Dr Hinda Ahmed

Vaccine Preventable Diseases and Immunization

WHO/EMRO

Regional Measles and Rubella Goals

• Measles elimination from all countries by 2015

– Resolution EM/RC44/R.6 – 1997 (elimination by 2010), revised by

Resolution EM/RC58/R.5 – 2011 (elimination by 2015)

• No regional target for rubella/CRS elimination

– RTAG meeting November 2013: recommended developing

regional rubella/CRS elimination target by 2020

– Elimination target established in 15 countries

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Reported Measles cases and MCV1 coverage in the EMR, 1980- June 2014

Measles cases Measles coverage (WHO-UNICEF estimate)

Source: WHO UNICEF estimates, JRF reported dataCases 2013: country reports to EMRO

Catch up campaigns in all countries Follow up SIAs in several countries

81% reduction in reported measles cases 1998-2014 June with improved

surveillance

MCV1 coverage WHO UNICEF estimates, and number of countries reaching > 90% coverage. 2001 – 2013. (N=22)

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02468

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2001200220032004200520062007200820092010201120122013

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No. countries with ≥90% MCV1 coverage Regional MCV1 WHO-UNICEF MCV1 Est.

Palestine

Bahrain

MCV2 introduction into routine EPI in Countries of the EMR 2013

MCV2 already in EPI schedule (21)

No MCV2 introduction plans currently (1)

AFR countries

SIAs done in 2013 in the EMRCountry Vaccine Target Age

AdminCov

Survey Cov

Independent Review

Other Intervention

Afghanistan M 9 - 59 M 85% Penta, BCG

Lebanon M 9 M - 18 Y 85%

Lebanon M 9 M - 14 Y 90%

Jordan MR 6 M - 19 Y 102% 97% OPV, Vit A

Pakistan/Sindh M120-119 M -9Y

110% 85%

Pakistan/Punjab M 6 M - 9 Y 102% 95% OPV/Vit A

Pakistan/Baluch. M 9 M - 9 Y 106 89%

Morocco MR 9 M - 19 Y 91%

Somalia M 6-59M 85% Penta & ORS

Sudan M 9 - 14 Y 98% 97%

Syria MMR 6 - 10 Y 72%

Syria MMR 12 - 15 Y 92%

Yemen, Sa’da M 6 - 59 M 93% OPV, Vit A

64 Million people reached through SIAS in 2013 thanks to international , local partners and Gov support

Local funding raisedfor measles SIAs, 2013

CountryTotal Budget

(USD)Amount Raised Locally (USD)

% locally raised

Afghanistan 1,381,449 1,381,449 100%

Lebanon NA NA 100%

Jordan 4,285,065 4,285,065 100%

Pakistan 12,877,360 12,428,480 97%

Morocco 8,377,419 8,377,419 100%

Somalia 3,100,000 2,080,000 67%

Sudan 9,666,928 1,101,838 11%

Syria 5,025,000 5,025,000 100%

Yemen 116,279 9,302 8%

EMR 44,829,500 34,688,553 77%

86.7 Million people reached through SIAS in 2013 Thanks to our international , local Partners and Gov support

Resource Gaps 2014-2015

•*All figure are for 2014 except for AFG SIAS 2015•**MRI fund allocated: include amount committed/transferred to WHO & UNICEF•PAK received addition 4 M Locally from JICA•SOM received 701,000$ locally from OCHA for outbreak response & US$ 146,000 is expected

Country

Requirement* (USD) Available/Committed* (USD)

Funding gap*

Total Requirement SIAs, Surv, RI

GAVI Support Local MRI**

Total Committed (GAVI, MRI, Local

AFG 2014 2,029,375 0 0 1,489,375 1,489,375 540,000

AFG 2015 7,023,056 6,123,056 300,000 0 6,423,056 600,000

PAK 2014 65,693,669 34,983,274 25,282,519 2,740,000 63,005,792 0

SOM 2014 2,193,959 0 500,000 1,148,800 1,648,000 545,959

SUD 2014 150,000 0 0 150,000 150,000 0

YEM 2014 22,902,915 17,591,500 4,943,415 368,000 22,902,915 0

Total 99,992,974 58,697,830 31,025,934 5,896,175 95,619,138 1,685,959

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sMonthly distribution of confirmed Measles cases in the EMR 2006-June 2014

South SudanYemenUAETunisiaSyriaSudanSomaliaSaudi ArabiaQatarPalestinePakistanOmanMoroccoLibyaLebanonKuwaitEgyptJordanIraqIranDjiboutiBahrainAfghanistan

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5,988

Security situation and deteriorated performance in some countries

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2006 2007 2008 2009 2010 2011 2012 2013 2014

Iraq Measles outbreak Monthly distribution of confirmed

measles cases in the 2006-June 2014

Measles outbreak age distribution 2013-June 2014

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• The SIAs campaign to be conducted in 2 Phases:• Phase 1 for children 9-59 months once the vaccine arrives

(tentative date November 2014 but according to schedule of vaccine arrival it will not take place before Februay 2015)

• Phase 2 for children 15-19 yrs• The intention is to use MR vaccine if available for Phase

one need 5 million doses and another 5 for Phase 2 but UNICEF is already started the procurement for measles vaccine since MR is not available.

• Some of the funds are secured but not all. WHO will be requested to cover training and meetings, supervisors etc. around USD 6.2 M

Outbreak response and to move Measles elimination

Palestine

Bahrain

Rubella vaccine planned 2015-2016 (3 countries)

Rubella vaccine use in countries of the EMR, 2014

15

Rubella vaccine planned 2014 (Yemen)

Rubella vaccine in RI (16 country)

• A total of 4 countries are expected to introduce RCV by end 2018.

Rubella vaccine introduction not decided (Somalia and Pakistan)

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Monthly distribution of confirmed Rubella cases in the EMR 2006-June 2014

South Sudan

Yemen

UAE

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Saudi Arabia

Qatar

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Pakistan

Oman

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Libya

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Kuwait

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Jordan

Iraq

Iran

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Yemen Rubella outbreak Monthly distribution Rubella cases in Yemen 2006 - June 2014

Yemen Rubella Age distribution, 2013 & 2014

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Yemen Rubella confirmed cases by age Year 2013

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Yemen Rubella confirmed cases by age Year June 2014

MR SIAS

• MR routine introduction 6 Nov 2014

• GAVI application approved MR SIAs and will be conducted 19 Oct

• Target age group 9M to 14 Yrs

• Establishment of CRS surveillance

Yemen Rubella Plan 2014

2014-2016 Rubella introduction plans16/22 countries have introduced rubella vaccine in RI

• Yemen: – Routine introduction; July

2014– MR SIAs: September 2014

• Djibouti: – will apply in connection to

next follow up SIAs (2016?)

• Afghanistan: – UNICEF committed to support

routine introduction – low routine coverage? SIAs

quality and delays?

• Pakistan: – no discussion

• Sudan: – Discussion with UNICEF for

routine introduction is ongoing

– NITAG decision is pending– CRS establishment:

ongoing– Probable application with

next FU SIAs (2016?)

• Somalia: – Low routine coverage – RTAG recommended

holding on advocating for rubella vaccine introduction due to low

2014-2015 GAVI application and introduction plans for M, MR

CountryVaccine(MSD, MR, M)

Year of Intro (or MR SIA)

MCV1coverage (2013)

Year of planned GAVIapplication

Total Budget (GAVIapproved)

Pakistan M SIAs Roll-out startedMay 2014

61 Approved $ 65,593,669 (34,983,274)

Yemen MR routine

6 Nov 2014

78 Approved $ 965,581($ 767,500)

Yemen MR SIAs 19 Oct 2014

78 Approved $ 21,569,334($ 17,591,500)

Afghanistan M SIAs May-June 2015

82 Approved $ 6,723,056($ 6,123,056)

Challenges and constraints to achieving the target

• Security situation: rapidly deteriorating in the EMR

– Sustainability of achieved MCV coverage: decreased routine coverage: Syria, Yemen

– Delayed implementation of planned activities– Spread of outbreaks to previously free countries

• Higher priorities/Emerging priorities, low visibility of measles target

– Polio endemic countries

– Polio outbreak in Syria

• Pockets of susceptible populations/groups

– Hard to reach populations in low income countries

– Expatriate population in GCC States

• Vaccine availability

- MMR shortage for Egypt, Syria and Iraq

• Funding: Follow-up SIAs, Measles surveillance

Planned activities 2014-2015• Implementation of Measles/MR SIAs

– Afghanistan: Mop up SIAs in 2014 and FU SIAs in 2015

– Pakistan: roll-out SIAs

– Somalia: CHDs specially in the newly reachable areas

– Yemen: RI of MR and MR SIAs, 2014

– Morocco: Phase 2 of MR SIAs

– Syria and Iraq: SIAs

• Strengthening routine immunization and data quality

– RED in low coverage districts in Pakistan, AFG, Iraq

– Using PEI assets to strengthen RI: Pakistan, AFG and Somalia

– Vaccination weeks

• Reviews and assessments & Strengthen Cases base surveillance

– Review of the situation and preparation for verification of elimination: Bahrain, Palestine, Oman, Iran and Tunisia

– Sustain the strength and capacity of M&R Lab Net

• Measles risk assessment and Establishing CRS surveillance

– Sudan and Yemen

• Meetings

– Regional Technical Advisory Group (RTAG) and Regional Measles Verification Commission (RMVC), Meeting November 2014

– Inter-country meeting on Measles and Rubella control/elimination Nov 2014

Anne Ray Charitable Trust