A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of Health

Immunization Programme Sri Lanka : Vaccines used at present  BCG for Tuberculosis  Oral polio for Poliomyelitis  DPT / DT for Diphtheria, Pertusis [Whooping Cough] & Tetanus  Measles  Rubella  Tetanus  Hepatitis B  Japanese Encephalitis

Present status of the Immunization Programme, Sri Lanka  Dramatic reduction in illness, disability & death from Poliomyelitis (0) since 1994 Diptheria (0) in 2005 Tetanus (25) / Neonatal Tetanus (0) Whooping Cough (32) Measles (24) Childhood tuberculosis Japanese Encephalitis Rubella  Very high vaccine coverage > 95%

Decision Making Process  Evidence based decision making  Epidemiology Unit recognizes the needs  Makes addition to the surveillance system  Carries out burden & cost studies  Proposes to the Advisory Committee on Communicable Diseases  Reviewed & approved by the Advisory Committee on Communicable Diseases [ACCD]  Discussion with a wider group of stakeholders; [ “ Immunization Summit-held on 5 th January 2007”]  Negotiate for funding & convince the Finance Ministry  Acquire logistics, other facilities & prepare the field staff  Develop a communication strategy  Develop plans for Continuous follow up, Monitoring & Evaluation

Strength of the Sri Lankan EPI : Number of Years Taken to Reach Over 90% Coverage Following Introduction of a New Vaccine

Present Challenges  Sustaining high coverage  Achieving eradication & elimination targets  Ensuring vaccines of assured quality  Introducing new vaccines  Strengthening the capacity for surveillance of Vaccine-preventable diseases & Adverse Events following immunizations  Ensuring financial sustainability for the immunization programme  Strengthening Primary Health care system

Cost Considerations in the National EPI  Introduction of a new vaccine is always considered within the framework of the National EPI, not separately  Total cost Vaccine Injection supplies Other routine recurrent cost  Cold chain equipment  Transportation

Policies that would help us to achieve the desired status  Equity and equality  Ownership, partnership and responsibility Government Other stakeholders International organizations  Accountability publicly accountable for the policies, goals, strategies and actions  Assured quality, safe products and services Internationally recognized standards of quality, safety, and services are delivered according to best practices.

Policies that would help us to achieve the desired status  Adaptability to local needs and circumstances commitment of all responsible stakeholders to appropriately adapt to the local needs and circumstances.  Sustainability through technical and financial capacity building All stakeholders including the government should work collectively, to ensure financial and technical self reliance with continuing, incremental infrastructure building.  Policies and strategies based on evidence and best practices The choice of policies, strategies and practices should be based on evidence from surveillance, monitoring and evaluation, operational research, diseases burden and impact assessments, and economic analyses

Key Strategies  Implementing the comprehensive Multi Year Plan & annual plans  Reaching children in “difficult to reach areas”  Ensuring quality vaccine supply & accessories  Improving quality services by enhancing the service facilities, vaccine storage capacity & surveillance of Adverse Events Following Immunization  Creating a Community demand  Introducing new vaccines to combat ‘emerging’ new VPD with financial sustainability plans  Regular reviewing of the programme “What works & What not”

Key Strategies  Ensuring financial sustainability  Improving National regulatory authority activities by regular discussions  Promoting operational research : Disease Burden studies  Improving management of human resources  Strengthening laboratory capacity  Strengthening capacity for data management  Planning for immunization in complex emergencies  Develop & implement a comprehensive communication strategy  Include immunization in epidemic preparedness plans  Define & delegate responsibilities to stakeholders

Thank you Epidemiology Unit Ministry of Health