1. The Expanded Programme on Immunization in Thailand Pornsak Yoocharoen, MD. Bureau of General Communicable Disease, DDC, MOPH The implications for The border provinces And The Displace Person Tempolary Shelter

2. Administrative system for EPI in Thailand Permanent Secretary Office Provincial Health Office National Vaccine Com. Hospital, Health Center Monitoring, Supervision Technical support Budget Planning and Procurement Vaccine storage and supply (VMI) Immunization policy National Health Security Office : NHSO Dept of Disease Control GPO Ministry of Public Health Immunization Services Administrative monitoring & control monitoring & control Technical support Advisory Com. On Immunization Practice (ACIP) BoE Bogcd 12 Reg. Off. DPC

3. Immunization Policy Immunization is the basic health need All people have the right to be prevented from VPDs The service must be provided with equality and free of charge The service must be safe and in good quality

4. Polio Eradication Measles Elimination Neonatal Tetanus Elimination Immunization Target and Strategies Maintain high vaccine coverage (> 90%) Keep good quality in vaccine administration & cold chain management Assessment Immunization Standard and Accreditation AEFI surveillance & management

5. Current vaccines in EPI Vaccine  BCG  HB  OPV  DTP-HB  DTP  JE  dT  MMR 20 – 25 M. US$

6. AgeVaccine At Birth HB1 BCG, HB1 2 Month DTP-HB1 OPV1, DTP-HB1 4 Month DTP-HB2 OPV2, DTP-HB2 6 Month DTP-HB3 OPV3, DTP-HB3 9 Month MeaslesMMR1* Measles ---- > MMR1* 18 Month OPV4, DTP4, JE1, JE2 # 2 1 / 2 Year JE3 4 Year OPV5, DTP5 7 Year (School gr.1) MMR2 12 Year (School gr.6)dT Pregnant womandT3 (depend on immunization history) Current National Immunization Schedule * Started in 2010 ; # = 1 month apart from JE1

7. Oversea manufacturers Air port GPO Hospital storage (CUP) Health care provider (HC) Vaccine procurement and distribution by VMI system (NHSO) Local manufacturer (GPO, TRCS) Monthly supply National Health Security Office (NHSO) Vendor Managed Inventory (VMI) DPTS

8. EPI vaccine coverage and disease incidence, 1977-2012 Neonatal Tetanus Case rate/100,000 (case / 100,000 live births in NNT) Vaccine coverage Source: EPI, Bureau of General Communicable Diseases, DDC MOPH Encephalitis Start JE vaccine in 1991 (17 provinces) Diphtheria Pertussis Measles

9. Vaccine coverage in < 5 years Thailand 1999, 2003, 2008 Vaccine 199920032008 BCG98 99 99.9 DTP397 98 98.7 OPV397 98 98.7 HB395 96 98.4 Measles 94 96 98.1 JE2 84 87 94.6 JE3 - 62 89.3 DTP4 90 93 96.5 DTP5 - 54 79.4 T2 (or booster)90 93 93 National Immunization Program, Thailand

10. Vaccine Coverage (%) MMR gr.191.7 dT gr.694.1 Vaccine coverage survey in primary school, gr.1 and gr.6 in 2008 National Immunization Program, Thailand

11. High Risk Group : People in … Remote area Remote area Hard to reach Hard to reach  Migratory pop.  Urban slum  Illegal migrant worker Mobile team Mobile team Closed monitoring Closed monitoring  Coverage  Epidemiological surveillance Keep Up Keep Up Catch Up Catch Up Mop Up Mop Up

12. MOPHWHO DDC BOE (AEFIs) EPI, GCD Regional DDC (monitoring) FDA (Regulation, Licencing) MDSC (lot release, vaccine lab testing) PHO, BMA Hospital, Health Center, Imm. Clinic IPD, OPD, Well baby clinic AEFI Surveillance system AEFI Surveillance system Data flow Data feedback

13. Insurgency & Insecurity Health Reform Distrust in Health Services Migratory Pop. Severe AEFI & Rumors VPDOutbreak Believe & Concerns Geographical Barriers & Difficulties Low Vaccine Coverage Risk factors and Warning Signs

14. Challenges  Poor vaccine coverage or unknown in …  unrest areas  migrant workers (Thai and non-Thai)  DPTS  Undetected and un-controlled displace persons and illegal migrant workers move in and out the temporary shelters  Free movement of workers in SEAR from the declaration of AEC

15. Challenges  Many outbreak of VPDs were related to foreign migrant workers  Measles (Myanmar worker)  Rubella (Cambodian worker)  Diphtheria (Lao hill tribe, Mong)  Canceling of immunization coverage report from local and provincial level, keeping data at local area but no data at national level.

16. Challenges  Changing of budget allocation from MOPH to NHSO, limitation of budget but increase flexibility of budget management.  By law, the NHSO will support vaccine only Thai but not include non-Thai population  Dilemma of command line between MOPH and NHSO (direct command and financial support)

17. Challenges  To harmonize the separated function of immunization services by EPI program and vaccine procurement and delivery system by NHSO  High turn over rate among immunization health personnel  Reduce of health staff and Increase of treatment care from public sector and health care reformation

18. Opportunities Fully support at national level, NHSO have potentially supported with high level of finance. Outsource of the delivery system to public- private sector using Vender Manage Inventory system (VMI). Potentially support equipment for cold chain system. (Refrigerator, vaccine carrier, thermometer …)

19. To convince the NHSO should have fully support the routine immunization vaccines to DPTS and also others foreign children who live in Thailand. To co-operate with neighboring countries around Thailand should intensify routine immunization activities to increase and maintain high vaccine coverage, more than 90%, in every country. Next steps implication

20. Thank You An ounce of prevention is always better than A pound of cure.