
* Started in 2010 ; # = 1 month apart from JE1
Vaccine procurement and distribution by VMI
system (NHSO)
Oversea
manufacturers
Air port
Local manufacturer
(GPO, TRCS)
National Health Security
Office (NHSO)
GPO
Monthly supply
Vendor Managed
Inventory
(VMI)
DPTS
Hospital storage
(CUP)
Health care
provider (HC)
EPI vaccine coverage and disease incidence, 1977-2012
Vaccine Coverage
100
Cases rate
100
100
100
80
80
60
80
80
60
60
60
40
40
20
20
20
20
0
0
0
0
2011
2009
2007
2005
2003
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
8
2001
Measles
40
100
7
80
6
Neonatal Tetanus
1977 1981 1985 1989 1993 1997 2001 2005 2009
15
100
13
80
11
5
Diphtheria
4
3
60
9
40
7
Pertussis
60
40
5
2
20
3
0
1
1
0
1977
1981
1985
1989
1993
1997
2001
2005
2009
100
5
80
4
Encephalitis
3
60
Start JE vaccine in 1991
(17 provinces)
2
40
20
1
0
0
1977
1981
1985
1989
1993
1997
2001
2005
2009
20
-1
6
40
0
1977
1981
1985
1989
1993
1997
2001
2005
2009
Case rate/100,000
(case / 100,000 live births in NNT)
Vaccine coverage
Source: EPI, Bureau of General Communicable Diseases, DDC MOPH
Vaccine coverage in < 5 years Thailand
1999, 2003, 2008
Vaccine
BCG
DTP3
OPV3
HB3
Measles
JE2
JE3
DTP4
DTP5
T2 (or booster)
1999
2003
98
97
97
95
94
84
90
90
99
98
98
96
96
87
62
93
54
93
2008
99.9
98.7
98.7
98.4
98.1
94.6
89.3
96.5
79.4
93
National Immunization Program, Thailand
Vaccine coverage survey in primary school,
gr.1 and gr.6 in 2008
Vaccine
Coverage (%)
MMR gr.1
91.7
dT gr.6
94.1
National Immunization Program, Thailand
High Risk Group : People in …
• Remote area
• Hard to reach
 Migratory
pop.
 Urban slum
 Illegal migrant
worker
• Mobile team
• Closed monitoring
 Keep Up
 Catch Up
 Mop Up
Coverage
 Epidemiological
surveillance

AEFI
Surveillance system
MOPH
WHO
DDC
FDA
(Regulation, Licencing)
MDSC
EPI, GCD
BOE
(AEFIs)
Regional DDC
(monitoring)
(lot release, vaccine lab
testing)
PHO, BMA
Data flow
Data feedback
Hospital, Health Center, Imm. Clinic
IPD, OPD, Well baby clinic
Risk factors and Warning Signs
Insurgency
Distrust
in
&
Insecurity
Health Reform
Health Services
Geographical
Barriers &
Difficulties
Low
Vaccine Coverage
Severe AEFI
Believe &
Concerns
Migratory Pop.
&
Rumors
VPD
Outbreak
Challenges
 Poor vaccine coverage or unknown in …
 unrest areas
 migrant workers (Thai and non-Thai)
 DPTS
 Free movement of workers in SEAR
from the declaration of AEC
 Undetected and un-controlled
displace persons and illegal migrant
workers move in and out the
temporary shelters
Challenges
 Canceling of immunization coverage report
from local and provincial level, keeping
data at local area but no data at national
level.
 Many outbreak of VPDs were related to
foreign migrant workers
 Measles (Myanmar worker)
 Rubella (Cambodian worker)
 Diphtheria (Lao hill tribe, Mong)
Challenges
 Changing of budget allocation from MOPH
to NHSO, limitation of budget but increase
flexibility of budget management.
 By law, the NHSO will support vaccine only
Thai but not include non-Thai population
 Dilemma of command line between MOPH
and NHSO (direct command and financial
support)
Challenges
 To harmonize the separated function
of immunization services by EPI
program and vaccine procurement
and delivery system by NHSO
 Reduce of health staff and Increase
of treatment care from public sector
and health care reformation
 High turn over rate among
immunization health personnel
Opportunities
• Fully support at national level, NHSO have
potentially supported with high level of
finance.
• Outsource of the delivery system to publicprivate sector using Vender Manage
Inventory system (VMI).
• Potentially support equipment for cold
chain system. (Refrigerator, vaccine
carrier, thermometer …)
Next steps implication
• To convince the NHSO should have fully
support the routine immunization vaccines
to DPTS and also others foreign children
who live in Thailand.
• To co-operate with neighboring countries
around Thailand should intensify routine
immunization activities to increase and
maintain high vaccine coverage, more
than 90%, in every country.
Thank You
An ounce of prevention
is always better than
A pound of cure.