Global Overview of Measles & Rubella 11 th Annual Meeting The Measles Initiative Washington, DC th September, 2012

Major causes of annual under 5yrs child mortality: : 9.6 million 2010 : 7.6 million Source: Li, Liu, at all The Lancet 379, June 9, 2012): 1990: 12.1 million 2008: 8.8 million Source: Van den Ent et al, J Infect Dis Suppl July 2011

Estimated measles deaths down by three - quarters, Target 74%

4 |4 | Trends in 1 st and 2 nd dose Measles delivery various strategies Number of doses of measles vaccine administered, by delivery strategy, Measles Initiative 1 st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2 nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data) 1 billion vaccinated as of July 2011

Measles and other interventions supplementary activities, 2011 Vitamin A – 12 De-worming – 10 Bed nets – 2 OPV – 16 Other interventions -5 WHO;August 2012 *OPV+VitA+Deworming+Mealses

6 |6 | 84% 2015 Target Annual Number of Reported Measles Cases and 1 st Dose Measles Vaccination Coverage, Worldwide,

7 |7 | Reduction in Estimated Measles Deaths by WHO Region 2000 to %76%79%85% 2010 reduction goal (90%) 78% Source: WHO/IVB, November %100% 26%

8 |8 | Pareto-Juran principle 20% of the work (the first 10% and the last 10%) consume 80% of your time and resources

9 |9 | India Phase 2 (157 districts) Phase 1 (45 districts covered) Remaining (159 districts) Source: Based on target population available with GoI Target pop (millions) Vaccinated (millions) Coverage Phase % Phase %* Phase-372.7Planned-- Total *-- * Phase-2 campaigns ongoing; data as on 23 Jan states with MCV1 coverage ≥ 80% introduced a routine second dose by August states with MCV1 < 80% are implementing measles SIAs

10 | Measles and Rubella Elimination Goals by WHO Region, February SEAR: 95% Mortality Reduction by 2015 Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals Americas and Europe have rubella elimination goals

Political advocacy, mobilizing decision makers Branding, advertising & ‘edu-tainment’ with national, provincial and community mass media Community engagement Meetings, forums, film showings and events Targeted selling Volunteer Social Mobilization Networks Point of service promotion Inter-personal communication Researched & Evidenced multi- pronged communication: Experience from GPEI COMBI Star adapted for polio eradication Challenges 1: Communication

12 | Challenges 2: Weak Immunization Systems 1 st dose: –67 Countries have MCV1 coverage < 90% 2 nd dose ( routine ): –54 countries do not have routine 2 nd dose Campaigns: –Variable quality Measles 1 st dose coverage among infants, % (24 countries or 12 %) 50-79% (41 countries or 21%) >=90% (126 countries or 66%) <50% (2 countries or 1%)

13 | Challenges 3: Some set backs in Africa 4-fold increase since 2008 Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011) Outbreaks in drought affected Horn of Africa –High case-fatality Weekly Epidemiological Record (2011) 86:

14 | Historical procurement of Measles and MR vaccine through UNICEF in and forecasts for (in doses)

15 |SummarySummary Achievements –1 st dose coverage up to 85% –1 billion doses delivered in campaigns –2 / 3 reduction in cases –3 / 4 reduction in deaths Challenges –Catch - up in India; Outbreaks in Africa; Weak systems New Strategic Plan, 2012 – 2020 –Addressing rubella together with Measles –Taking the Initiative towards achieving regional goals More Harambee