1. 1 Progress Towards Global and Regional Immunization Goals Workshop on Prevention and Control of Vaccine Preventable Disease in Displaced Person Temporary Shelters and Migrant Communities Bangkok, 27 September 2012

2. Objectives Provide update on global and SEAR developments on immunization policies and programs Review progress towards key global/regional immunization goals –Routine EPI –Eradication/elimination goals Provide update on latest vaccine developments Outline implications for border and migrant populations in Thailand

3. 3 Global and South-east Asia Regional Developments

4. Decade of Vaccines: Global Vaccine Action Plan (endorsed at WHA, May 2012)

5. South-east Asia Region (2010-2013) Selected Targets DTP3 90% national coverage and 80% in every district by 2013 Polio free by 2010 Reduce measles mortality by 90% by 2013 compared to 2000 At least 1 new vaccine to be introduced In every country by 2013 VPD cases and outbreaks rapidly detected, reported, and investigated

6. Major cause of mortality among children under 5 years, 2000-2010 2000 9.6 million 2010 7.6 million (1.5-2m VPD) Measles accounts 18% of total reduction Source: Li, Liu, at all “Global, Regional, and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends Since 2000.” The Lancet 379, no. 9832 (June 9, 2012): 2151–2161.

7. Progress towards key global/regional immunization goals -Routine EPI -Eradication/elimination goals NOTE: data source-- UNICEF/WHO ‘best estimates’

8. Global Immunization 1980-2011, DTP3 coverage global coverage at 83% in 2011 Source: WHO/UNICEF coverage estimates 2011 revision. July 2012 Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 18 July 2012.

9. Source: WHO-UNICEF Best Estimates (draft as of 15 May 2012) SEAR DTP3 Coverage 9m of 21m under- immunized children

10. 1988: 125 endemic countries; >360,000 cases 2012: 3 endemic countries; 145 cases Nigeria 88 Pakistan 35 Afghanistan 17 Chad 5 GVAP: interrupt transmission by 2015 SEAR: -last case in India, January 2011 -regional certification: 2014

11. Measles and Rubella Elimination Goals by WHO Region, February 2012 2015 2015 2015 2012 SEAR: 95% Measles Mortality Reduction by 2015 Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals Americas and Europe have rubella elimination goals 2020 2000 2010 GVAP: measles elimination in at least 4 regions by 2015; 5 by 2020

12. Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010 74%76%79%85% 90% 2010 reduction goal 78% Source: WHO/IVB, November 2009 87%100% 26% 95% 2015 reduction goal

13. MCV1 Coverage 1 and Measles Cases 2, SEAR 1980- 2010 Updated on 26 Dec 2011 1 WHO/UNICEF Estimated Coverage, 1990-2010 2 WHO vaccine-preventable diseases: monitoring system 2011 global summary

14. * Source: WPRO measles-rubella monthly country reports, data received through March 2012 Confirmed Measles Cases, by Month of Onset and Country, Western Pacific Region 2007 — 2012* National SIAs conducted VTN CAM PHL JPN PHL CAM LAO PNG National SIAs conducted CHNCAM LAO

15. Clinical and Lab Confirmed Measles Cases and Deaths, SEAR and WPR, to date 2012 SEARO^ Cases (deaths) –Bangladesh 3909 (1) –India NR –Indonesia1103 (1) –Myanmar1127 (16) –Nepal1308 (7) –Thailand 93 –Other 41 –TOTAL7581 (25) WPRO* Cases (deaths) –Cambodia1 –China3439 (6) –Japan165 –Lao PDR6 –Malaysia1455 –Philippines946 (4) –Vietnam207 –Other138 TOTAL6357 (10) Source: *WHO WPRO data from January to 31 July 2012 ^WHO SEARO data from January to 27 Aug 2012

16. Latest vaccine developments -’new and underutilized’ vaccine introductions -development status

17. GAVI targets for new vaccine introduction in low- income countries Phase I: Hib, Hep B, YF (2000 -2005) Phase II: Rotavirus, Pneumo (2005-2015) Vaccine Investment Strategy (2008 onward): –Meningitis A Conjugate (2011) –Measles (2 nd dose)/Rubella (2012) –HPV (opening applications in 2012) Vaccines being considered for future support: – JE, typhoid, Vaccine cost FIC -All EPI vaccines:$2 -New vaccines: Pentavalent: $7.75 PCV: $10.50 Rota: $5 HPV: $15 MAC: <$1

18. Countries having introduced Hib vaccine in 1997 and 2011 29 countries introduced 1997 174 countries introduced 2011 3 country partially introduced The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2012. All rights reserved 2 countries partially introduced Source: WHO/UNICEF coverage estimates 2011 revision. July 2012 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 3 September 2012

19. Immunization coverage with PCV3 containing vaccines in infants, 2011 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2012. All rights reserved PCV3 vaccine not introduced (123 countries or 63%) 80-89% (5 countries or 3%) 50-79% (18 countries or 9%) >=90% (22 countries or 12%) <50% (9 countries or 5%) PCV3 vaccine introduced but no coverage data reported (17 countries or 8%) Not applicable Source: WHO/UNICEF coverage estimates 2011 revision. July 2012 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 3 September 2012. 2012 Non GAVI- 60 GAVI- 17

20. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2012 All rights reserved Rota vaccine not introduced (161 countries or 83%) 80-89% (8 countries or 4%) 50-79% (8 countries or 4%) >=90% (7 countries or 3%) <50% (3 countries or 2%) Rota vaccine introduced but no coverage data reported (5 countries or 3%) Immunization coverage with Rota containing vaccines in infants, 2011 Source: WHO/UNICEF coverage estimates 2011 revision. July 2012 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 22 August 2012. Not applicable 2012 37 introduced

21. Cholera vaccine 2 WHO pre-qualified oral vaccines: Dukoral and Shanchol –Different formulations, ease of administration, price –safe and immunogenic with a protective two-dose efficacy of 66%–85% in clinical trials WHO OCV Stockpile w/ 2 million doses (Shanchol) planned to be operational by 2013 Other vaccines –mORCVAX®, similar to Shanchol™, is licensed in Vietnam –Peru-15 (USA and China), V. cholerae 638 (Cuba), and VA1.4 (India) are at least several years away from becoming widely available 21

22. Status of other new vaccine development Malaria: RTS,S/AS01 (on hep B backbone) –Phase II trial showed 51% efficacy in 5-17mo in Kenya –Now in Phase III trial with possible policy recommendation by 2015 Dengue: CYD-TDV (Live attenuated tetravalent vaccine) –Phase IIb trial in Thailand: safe, 30.2% efficacy; Phase III now HIV –Over 30 candidates tested since 1987; 2 Phase III, but –“The development of a safe, effective, and affordable HIV vaccine remains a formidable scientific and public health challenge” (WHO) 22

23. 23 Implications

24. Implications for Thai Border and Migrant Populations Need to continue OPV given risks for importations and global goal of polio eradication Priority of measles elimination for Thailand, region, global goals highlight emphasis on control: need to sustain >90% coverage of 2 doses of measles vaccine New vaccines becoming more widely available but costly OCV campaign planned in Mae La Camp (Thai MoPH, USCDC, PU-AMI) 24

25. Thank you 25