Increasing Access to Immunization Services in AFRO, an Overview

57 Pages·2011·0.91 MB·English

Final Report

nd
2 African Regional Conference on
Immunization (ARCI)

Ouagadougou, Burkina Faso

06 - 08 December 2010
Contents
Page

Abbreviations……………………………………………………………………………... 3

Executive Summary of Conference Outcomes…………………………………………..5

Summary of outcomes……………..……………………………………………………...5

Polio Eradication……………………………………………………………………. 5

Reaching Un/Under-Immunized Children in the African Region………………… 6

Accelerated Disease Control Initiatives in the African Region……………………... 7

Session 1: Opening Ceremony…........................................................................................ 9

Session 2: Polio Eradication……………………………………………………………… 11
Parallel session: Interrupting endemic & re-established transmission…………. 14
Parallel session: Preventing new international spread & outbreaks……………. 16

Session 3: Reducing number of un /under-immunized children ……………………… 20
Parallel session: Routine immunization………………………………………… 26
Parallel session: New vaccines…………………………………………………. 30
Parallel session: Immunization Financing……………………………………… 35

Session 4: Accelerated Disease Control Initiative in the African Region……………... 38

Session 5: Closing Ceremony…………………………………………………………….. 45

Annexes

1. List of Participants ……………………………………………………………………… 47

2
Abbreviations

ACPE Advisory Committee on Poliomyelitis Eradication

AFP Acute Flaccid Paralysis

ARCC African Regional Certification Commission

ARCI Annual Regional Conference on Immunization

BMGF Bill and Melinda Gates Foundation

bOPV bivalent Oral Polio Vaccine

CDC Centers for Disease Control and Prevention

cVDP circulating Vaccine-Derived Poliovirus

DoV Decade of Vaccines

EPI Expanded Programme on Immunization

EU European Union

FRR Financial Resource Requirements

GAP.III Third edition of the Global Action Plan to minimize post
eradication poliovirus facility-associated risk

GIVS Global Immunization Vision and Strategy

GPEI Global Polio Eradication Initiative

GPLN Global Polio Laboratory Network

GPMT Global Polio Management Team

ICC Interagency Coordinating Committee

IPD Immunization Plus Day

IST Intercountry Support Team

iVDPV Immunodeficiency-Associated Vaccine-Derived Poliovirus

JSI John Snow Incorporated

LGA Local Government Area
3
LQAS Lot Quality Assurance Sampling

MDGs Millennium Development Goals

mOPV Monovalent Oral Polio Vaccine

NGO Non Governmental Organization

NID National Immunization Day

OPV Oral Polio Vaccine

PCV Pneumococcal Conjugate Vaccine

RED Reaching Every District

SAGE Strategic Advisory Group of Experts on Immunization

SIA Supplementary Immunization Activity

SIAD Short Interval Additional Dose

SNID Sub-National Immunization Day

TAG Technical Advisory Group

tOPV trivalent Oral Polio Vaccine

UNICEF United Nations International Children Emergency Fund

VAPP Vaccine-Associated Paralytic Polio

VDPV Vaccine -Derived Poliovirus

VPD Vaccine-Preventable Disease

WHA World Health Assembly

WHO World Health Organization

WPV Wild Poliovirus

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Executive Summary of Conference Outcomes

The second African Regional Conference on Immunisation was convened in Ouagadougou,
Burkina Faso from 6 to 8 December 2010. The conference was officially opened by the Prime
Minister His Excellency Mr. Tertius Zongo, in the presence of the chairman of the 60th Session
of the Regional Committee the Honourable Minister of Health from Equatorial Guinea, the
Minister of Health for Burkina Faso, WHO Director General, the President of the Global Health
Program of the Bill and Melinda Gates Foundation, WHO Regional Director for Africa, the
Acting CEO of GAVI, Parliamentarians from DR Congo and Cameroun, Traditional Leaders
from Nigeria, National EPI programme managers, UN agencies, immunization partners, donors,
and TFI members.

Three core themes on immunization in Africa were thoroughly reviewed and discussed and the
main outcomes are highlighted below:

(1) Polio Eradication:

The conference commended Nigeria for the significant progress made in reducing wild
poliovirus (WPV) cases. The meeting also recognised the efforts made by Chad and the
importation countries in West Africa in limiting the circulation of WPV.

Concerns were however raised with continued circulation of WPV in DR Congo and Angola, the
outbreak in Congo Brazzaville affecting mostly adults and the poor surveillance in
Kenya/Uganda border and East DR Congo evidenced by missed circulation of WPV (orphan
viruses).

The conference proposed the following actions:

1. The conference commended the coordination efforts in West Africa by WHO, UNICEF and
countries and requested that this model be adopted in all countries and sub regions
experiencing polio outbreaks.

2. The conference recognized the institutionalization of Independent Monitoring (IM) in Polio
SIA and the use of the generated data in tracking progress towards achieving the global polio
eradication milestones. The conference called upon WHO and partners to support countries
fully implement corrective measures whenever shortcomings in SIA quality are identified
through IM.

3. Recognizing the high level advocacy that lead to the development of the 6-months Polio
Emergency Plan currently being implemented, the conference called upon Angola to review
and intensify implementation in 2011

4. The conference noted with concern the intense transmission of WPV in DR Congo and
urged the country to urgently develop and implement an Emergency Plan to address chronic
SIA gaps and sub-national surveillance weaknesses. Additionally, WHO should provide
technical assistance to improve the performance of the National Polio Laboratory in DR
Congo

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5. Nigeria and Chad should develop and implement aggressive mop ups strategies to reach high
risk areas, migrant and mobile populations in order to interrupt transmission in line with the
set milestones.

6. Countries with the support from partners should develop a comprehensive package that
includes social economic and communication factors to address surveillance, SIA gaps and
create demand for better delivery of immunization services. Communications indicators
should be included in this package.

7. The risk assessment model presented to the conference offered an opportunity for the region
to predict polio outbreaks. However, changes in the intensity of polio transmission and data
quality seem to affect the accuracy of predictability of the model. Efforts should be made to
revise the model and address its limitations. There is also need to initiate consultations
before its use.
.

8. WHO and partners should promote social, operational and applied research in order to reach
the unreached populations and also to address population immunity gaps including adults
and migrant / mobile populations

9. WHO and UNICEF should ensure:
a) Adequate supply of appropriate types of OPV for use in polio outbreak response in the
region.
b) Continued and enhanced support for pre-qualification and licensure of additional
products to increase vaccine security in the market and at the country-level

(2) Reaching Un/Under- Immunized Children in the African Region- Progress, Challenges
and Opportunities

The Conference noted with satisfaction the progress that had been made in reducing the number
of un/under immunized children in the African Region. New innovations had been implemented
in some countries such as Ethiopia resulting in significant reduction in the number of
unimmunised children in 2010.

However, the conference expressed concern on the declining or stagnating performance of
routine immunization in a number of countries. In addition, inadequate financing of
immunization services in general and routine immunization in particular pose a threat to the
maintenance or sustenance of coverage and the introduction of new vaccines. Discrepancies
between WHO/UNICEF immunisation coverage estimates and those reported annually by
countries were also highlighted.

The conference welcomed efforts by countries and immunisation partners in supporting the
introduction of new vaccines such as Pneumococcal and Rotavirus vaccines in the region.
However there is urgent need to accelerate introduction so that progress towards MDG 4
attainment in the African region could be achieved.

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The conference proposed the following actions

10. Countries with support from partners should implement all components of RED and other
innovative strategies to reduce the number of unimmunized children, especially in the top
ten countries with large number of un/under immunized children.

11. Countries should continue working to improve data quality and utilize fora such as EPI
managers and regional consultations meetings to identify and address the challenges.

12. The conference welcomed the “Decade of Vaccines” (DoV) and proposed active
consultation with the Regional Office and countries in the development and formulations of
the delivery component of DoV.

13. Countries with the support of WHO and partners should adopt a holistic approach to
synergize immunization with the control of pneumonia and diarrhea within the primary
health care context as elaborated in the Alma Ata and Ouagadougou Declarations to
accelerate attainment of MDG 4.

14. WHO and partners should support countries to strengthen surveillance capacity for new
vaccines for advocacy and support decision making on new vaccines introduction

15. WHO and Partners should support countries to develop local mechanisms to increase
funding for immunization services and maintaining immunization as a public health priority.

16. To strengthen logistic and delivery of vaccines, the conference proposed that WHO and
partners should consider introducing for discussion a document on the creation of
Logisticians for Health during the Regional Committee of Health Ministers

(3) Accelerated Disease Control Initiatives in African Region

The conference was informed that improvement in the routine measles immunisation coverage
was slow, and that only 14 countries in the African Region had maintained at least 80% measles
coverage over the past 3 years. In addition, scheduled follow up SIAs could not be implemented
on time in some countries due to the failure to mobilise adequate resources from governments
and partners.

The gaps in routine immunisation coverage and SIAs quality have contributed to the significant
increase in the number of measles outbreaks. These outbreaks, due to low population immunity,
undermine the progress made and endanger the prospects of meeting the measles pre-elimination
targets for 2012.

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On Maternal and Neonatal Tetanus elimination (MNTE), the conference was informed that a
good number of planned SIA activities by countries were not implemented which is affecting the
progress towards MNTe.

The conference was also informed that the Meningitis Vaccine Project (MVP) between WHO
and PATH has resulted in the development of Meningitis A Conjugate Vaccine (MCV) that was
pre-qualified in June 2010 and initially rolled out in 3 countries (Burkina Faso, Mali and Niger)
but will eventually reach 14 targeted countries.

The conference suggested the following actions:

17. In view of resurgence of measles outbreaks in the region, the African Regional Measles
TAG should assess the progress towards meeting measles pre-elimination targets and
provide guidance to countries

18. The conference noted the efforts by some countries to mobilize resources from within and
encouraged all countries to continue mobilizing local resources for measles SIAs

19. In order to support Maternal and Neonatal Tetanus Elimination goals, the conference called
upon countries and partner to implement the planned activities to achieve elimination

20. The conference appreciated the recent launch of the Meningitis A Conjugate vaccine in
Burkina Faso and calls upon WHO, partners and targeted countries in the meningitis belt to
ensure accelerated introduction.

21. The strategy for the control of Viral Hepatitis B in the African region was discussed and the
conference requested that this document be disseminated to countries

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Session 1: Opening Ceremony

The Second Annual African Regional Conference on Immunization held in Ouagadougou,
Burkina Faso, was officially opened by the Honourable Prime Minister of Burkina Faso, His
Excellency Mr. Tertius Zongo. The Conference brought together about 200 participants
including the Minister of Health of Burkina Faso, the Minister of Health of Equatorial Guinea
who is also Chairman of the WHO Regional Committee, the WHO Director-General, the WHO
Regional Director, the President of the Global Health Programme of the Bill and Melinda Gates
Foundation and the interim Chief Executive of GAVI. Other participants included
parliamentarians from Cameroon and DRC, traditional leaders from Nigeria, National
Programme Managers of the Expanded Programme on Immunization, agencies of the United
Nations system, partners and the Task Force on Immunization (TFI) which is a regional technical

advisory body on immunization set up by the WHO Regional Director in 1989 and experts.
The Conference opened with a call for intensification of priority interventions and investments to
speed up progress towards achieving the Millennium Development Goals related to maternal and
child health. Countries, with the support of WHO and partners, should strive to meet this
challenge in order to avoid needless deaths from vaccine preventable diseases (VPDs) such as
measles, polio and meningitis, to mention only a few. The Conference made this call through the
theme “Reaching Every Child with Immunization”.
The five major addresses delivered at the opening ceremony included that of the Prime Minister
of Burkina Faso, the WHO Director-General, the WHO Regional Director for Africa, partners
and the Chairman of the Conference. The speakers unanimously commended the progress in the
control of vaccine-preventable diseases and urged countries to redouble their efforts.
In his address, the Prime Minister of Burkina Faso, H.E. Mr Tertius Zongo, expressed optimism
about the capacity of African countries to conquer these diseases. He recounted the milestones
achieved over the years especially the victory over smallpox, the successful implementation of
the Expanded Programme on Immunization and the development of new vaccines. Mr Zongo
further invited countries to work out better vaccine procurement procedures, promote vaccine
management and give special attention to the side effects of vaccines.
For his part, the Chairman of the Conference, Dr Sodiomon Sirima, emphasized the duties and
obligations of each and everyone. “We should make all children benefit from the existing
preventive facilities”, he said. He warmly congratulated his predecessor, Prof. Peter Ndumbe, on
the progress made under his Chairmanship.
Addressing the gathering, the WHO Regional Director, Dr Luis Gomes Sambo, hailed the launch
of MenAfriVac, the new vaccine against meningococcal meningitis A and underscored the
personal commitment of the President of Burkina Faso, H.E. Mr. Blaise Compaore, as sponsor of
the initiative to eliminate meningitis epidemics in Africa.
He called on countries and partners to make concerted efforts to mobilize additional financial
resources in order to guarantee access to this vaccine to rid Africa of the terrible suffering of the
past.
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Dr Sambo informed participants of the progress made in routine immunization with a 79% DPT3
immunization coverage and a spectacular reduction of about 97% of poliomyelitis cases in
Nigeria.
“The challenge Nigeria now faces is to maintain this achievement” said the WHO Director-
General, Dr Margaret Chan who proudly outlined the health benefits of immunization as the best
life-saving weapon available. Three-to-five million lives are saved each year through
immunization, she added.
The Director-General paid tribute to Africa for the Conference theme which, in her opinion,
reflects Africa’s vision and commitment in regard to health.
Other partners especially GAVI and the Bill and Melinda Gates Foundation added their voices to
those of the other speakers in commending the partnership without which no achievement was
possible. Bill and Melinda Gates Foundation pledged US$ 10 million for the Decade.
GAVI was represented at the Conference by its current acting Chief Executive Officer, Ms Helen
Evans, and Bill and Melinda Gates Foundation by Dr Tachi Yamada, President of the Global
Health Programme.
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