Session 1: New Opportunities and New Direction Chair: Narendra Arora Rapporteur: Kaushik Banerjee Session Lead: Peter Strebel

Objectives To provide brief updates on the programme and laboratory network To inform participants about the new Gavi measles strategy To share conclusions and draft recommendations from the midterm review Time for comment and Q and A

Agenda Time Topic Presenter 9:15 1. Global measles and rubella update Peter Strebel 9:30 2. Global Measles and Rubella Laboratory Network update Mick Mulders 9:45 3. The new Gavi measles strategy (Commentary from Gavi) Devi Aung (Seth Berkley) 10:00 Discussion 10:30 Coffee break 11:00 4. Findings and recommendations from the Midterm Review Walter Orenstein 11:40 Commentary Rebecca Martin Peter Figueroa 12:00 Plenary Q and A 12:30 Lunch

Global Measles and Rubella Programme Update Accelerating Progress Towards Measles and Rubella Control/Elimination Goals Geneva, 21 June 2016 Peter Strebel, WHO, IVB/EPI

E. Mediterranean, W. Pacific 2015 Status Report Milestone/Goal Achieved Not Achieved Global control milestones: Measles mortality reduction >95% vs. 2000 79% Further 16% reduction National MCV1 coverage >90% 122 (63%) countries 62 (37%) countries Reported measles incidence <5 per million 125 (64%) countries 69 (36%) countries Regional elimination goals: Elimination of measles in 4 WHO Regions None American, European, E. Mediterranean, W. Pacific Elimination of rubella in 2 WHO Regions American Region European Region

Measles

Annual reported measles cases and MCV1* and MCV2** coverage, 1980-2015 * MCV1 coverage: coverage with first dose of measles-containing vaccine as estimated by WHO and UNICEF. **MCV2 estimates is only available from 2000 when global data collection started, however some countries have introduced the vaccine earlier. Source: WHO/IVB database, 2015 194 WHO Member States. Updated on 15 July 2015

Annual number of measles cases by WHO Region, 1980-2015*

World Health Organization 16 November, 2018 WHO/UNICEF Estimates of Vaccination Coverage with the 1st Dose of Measles Containing Vaccine, 2014 37 (20%) countries have <80% coverage with 1st dose of measles containing vaccines <50% (4 countries or 2%) 50-79% (33 countries or 17%) 80-89% (35 countries or 18%) 90-94% (46 countries or 24%) >=95% (76 countries or 39%) Not available The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2015. All rights reserved Not applicable

Countries using a routine 2nd dose of measles containing vaccine (MCV2) in their national programme 32 countries have introduced a routine 2nd dose of measles vaccine since 2008 Introduced before 2008 (128 countries or 66%) Planned introductions in 2016 (2 countries or 2%) Not Available/ Not Introduced/ No Plans (32 countries or 16%) Not applicable Introduced between 2008 and 2015 (32 countries or 16%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2016. All rights reserved. Data source: WHO/IVB Database, as of 14 June 2016 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization

Measles Campaigns in 39 Countries in 2015 180 million children reached 40/66 (61%) attained 95% coverage 18/66 (27%) with coverage survey 4 surveys document >95% coverage 42 of 66 SIAs integrated 1 or more other interventions Measles (21) Measles and Rubella (15) Measles, Mumps and Rubella (3) OPV – 15 Vitamin A – 15 De-worming – 8 Other interventions – 1 No SIA in 2015 Not Applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2014. All rights reserved. Updated on 15 April 2016

Reported Measles Incidence Rate*, May 2015 to April 2016 *Rate per 1'000'000 population <1 (92 countries or 47%) ≥1 - <5 (33 countries or 17%) ≥5 - <10 (21 countries or 11%) ≥10 - <50 (25 countries or 13%) ≥50 (13 countries or 7%) No data reported to WHO HQ (10 countries or 5%) Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2016. All rights reserved. Data source: surveillance DEF file Data in HQ as of 13 June 2016

Vaccination status of reported measles cases, 63% of cases

Rubella

World Health Organization 16 November 2018 WHO/UNICEF Estimates of Vaccination Coverage with Rubella Containing Vaccine* (RCV), 2014 46% Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 16 July 2015. *MCV1 was used as a proxy in the Member States that have introduced Rubella vaccine.

17 countries introduced rubella vaccine during 2012-2015 Countries with rubella vaccine in the national immunization programme, by year of vaccine introduction 17 countries introduced rubella vaccine during 2012-2015 16 countries planning introduction in 2016-2018 Introduced before 2012 (130 countries or 67%) Planned introductions in 2016-2018 (16 countries or 8.2%) Not Available/ Not Introduced/ No Plans (31 countries or 16%) Not applicable Introduced between 2012 and 2015 (17 countries or 8.8%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2016. All rights reserved. Data source: WHO/IVB Database, as of 14 June 2016 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization

Estimates of the median incidence of CRS per 100,000 live births by country in 2010 Vynnycky E, Adams EJ, Cutts FT, Reef SE, Navar AM, et al. (2016) Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review. PLoS ONE 11(3): e0149160. doi:10.1371/journal.pone.0149160 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0149160

Regional Elimination

Progress Towards Measles & Rubella Elimination, by WHO Region, 2014-5 Regional Verification Commissions Established Measles Elimination Achieved Rubella Elimination Achieved No. of countries % of countries Americas1 Yes 34 97% 35 100% Europe2 22 41% 23 43% Western Pacific3 6 22% - Eastern Mediterranean No South-East Asia Africa 1. Progress report on Plan of Action for Maintaining Measles, Rubella, and CRS Elimination in the Americas, 12 Sept 2014 2. Third meeting of the European Regional Verification Commission for Measles and Rubella Elimination 10-12 Nov 2014 3. http://www.wpro.who.int/mediacentre/releases/2015/20150327/en/

2015 Assessment Report of GVAP -- on measles and rubella goals Conclusion: The elimination strategies for maternal and neonatal tetanus, and for measles and rubella, and their implementation, are in urgent need of change and adequate resourcing. Recommendation: Global, regional and national development partners support countries in securing the required resources and in implementing their measles and rubella elimination or control goals taking into account the results and recommendations of the midterm strategy review to be conducted in 2016.

Summary High level measles control being maintained and over a million measles-related deaths averted each year Large outbreaks continue and progress has slowed Rubella elimination verified in the Americas and gradual increase in global rubella vaccination coverage Over half of the world's children not being vaccinated Global 2015 measles control milestones will not be achieved on time and regional measles and rubella elimination targets are off-track (except for Americas) Midterm review to understand why and what can be done

Acknowledgements Information provided by: Funding support by: Country programmes WHO Regional Offices Strategic Information Group, WHO/EPI Minal Patel Laure Dumolard Catherine Steulet Olivier Beauvais Marta Gacic-Dobo Funding support by: