Published on February 15, 2014
Stage is set for a strong link between Microbiology & Epidemiology : A few stories of success New Vaccines to the NIP Dr. P.R.Wijesinghe Consultant Epidemiologist, Epidemiology Unit Dr. Nihal Abeysinghe WHO SEARO [TIP, New Vaccine Introduction], former Chief Epidemiologist, Ministry of Health, Sri Lanka
Present Success achieved by NIP • Milestones in vaccine introduction & AEFI surveillance • • • • • • • Vaccination ordinance 1886- compulsory vaccination against small pox BCG vaccination-1941 DPT vaccination -1961 Oral Polio vaccination -1962 Introduction of EPI – 1978 Universal Child Immunisation (UCI) status - 1989 Introduction of additional vaccines – – – – – – Measles in 1984 JE in high risk districts 1989 Rubella in 1995 ATd & MR in 2001 Hepatitis B on phase basis in 2003 Hib vaccine in 2008 • AD syringes and sharp collection system-2003 • Establishment of an AEFI surveillance system in 1995
Epidemiologists’ dilemma • Are we going to boast old glory and stay put ? • Are we able to introduce benefits of new vaccines to the SL public especially children ? • If so, what are the constraints? • How do we plan to overcome these issues? • What are the choices to be made?
Traditional role played by the WHO & Unicef is still continuing • WHO & UNICEFF Support • Technical assistance & logistic support for EPI • Efficient service delivery • Infrastructure development – (central & regional cold facilities etc) • Vaccine and associated equipment procurement • Vaccine delivery – ( vaccine transport vehicles etc) • Surveys – ( EVMS,VMA, coverage ) • Capacity building
Entry of New Partners • Global Alliance for Vaccines and Immunisation (GAVI) • radical improvement of access to vaccines • strengthen immunization services in poor nations • GAVI funded vaccines accelerated development and introduction plans – HIB initiative – PneumoADIP – Rota ADIP • Partnerships, coordination, strategic alliance with WHO
Entry of New Partners • Support for evidence based decision making and appropriate choice of vaccines • Establish value : BOD, protection through vaccination • Communicate value : ensuring availability of research data • Deliver value : – Availability of quality , affordable vaccines – Delivery system – Finance for sustenance
Entry of New Partners • International Vaccine Institute (IVI) • Centre of research, training and technical assistance for vaccine needs in developing countries • Program for Appropriate Health (PATH) • Improvement of health by advancing technologies, strengthening systems, and encouraging healthy behaviors . • UNFPA • Poverty reduction, ensuring every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect [ supporting HPV prevalence study].
Changes in the vaccine industry • Advance Market Commitment • Target Product Profiles • Product complying with detailed specification • Product containing ideal attributes • Co-Financing & Ownership • Sharing vaccine cost with the GAVI alliance – a WIN WIN relationship
New GAVI option for 7 vaccines • • • • • • • JE Meningococcal A Rubella Typhoid Cholera HPV Rabies
Surveillance and Research • Hib & Pneumo surveillance : in- country net work ( SLPnSN) – Hib burden study – with microbiologists at the LRH, NIHS, CSTH, NCTH, Karapitiya TH – Adult surveillance at the NHSL- 2008 /09 ?? • Rota surveillance at the LRH – with the virology department of the MRI • Study assessing the safety and immunogenicity of the live JEV SA 14-14-2
Surveillance and Research • Active surveillance for prevalence/incidence of dengue ( Pediatric Dengue Vaccine Initiative) • Prevalence of carcinogenic Human Papiloma Virus (HPV) infection and burden of cervical cancer attributable to HPV ( UNFPA) • Morbidity cost study of rotavirus diarrhoea (with the virology Dept. MRI) • Cost effectiveness of introducing Pneumococcal vaccine to the EPI in Sri Lanka (based on surveillance data from LRH & CSTH)
The stage is set • Hib > JE SA 14-14-2 > Mumps > Pneumo > Rota > HPV [risk groups] Typhoid [risk areas & groups] Hepatitis A [risk areas &groups]
Take it or Leave it • Sustainability issues • Rising vaccine and AD syringe cost with every new vaccine • Ownership issue for NPI when co financing expires • Ability to self sustain if GAVI eligibility is revised – Least poor group, GNI >1000US $ • Need for cost minimization within the vaccine budget – – – – – Accountability & transparency Minimizing vaccine wastage Need for bulk procurement Alternative vaccines Promotion of the private sector participation in immunisation
Take it or leave it • Issues related to safety • Experience of safety issues related to Hib vaccine • Complicated nature of causality determination • Impact on the acceptance of the programme • Need to Prevent and minimize AEFI • Phased based introduction?? • Need of sound post marketing surveillance data • Enhanced surveillance of AEFI following introduction
Gratitude • • • • • • • All ministry officials All Epidemiologists and the staff at the Epid Unit All Directors /MCH and the staff at the FHB All Clinicians & All Microbiologists REE, MOO/MCH & other district health staff MOOH, PHNSS, PHMM, PHII, All other curative sector health staff of current & yesteryears for their contribution to the success of NIP • The media friends who understand the importance of strong NIP
Gratitude Wonderful Sri Lankan parents without whose support EPI would have been an illusion
Shouldn’t we face all challenges & get the maximum benefits to our motherland?
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