State of Measles Initiative Financing Partners for Measles Advocacy Meeting Washington, D.C. September 22, 2008 Andrea Gay

Investing in the Measles Initiative What Dividends Has It Paid? Current investment of $635 million (2001-2007) has paid high dividends in mortality and morbidity reduction Extremely cost effective with high impact: equity, meet (exceed) UN targets on time, vaccinate over 600 million children (by end 2008), prevent 2.3 million deaths (end 2006) at cost of $184/death averted Contribute to achievement of MDG # 4 Expand and strengthen polio surveillance system – useful for new vaccine introduction Equity: only criteria is age; Exceed UN targets on time: 2010 90% mortality reduction-PAHO,AF,EM,EU,WP[no SE]

Dividends continued Good future for measles mortality reduction & Enable scale-up coverage with preventive health interventions: vitamin A, deworming, ITNs and other vaccines (OPV, Rubella) Countries financial commitments are increasing for sustainability: experience with follow-up campaigns 31 countries contributed to operational costs up to 50% with upward trend Good future for measles mortality reduction & elimination if sufficient finances available

Components of campaigns that strengthen health systems: Micro-planning Investing in Measles Initiative Entry Point to Strengthening Health Systems Components of campaigns that strengthen health systems: Micro-planning Training – injection safety Cold chain improvement Logistics Increase community demand for immunizations with social mobilization Waste management improvement Disease surveillance and data management

Immunization Strengthening Support WHO AFRO 2007: 6 countries received $348,575 (range $6,000 – 184,704) 2008: 9 countries received $1,050,000 (range $80,000 – 250,000)

* Excluding country contributions for catch-up and follow-up SIAs Measles Initiative Annual Donations 2001-2008 and Estimated Financial Resource Requirements, Contributions, Funding Gap 2009* 2009: Funding gap US$ 35 million Excluding India * Excluding country contributions for catch-up and follow-up SIAs

Resource Requirements 2009 Total required for at least 26 follow-up campaigns (plus possible India catch-up), surveillance, minimal routine strengthening: approximately $55 million (plus India) Total pledged by existing donors: approximately $20 million (CDC, ARC, UNF, Merck, LDS, Vodafone Fdn) Gap: approximately $35 million

Options to Address Funding Gap for 2009 Decrease number of countries conducting SIAs Shorten age range of target populations Cease specific support for routine immunization Increase countries’ share of budget beyond 50% ops costs (ex: Nigeria) Rather than proactively conduct SIAs to prevent outbreaks, simply respond to outbreaks when they occur (without donor support)

Annual Donor Expenditure and Financial Resource Requirements (FRR) 103 Slide used in April 2008 – in process of updating for 2008 (no gap), 2009 and 2010. India is wild card

Financial Strategy (Banker) Support follow-up SIAs and improve routine coverage Avoid collapse of gains, resurgence of measles Use smaller age range when possible & appropriate Increase sustainability with increased country financial responsibility (shift costs) Increase separate financing for surveillance (as global public good?) Increase number/type of donors Improve cost sharing with added interventions

Financial Challenges Consistent immunization donors are limited: bilaterals [notably CDC], GAVI, ARC, UNF, Vodafone Fdn., LDS, Gates Fdn., Rotary International, BD, and most recently, Merck How broaden this base? Countries can use SWAP, country multi-year plan (CMYP) funds for measles, but compete with newer vaccines being introduced How involve measles staff in CMYP process to access funds?

Should global measles elimination be considered?? WHO Executive Board consideration for elimination 1/09 4 of 6 WHO regions have elimination targets: PAHO – 2002, EURO & EMRO – 2010, WPRO – 2012 1 WHO region has “pre-elimination” target: AFRO – 2012 1 WHO region has no target: SEARO Measles goals have been met on time Political will currently exists in countries For sustainability and elimination goals need more predictable multi-year financing Potential donor support (appetite for large scale activities not evident) Late to ask question but relevant to financing issues

Questions to Ponder Why donors reluctant to continue support when innovative strategy proven to work? When is proven strategy no longer “innovative”? What is time frame for innovation? What is the value of innovation/catalytic? Pilot / lessons learned / lessons lost