1. Think Locally, Act Globally
The 42nd National Immunization Conference, Atlanta, GA
David Fleming, MD
March 18, 2008

2. Impact of Vaccines in the 20th Century
Disease
20th Century Annual Morbidity
2005 Total
Percent Decrease
Smallpox
48,164
100
Diphtheria
175,885
Pertussis
147,271
25,616 83
Tetanus
1,314 27 98
Polio (paralytic)
16,316 1*
>99.9
Measles
503,282 66
Mumps
152,209
314
>99
Rubella
47,745 11
Congenital rubella
823 1
99.8
Haemophius influenzae (<5 yrs)
20,000 (est)
226
(serotype B or unknown) 99
*Imported vaccine-associated paralytic polio
Sources:
CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th Edition, January 2007.
CDC. Impact of vaccines universally recommended for children – United States, MMWR 1999;48(12):243-8.
CDC. Notice to Readers: Final 2005 Reports of Notifiable Diseases. MMWR 2006;55(32):

4. A Ten Year Transformation in Global Immunization:
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Increased coverage for routine vaccines
Substantial increase in coverage in developing countries, particularly sub-saharan Africa.
Increased coverage for new and underused vaccines
15.6 million children immunised against hepatitis B
28.3 million children immunised against Hib
26.3 million children immunised against yellow fever
Increased spending
Spending on immunization in developing countries has risen from all sources. 4 4
HARWYN\Presentations\GROUP Presentation Oct 05 FINAL.ppt
HARWYN\Presentations\GROUP Presentation Oct 05 FINAL.ppt
HARWYN\Presentations\GROUP Presentation Oct 05 FINAL.ppt 4 4 4

7. Varicella vaccine uptake

8. +4 doses of diphtheria, tetanus toxiods, and pertussis vaccines; 3 doses of polio vaccine; 1 dose of measles-mumps-rubella vaccine; 3 doses of Haemophius influenzae type b vaccine; 3 doses of hepatitis vaccine

10. GAVI Alliance: a public-private partnership10

12. Vaccine introduction strategy
Alliance Introduction Design
Agreement on policy objectives to guide introduction decisions
Design of processes and methods for development of vaccine introduction strategy
Alliance Vaccine Introduction Strategy Development
Definition of Alliance’s vaccine introduction strategy
Vaccines for introduction
Activities for support (ADIP’S)
Timeframe for introduction
Thorough engagement with countries and other stakeholders
WHO Vaccine Recommendations
Thank WHO and SAGE for the work being done on this.
Warmly welcome the expert guidance enabling well targeted activities- a core feature of the Alliance.
Scale of new vaccines in pipeline requires consideration of how to prioritise investment.
GAVI’s investment strategy will be presented to the Board by mid ’08.
Definition of priority vaccines
Recommendations for vaccine use
Alliance process of analysis, evaluation and prioritization will start with this list 12

13. Funding innovations
IFFIm: International Finance Facility for Immunisation: US$ 4 billion frontloaded from the capital markets
AMC: Advance market commitment for pneumo vaccine: accelerating access 13

14. Health System Strengthening (HSS)
US$800 million approved for the period
Countries can use this flexible funding for individual priorities including:
Recruiting and training health care workers
Building/updating facilities
Reporting & monitoring systems
DECISION
The GAVI Alliance Board: Feb 2008
Approved an increase in the GAVI Health Systems Strengthening window by US$ 300 million, allowing all countries to apply for one round, and three countries (Pakistan, Rwanda and Sierra Leone) with planning cycles ending in December 2009, to reapply for one additional round of funding. This decision is taken with the understanding that the above considerations will be addressed.
Reaching MDG 4 or 5 by 2015 will need significant investment in the Health Systems to actually deliver the health packages required to reduce childhood and maternal mortality and morbidity. The GAVI Alliance has launched an initial health strengthening investment of $500 million that will assist countries to identify and overcome health system bottlenecks to delivering childhood health services, with a specific focus on immunization. This investment aims to integrate and harmonize as much as possible and will be driven by country feedback and needs. 14

15. Immunization Services Strengthening (ISS)
Performance-based, data driven program.
US$20 provided up front for each additional child pledged to be vaccinated.
“No strings attached” to use of money.
Local data with independent audits.
Effective in increasing coverage rates across a range of baselines.
DECISION
The GAVI Alliance Board: Feb 2008
Approved an increase in the GAVI Health Systems Strengthening window by US$ 300 million, allowing all countries to apply for one round, and three countries (Pakistan, Rwanda and Sierra Leone) with planning cycles ending in December 2009, to reapply for one additional round of funding. This decision is taken with the understanding that the above considerations will be addressed.
Reaching MDG 4 or 5 by 2015 will need significant investment in the Health Systems to actually deliver the health packages required to reduce childhood and maternal mortality and morbidity. The GAVI Alliance has launched an initial health strengthening investment of $500 million that will assist countries to identify and overcome health system bottlenecks to delivering childhood health services, with a specific focus on immunization. This investment aims to integrate and harmonize as much as possible and will be driven by country feedback and needs. 15

18. ? Total doses administered in 2007 = 9750
Total doses for 100% coverage: 60,678 (based on 3-dose series, cohort of yr females=20, 216)
Proportion administered 16% 18

20. Panel Advises Flu Shots for Children Up to Age 18
                                                                                                                                                                                    
David Maxwell for The New York Times
In 2006, Tommy Mericle received a flu shot at the Mahoning
County District Board of Health in Ohio
By LAWRENCE K. ALTMAN
Published: February 28, 2008
All children ages 6 months to 18 years in this country should receive an
influenza shot every year, a federal advisory panel said on Wednesday.

21. 2006 National Coverage = 77%
# States* Percent range % %
% *includes DC