Post00328 GAVI UPDATE 2 March 2001 CONTENTS 1.UPDATE ON COUNTRY-LEVEL GAVI & GFCV RELATED ACTIVITIES From: [[email protected]][email protected][/email] To: Technet Moderator Subject: GAVI Information Update Date: Fri, 23 Feb 2001 15:37:01 +0100 Please find herewith the latest information update on country and regional level GAVI and GFCV-related activities. Please send any information you would like included in this update directly to me. Gill Mayers Technical Officer HTP/V&B/EPI [email protected] Tel: 00.41.22.791.4674 Fax: 00.41.22.791.4193 ___________________________________________________________________________ UPDATE ON COUNTRY-LEVEL GAVI & GFCV RELATED ACTIVITIES As at 23/02/01 Update since last issue highlighted in yellow with date of update GENERAL NOTE ON THE GFCV APPLICATION PROCESS * The country activities listed below are those which have been initiated by various Partners of the Alliance. * The application process is an ongoing one throughout the year with the following timing: * 2001: 15 January, 3rd round; 1 May, 4th round; 1 October, 5th round. * Applications received by the 15 January deadline were reviewed during the second week of February. GAVI BOARD 22/01 from GAVI Secretariat: Welcomes the following four new members who have been selected in consultation with the respective constituencies to fill currently unoccupied seats. Their terms of office will be January 2001 to January 2003: * Developing country industry seat: Centro de Ingenieria Genetica y Biotecnologia (CIGB), Cuba. Represented by Director-General Luis Saturnino Herrera Martinez * One of the two developing country government seats: Mali. Represented by Minister of Health Fatoumata Nafo-Traore * One of the three OECD country government seats: Norway. Represented by State Secretary Sigrun Mogedal * Technical health institute seat: U.S. Centers for Disease Control (CDC). Represented by David Fleming, Deputy Director for Science and Public Health REVIEW PROCESS: 23/02 from WHO/HQ: * For the third round, new applications were received from 13 countries and three countries resubmitted applications that had previously received Conditional Approvals. Six countries are applying for immunization services support, four for new vaccine introduction and six for support from both the immunization services and new vaccines sub-accounts. * The results of the third review will be communicated to the countries in mid-March, after the GAVI Board decision on March 7. * At present, the final results of the Independent Review Committee's deliberations on rounds 1 and 2 show that 30 applications from 21 countries for assistance from the GFCV have received final approval: 5 countries will receive assistance under the immunization services strengthening sub- account; 7 countries under the new vaccines sub-account; and 9 countries under both sub-accounts. * The GAVI Secretariat, in consultation with WHO and UNICEF, organised a Country Consultation Meeting in Geneva on 13 February for discussions between the ICC Chairs and WHO and UNICEF Country Representatives from the seven countries now approved for assistance in the 2nd tranche. COUNTRY COORDINATION: 23/02 from the Task Force on Country Coordination: The meeting of the Core Group of the Task Force was held in Geneva from 1-2 February. The priority activities for the 2001 workplan in the areas of technical assistance, capacity building and monitoring and evaluation were agreed upon. The workplan will be completed by end of February. The principle that Regional Working Groups should be increasingly strengthened to assist countries was acknowledged. As Regional Working Groups become more operational, all will be invited to participate in Core activities. An inter Task Force group including members from the Finance and Advocacy Task Forces was formed to draft a strategy for capacity building. As part of Capacity Building, the concept of providing long-term Immunization Advisors to countries where requested or needed was strongly supported by all partners. Recommendations on how to improve the process of the Immunization Data Quality Audit (IDQA) were drafted to be presented to the Global Working Group. An update from last two core group conference calls follows: 23/01 Conference Call - Action Points: * Dates for the Core Group Meetings have been established, and the full meeting of the Task Force is scheduled for 3-4 October 2001 with the Core Group meeting on the 2nd. * The questionnaire for the GAVI Rapid Assessment of Implementation Impact is currently being finalized and a list of countries and teams for interviews will soon be identified. * The appropriate role and responsibilities of the Regional Working Groups should be better defined at the 1-2 February Core Group Meeting. * The initiative for ICC facilitators will be further discussed and expanded upon at the Core Group Meeting, and Tanzania has been identified as a possible country of placement. 09/01 Conference Call - Action Points: * Funding for Ghana Experience of Injection Safety to be identified and planning activities to start ASAP * Capacity Building Strategy to be developed by 1-2 March therefore to be outlined at 1-2 February meeting. Current summary of capacity building issues to be revised. FINANCING 23/02 from Julie Milstien, WHO/HQ: The Core Group and the various sub- groups of the Financing Task Force met in Washington on 30 January. * The vaccine forecasting sub-group ratified the forecasting model used and expressed a desire for extending it to demand and capacity data for all vaccines and for all sources. * The procurement sub-group received a briefing on the procurement process for the GFCV and determined the need for an independent review of lessons learned, especially on the issue of creating demand for Uniject and Hib. * The procurement sub-group determined the need for a study of the divergence in products between industrialized and developing country markets which WHO is to lead. NEW AND UNDERUTILIZED VACCINES 23/02 from Jay Wenger, WHO/HQ: A training session on Hib disease, vaccine, and use of the new rapid Hib burden assessment tool was held in Harare, Zimbabwe, from 15-16 February. The meeting, organized by WHO/AFRO, had about 30 participants, primarily WHO/EPI Country staff from Eastern and Southern Block countries. The facilitators were from WHO and CDC. Highlights included: data on Hib burden in Africa; vaccine effectiveness information; and a half day field exercise in two local hospitals as part of the Hib burden rapid assessment exercise. The meeting was very well received by participants, and most countries have plans to either perform the rapid assessment in their countries or to proceed with available data to prioritize the use of Hib vaccine in their national immunization programmess. A similar meeting - general Hib disease and vaccine information, and training on rapid assessment - is scheduled for Western Block countries in March in Mali. A meeting/laboratory training session to initiate routine bacterial meningitis surveillance in 22 GFCV-eligible African countries is planned for June 2001. This will include an overview of Hib disease, surveillance techniques, and laboratory training on bacterial meningitis pathogens (Hib, meningococcus and pneumococcus). YELLOW FEVER 23/02 from Alya Dabbagh, WHO/HQ: Because of recent yellow fever outbreaks and global shortage of yellow fever (YF) vaccine, the creation of an ICG- like mechanism for Yellow Fever vaccine distribution and support was discussed during the meeting of the ICG-executive sub-group. The meeting concluded the following: * A two million dose stock pile for YF outbreak response was agreed upon as a starting point. UNICEF expects to have this amount by end of June 2001. * The current ICG Executive Sub-group members agreed to provide a rapid assessment of requests for yellow fever vaccine from the UNICEF stockpile * UNICEF will only release vaccine from the emergency stockpile following consultation with the ICG sub-group and will not release vaccine from the current tender until the stockpile has reached 2 million . Once the stockpile reaches two million doses, UNICEF can release vaccines for routine immunization with priority given to countries which have already incorporated YF into their routine program. * WHO/CSR will be responsible for carrying out the consultation and communicating the decision to UNICEF. The decision of release of stock pile will be based on the presence of evidence of an outbreak as confirmed by lab; vaccination plan; and evidence of a coordinating body for an out break response. A meeting was held on 9 February between WHO, UNICEF and Aventis Pasteur to discuss supply and demand of YF vaccine. Aventis need to plan production levels at least three years ahead, this being the lead time necessary for such a significant increase in their production capacity to occur. Demand forecasts were made by WHO and UNICEF and a global demand of 50 million doses per year (for routine, catch up campaigns and outbreaks) was agreed upon as a goal for 2003. STRENTHENING IMMUNIZATION SERVICES 24/11 from Tom O'Connel, WHO/HQ: The project's Advisory Panel meets Feb 22 to review materials developed, and discuss the action plan for the next 3-6 months. A first draft of the manager's resource manual will be ready for review at that time. A set of training materials to accompany the manual is also being developed, which will focus strongly on participatory case studies. Learners will work on actual priority problems from their district/region, and develop plans of action to be implemented upon the course's end. National managers will follow up the progress on these plans, using key indicators (i.e. coverage, drop-out rates, etc). Field testing of both components tentatively planned for early April. IMMUNIZATION SERVICES COMMON ASSESSMENT TOOL Available on: http://www.who.int/vaccines-diseases/service/immsystemassess. COUNTRY-SPECIFIC INFORMATION AFGHANISTAN 24/11 from Ezzedine Mohsni, WHO/EMRO: A consultant has been requested for three weeks in February 2001 to assist with conducting an EPI review, completing a Multi-Year Plan, and assisting with preparation of the GFCV application for immunization services support. ALBANIA 23/02 from Denis Maire, WHO/EURO: MoH has requested support to finalize their documentation for the GFCV application. Denis Maire and Dr. Popova will visit from 11-18 March to provide this assistance. 8/12: Application for New Vaccines received Conditional Approval. ARMENIA 23/02: Application for New Vaccines resubmitted in third round. 8/12: Application for Immunization Services Approved. Application for HepB received Conditional Approval and application for Hib is to be re-submitted. AZERBAIJAN 23/02: Applications for Immunization Services and New Vaccines approved. 8/12: Applications for Immunization Services and New Vaccines received Approval with Clarifications. BANGLADESH 24/11 from Abdulaziz Adish, WHO/SEARO: Remaining items to be completed for GFCV application: TORs for the ICC need to be finalized and approved; application form needs to be completed, and supporting documentation need to be gathered. Application expected April 2001. BENIN 23/02: Applications for Immunization Services and New Vaccines submitted in third round. BHUTAN 23/02: Application for support for New Vaccines approved. 8/12: Application for support for New Vaccines received Approval with Clarifications. BOSNIA & HERZEGOVINA 23/02 from Denis Maire, WHO/EURO: A joint WHO/UNICEF mission took place in February to assist the MoHs of the Federation of BiH and Republika Sprska in drafting a common EPI 5 year plan and to work with the ICC on the GAVI proposal. Although the ICC is not yet officially created, meetings take place between the two EPI Managers, WHO and UNICEF. The World Bank has just joined, and a representative from USAID is expected shortly. Despite the fact that BiH is presently structured in two entities, each with its own MoH, BiH will be able to submit a common application to the fund by 15 April. BURKINA FASO 23/02: Application for Immunization Services submitted in third round. 8/12: Application for Immunization Services received Conditional Approval in second round. Not currently eligible for support for New Vaccines. BURUNDI 22/01 from Rudi Eggers, WHO/AFRO: ICC is currently not functioning, no EPI review has been conducted recently and there is no current multi-year plan. Possible application in October 2001. CAMBODIA 22/08: Application for support for New Vaccines approved. CAMEROON 23/2: Applications for Immunization Services and New Vaccines submitted in third round. CENTRAL AFRICAN REPUBLIC 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. CHAD 23/02: Application for Immunization Services resubmitted in third round. CHINA 23/02 from Jay Wenger, WHO/HQ: Following a request from the MoH, a visit of GAVI Partners took place from 11-13 December 2000: * Extensive discussions were held with the MoH and immunization programme personnel, as well as key partners, including WHO and UNICEF. Main topics discussed were the status of the immunization programme in the Western provinces, potential mechanisms of assistance for improving hepatitis B vaccine coverage, and studies of Hib and pneumococcal disease burden. * A proposal to the GFCV will be submitted and may include assistance under the immunization services sub-account, increasing hepatitis B immunization and an evaluation of pneumonia burden. * A GAVI ICC subgroup will further develop the above plans. CÔ”E D'IVOIRE 8/12: Application for New Vaccines approved. 27/10: Application for support for Immunization Services approved. However, given the political situation, disbursement of funds has been delayed. CUBA 8/12: Application for support for New Vaccines not accepted as this would replace current support. Not eligible for support for Immunization Services. DJIBOUTI 23/02 from Anne Golaz, CDC: Anne Golaz, CDC, visited from 10-23 January 2001 to follow up on the previous EPI review, assist in revising and updating the Multi-Year Plan, and assist with preparation of the GFCV application for immunization services support. At present, the EPI Programme does not fulfil the conditions required by the GFCV for an application to be accepted. However, the MoH will be working hard in the short-term to make the EPI Programme operational by hiring all the needed staff and moving their offices and cold chain to a new facility. Regular ICC meetings also need to be instituted. DPR KOREA 24/11 from Abdulaziz Adish, WHO/SEARO: Not ready to apply in January, especially for introduction of new vaccines window. TORs for the ICC need to be reworked; Multi-Year Plan of action needs to be elaborated and application needs to be prepared with outside assistance. If these steps are taken, possible application for support for immunization services in January 2001. To introduce new vaccines, DTP3 coverage has to rise above 50%, and a hepatitis B disease burden study (or review of existing studies) is needed, together with a hepatitis B introduction plan. ERITREA 23/02 from WHO/HQ: In response to a request from the MoH, Hussain Yusuf (CDC) and Thompson Kinge (WHO/AFRO) undertook a consultancy from 27 January through 10 February to assist the country with formulating its Hepatitis B introduction plan, with the following recommendations: * Countrywide introduction of HepB vaccine beginning 1 January 2002 while there are no new initiatives planned for that time, and polio NIDs will have been completed in Nov/Dec 2001. A six-month preparatory phase is foreseen. * Birth-dose will not be incorporated at present, its inclusion will be re- evaluated in the future. * Hopefully the combined DPT/hepB vaccine in 10 dose vials will be made available, but if not, monovalent hepB vaccine in 10 dose vials will be used. * Deliver all vaccines according to safe injection practices * Train health care workers and sensitize policy makers and the community * Reduce vaccine wastage by promoting the open vial policy and other measures * Target HepB3 coverage by 12 months of age -- 80% in 2003, 90% in 2006 * Ultimate Goal - reduce disease burden 24/11 from WHO/HQ: A joint WHO/HQ and WHO/AFRO took place 18 November-2 December to conduct an EPI Review. Eritrea have also requested assistance with rewriting their Multi-Year Plan incorporating the review recommendations, completing their GFCV application, and developing their Hepatitis B vaccine introduction plan. ETHIOPIA 24/11 from Beth Mathews, WHO/HQ: Ethiopia received a grant from USAID to support strengthening of routine immunization. Specific objectives of the project are: improve knowledge and skills of health workers and cold chain technicians; support immunization contact of the best standard; and, support accurate and timely EPI data for programme monitoring at all levels. Ten of the poorest performing zones have been selected for implementation of this project. It is hoped that if good results are demonstrated, additional zones can be included in future funding. Grace Kagondu, WHO/AFRO and Beth Mathews, WHO/HQ visited from 25 September to 3 October to review routine immunization services. They met with representatives from the WHO/EPI team, UNICEF, USAID and MoH Zonal Health Team in one of the zones chosen for USAID project intervention. They reviewed progress to date, held discussions with the team and made recommendations for strengthening programme implementation, and carried out advocacy for increased funding to support implementation of vitamin A supplementation with routine immunization. GAMBIA 8/12: Application for New Vaccines to be re-submitted. Not currently eligible for support for Immunization Services. GEORGIA 23/02: Applications for Immunization Services and New Vaccines submitted in third round. 27/10 from Denis Maire, WHO/EURO: A mission to assist in the development of the five year plan and the preparation of the GFCV application took place from 1-12 October. However, due to unforeseen circumstances, the application was not finalized and a further one week mission should be undertaken to follow up and review the HepB introduction plan. Georgia introduced HepB this year, phasing it in in the major urban centres. Georgia is expected to apply in April for assistance with strengthening immunization services, and in 2002 for further assistance with hepatitis B vaccine. GHANA 22/01 from Sarah England, WHO/HQ: Will visit 18-25 February for workplanning with WHO/AFRO (Modibo Dicko) and follow up to October mission re USAID grant for routine immunization. Will also lay groundwork for financing case study on immunization finance (focus on impact of SWAP) if agreed with WHO/AFRO. 24/11 from Sarah England, WHO/HQ: A joint visit between WHO/AFRO (Modibo Dicko) and WHO/HQ (Sarah England) took place from 23-28 October to assist in the preparation of a Memorandum of Understanding among ICC members for the implementation of a USAID grant for routine immunization through a consensus-building process among key stakeholders, and to review the implementation of the grant to date and its impacts. A field trip was also undertaken to Kpando (Volta Region) to see boats purchased with USAID funds being used to reach previously unreached populations on the islands and peninsulas of Volta Lake during NIDs, and communities not previously served with any form of health service prior to NIDs. Discussions were held on optimum use of the boats, and sustainable outreach services (SOS) was suggested as a possibility. The final MoU, which extends beyond the USAID grant to propose issue for further discussion by the ICC, will be presented to the ICC for endorsement at its next meeting. 27/10: Both applications for support for New Vaccines and Immunization Services approved. GUINEA 23/02: Application not submitted. 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. GUINEA-BISSAU 23/02: Application not submitted. 30/06: Application postponed to 15 October deadline. GUYANA 27/10: Application for support for New Vaccines approved. HAITI 23/02: Application for Immunization Services Approved. 8/12: Application for New Vaccines to be re-submitted. HONDURAS 8/12: Not eligible for assistance for Immunization Services. INDIA 22/01 from Abdulaziz Adish, WHO/SEARO: India will not apply for assistance from the strengthening immunization services window. It will, however, apply for assistance with the introduction of Hepatitis B vaccine in April 2001. In the meantime, two local consultants will work on the EPI Review and the Multi-Year Plan of Action. 8/12 from Madhu Krishna, CVP: GoI will apply to the GFCV for assistance with a phased introduction of HepB vaccine for infants, the first phase of which will be implemented in areas with high routine coverage. In the absence of sufficient stocks of combination vaccine, monovalent hepatitis B vaccine will be used according to WHO recommended schedule. In the first phase, hepatitis B vaccine will be introduced in slums in 12 metropolitan cities and 20 rural districts. Total number of infants expected to be covered is + 1.5 million. Such a phased introduction will allow the GoI to evaluate the impact of this introduction. Time frame for the first phase is two years, after which the GoI plans to include hepatitis B vaccine in the NIP in its Xth 5-Year Plan. INDONESIA 23/02 from John Lloyd, PATH/CVP: A two-week national-level assessment of immunization services is being proposed for April/May to enable Indonesia to apply to the GFCV for the reimbursement of locally purchased, locally manufactured hepatitis B or DTP-HepB combination vaccine. A subsequent provincial-level assessment may well take place later in the year. A special submission date in June for Indonesia has been requested from the GAVI Secretariat. 24/11 from Abdulaziz Adish, WHO/SEARO: It has been decided that Indonesia be eligible for funding for Immunization Strengthening in four provinces with less than 80% DTP3 coverage and for support to Biopharma's vaccine production capacity. Existing specialized reviews will be used to develop an EPI review at national and regional levels, and the existing comprehensive health PoA will be used as a background document to develop a Multi-Year Plan of Action at national levels. An application for support to improve the production capacity of Biopharma was submitted in October 2000. KENYA 27/10: Both applications for support for New Vaccines and Immunization approved. KYRGYZSTAN 27/10: Application for support for New Vaccines approved. LAO PDR 27/10: Application for support for New Vaccines approved. LESOTHO 8/12: Applications for New Vaccines and Immunization Services to be re- submitted. LIBERIA 23/02: Application for Immunization Services Approved. 8/12: Not currently eligible for New Vaccines. MADAGASCAR 27/10: Both applications for support for New Vaccines and Immunization Services approved. MALAWI 27/10: Application for support for New Vaccines approved. MALI 27/10: Application for New Vaccines received Approval with Clarifications. Application for support for Immunization Services approved. MOLDOVA 22/01 from Denis Maire, WHO/EURO: Expected to apply in April 2001. MOZAMBIQUE 27/10: Both applications for support for New Vaccines and Immunization Services approved. MYANMAR 8/12 from Beverley Biggs, MAVI/CVP: Two consultants (Alan Bass & Grace Chee) will be assisting with the immunization assessment in the first half of 2001. An additional consultant is also needed to help prepare the HepB vaccine introduction plan. NEPAL 23/02: Application for New Vaccines Submitted in round three. 24/11 from Abdulaziz Adish, WHO/SEARO: 1) Visited from 18-29 September to: consult with HMG Nepal on GAVI and provide technical assistance on GFCV applications; follow up on the recommendations of the "advance team" mission 14 August-8 September; consult with WHO/Nepal on non-polio EPI activities. In addition, meetings were also held with the Director of Child Health, UNICEF Programme Officer, and other WHO, UNICEF and USAID personnel. Recommendations include: * Alasdair Wylie to be invited back to assist with EPI Review and Multi-Year Plan of Action * Strong participation of local staff in EPI review and PoA highly recommended * Injection safety assessment should be conducted as soon as consultant is identified * ICC should try to have all GFCV application requirements in place to apply by January 2001 or soon thereafter * Frequent consultation should take place between WHO and HMG finance staff to improve flow of funds * Administrative support to EPI Chief to be increased to augment his management capacity. 2) WHO/SEARO have recruited a consultant to review all existing hepatitis B data and write the plan of action to introduce HBV into routine EPI. WHO, in collaboration with HMG Nepal Child Health section will conduct a 1-day conference, to be attended by the local scientific community, to discuss the introduction of hepatitis B into routine EPI in Nepal. The consultant will participate and present his findings to this conference. 3) The consultant for the EPI Review will assist in completing the GFCV application in conformity with the GAVI Guidelines for Country Applications. 4) In the last two months, WHO/SEARO have conducted two GAVI-related visits to Nepal. If the recommendations from these visits are followed, HMG Nepal should be in a position to apply for assistance in January 2001. NIGER 23/02: Application for Immunization Services resubmitted in round three. NIGERIA 23/02 from Bjorn Melgaard, WHO/HQ: A mission consisting of Bjorn Melgaard, Suomi Sakai (UNICEF) and Okwo Bele (WHO/AFRO) visited Nigeria from 13-16 February, and worked with the National Programme on Immunization (NPI) on the draft application to the GFCV for support from the Immunization Services sub-account. More work is needed on the application, and two consultants will be mobilised to help ensure that an application will be submitted in time for the 1 May deadline. 22/01 from Michel Zaffran, WHO/HQ: Joint WHO/UNICEF visit planned for week of 14-18 February. Dr. Bjorn Melgaard, WHO/HQ, Dr. Suomi Sakai, UNICEF/HQ and Dr. Okwo Bele, WHO/AFRO plan to participate in and provide feedback on draft application. PAKISTAN 8/12: Application for New Vaccines approved. RWANDA 23/02: Application for New Vaccines approved. 27/10: Application for support for Immunization Services approved. SAO TOME 8/12: Application for Immunization Services approved. Application for support for New Vaccines to be re-submitted. SENEGAL 23/02: Applications for Immunization Services and New Vaccines submitted in third round. SIERRA LEONE 23/02: Application for Immunization Services received Approval with Clarifications. Application resubmitted in round three. 8/12: Application for Immunization Services received Conditional Approval. Not currently eligible to apply for support for New Vaccines. SOMALIA 24/11 from Ezzedine Mohsni, WHO/EMRO: Three consultant have been requested for two weeks in February 2001 to assist with conducting an EPI review, completing a Multi-Year Plan, and assisting with preparation of the GFCV application for immunization services support. SRI LANKA 8/12 from Taslima Siddiqua, WHO/SEARO: A consultant (Dr Nick Ward) will assist the Government in coordinating and organizing an EPI review in line with GAVI requirements. In consultation with the ICC, the consultant will either compile existing information into a comprehensive review, or, if deemed necessary, coordinate a full EPI review. The three week assignment has been proposed for mid January 2001 and, it is hoped, will enable Sri Lanka to submit an application for New Vaccines by April 2001. A local expert should prepare the draft of the Multi-Year Plan, and the consultant conducting the EPI Review will help in finalizing the Multi-Year Plan. WHO/SEARO will assist in recruiting a consultant to conduct a hepatitis B disease burden study, and, if the findings indicate, to write the hepatitis B introduction plan. SUDAN 24/11 from Ezzedine Mohsni, WHO/EMRO: In line with the recommendations of Dr. Hallaj, WHO/EMRO, following his 22-27 September visit, three consultants have been requested for two weeks in December 2000 to assist with conducting a cold chain review, completing a Multi-Year Plan, and assisting with preparation of the GFCV application for immunization services support. Gordon Larsen, WHO/HQ, visited from 6-21 December for the cold chain review, and another two consultants are still needed. 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. TADJIKISTAN: 23/02: Applications for Immunization Services and New Vaccines submitted in third round. 22/01 from Denis Maire, WHO/EURO: MoH application is drafted, but support will be needed before they submit their application. Mission being organized for January/February 2001. TANZANIA 22/01 From Tom O'Connell, WHO/HQ: A visit took place from 10-24 December, to assess training needs in Tanzania and Zanzibar, and to follow-up on assessment of immunization safety in March, 2000. 7th ICC meeting: ICC very active , but unable to finalise work on budget. Committed to moving towards introduction of ADS for all injections. Injection safety, and waste disposal, still have many unresolved issues. ICC highlighting this as a top priority for coming months. Discussing strategies for HepB introduction, while waiting for combination form availability. A third follow up assessment of immunization safety planned for in near future. 27/10: Both applications for support for New Vaccines and Immunization Services approved. TOGO 23/02 from WHO Office, Togo: Coverage in Togo has been declining since its peak in the 1980s, mainly due to lack of funding in the EPI Programme, demotivated staff, and an outdated cold chain. The government would like to improve routine immunization through the Immunization Services sub-account of the GFCV, and in order to accomplish this it coordinated an EPI Review from 29 January through 3 February. One outcome of this review will be the revision of the Multi-Year Plan and an application for strengthening of immunization services from the GFCV. The report of the review should be available at the end of February. 23/02 from Bob de Wolfe, PATH/CVP, C?d'Ivoire: The national vaccination programme in Togo was evaluated by an external team consisting of consultants provided by PATH/CVP and AMP (8), WHO/AFRO (2) and UNICEF (1). Most member organizations of the ICC are contributing financially to the review as well. There are also nine national evaluation team members. The data collection will be completed before 11 February, and an updated 5-year plan and application to the GFCV will be completed by the 1 April deadline for Round 4. TURKMENISTAN 23/02: Application for New Vaccines submitted in third round. 22/01: From 23 November through 9 December, Ms. L. Shteinke, sanitary and epidemiological adviser of Kyrgyz Health Care Ministry visited Turkmenistan at the request of the Central Asia CDC Office to assist with preparation of their GFCV application for the introduction of Hepatitis B vaccine. UKRAINE 23/02: Application for New Vaccines submitted in third round. 22/01 from Dave Mercer, CVP/PATH: CVP sent a technical team to Kiev the week of January 7-14 to assist the MoH in completion of their multi-year immunization plan and application to GAVI for new vaccine assistance. The team consisted of Dr. Pam Ching, from CDC, Dr. Alexander Telyukov, from Abt Associates, David Mercer, and Molly Mort, from PATH. It is hoped that the plan and application will be ready for discussion and approval, if warranted, at a meeting of the Ukraine ICC scheduled for Friday, January 12. UGANDA 22/01 from Dr. Makumbi, UNEPI: * Uganda GAVI application was approved unconditionally for introducing HepB in 2001 and strengthening immunization services. * Drs. Wenger and Nelson made a preliminary estimate of burden of disease of Haemophilus influenza b - 43-59 per 100,000 children under five years. * Dr. Steinglass visited Uganda and participated in interviewing district immunization advisors. 8/12: Applications for Immunization Services and for New Vaccines approved. UZBEKISTAN 23/02 from Denis Maire, WHO/EURO: Dr. Balsanian visited from 29 January to 3 February to revise the application. The MoH has designated Dr. Ashirova as the focal point for all issues related to GAVI, and two working groups have been set up to work on financial and technical issues. A National ICC meeting took place on 19 January. Some important issues remain, especially with respect to the Vaccine Independence Initiative, the provision of AD syringes, and waste disposal. Another mission by Dr. Balsanian and Denis Maire is scheduled for 26-30 March. The MoH has asked WHO to advise on producing AD syringes and existing options for the destruction of waste. Expected to re-submit an application by April 2001. 8/12: Applications for Immunization Services and New Vaccines to be re- submitted. VIET NAM 8/12: Application for New Vaccines received Conditional Approval. YEMEN 23/02 from WHO/HQ: A consultant, Mogens Munck, visited from 7-22 January to conduct a review of the cold chain and logistics in Yemen. Recommendations from the consultancy include: equipping vaccine stores with fire prevention measures; purchasing and installing walk-in cooling and freezing rooms to replacement chest units; purchasing of spare parts for those units delivered without spares; training of operations and maintenance staff of cold chain equipment, including CFC-free equipment; management decision to standardise on type of equipment suitable for national, sub-national and delivery services levels; introduction of software and computer equipment for stock management and training for store keepers; and introduction of a transport management system to ensure accountable inventory and maintenance of donated vehicles. 22/01 from Chris Nelson, WHO/HQ: * A mission was undertaken by Drs Chris Nelson and Ezzedine Mohsni, WHO/EMRO, from 9-15 November to conduct a rapid assessment of Hib disease burden in Yemen. The team visited hospitals in Sana'a city and Hadramoot governorate. At each facility, interviews were conducted in the paediatric clinic and the microbiology laboratory. In addition to a search for Hib- meningitis cases and deaths, several issues were discussed including: definition of the catchment population, access to care in the popoulation, case recognition, antibiotic use upon referral, use of lumbar punctures and the availability of laboratory facilities for chemistry and microbiology. This information was supplemented with reports from the local scientific literature and surveillance data from the MoH. * Using the regional estimate of hospitalised Hib meningitis incidence and other data, national estimates of Hib disease burden were calculated for the population of chlidren 1-59 months of age and showed that between 4,700 and 18,500 cases of Hib meningitis and pneumonia are occurring each year, resulting in between 1,140 and 4,500 Hib-related deaths. * Estimates of hepatitis B-related disease burden were also calculated using available seroprevalence data and using a model developed by the Vaccine Assessment and Monitoring (VAM) team at WHO/HQ. * It was thus estimated that over 2,000 Yemeni adults die each year from hepatoma and cirrhosis resulting from chronic hepatitis b infection. Because these outcomes are the result of infections which occur in early childhood, it is estimated that as many as 15,843 of the children born this year will die from these outcomes in the future if not protected from infection. 24/11 from Ezzedine Mohsni, WHO/EMRO: Three consultants have been requested for February 2001 to assist with conducting an EPI review, completing a Multi-Year Plan, and assisting with resubmission of the GFCV application for introduction of new vaccines. A CDC consultant has been proposed, and two more consultants are still needed. 22/08: Requested to resubmit proposal. ZAMBIA 23/02: Application for Immunization Services received Approval with Clarifications. 8/12: Application for New Vaccines to be re-submitted. ZIMBABWE 23/02: Application for Immunization Services submitted in third round. REGIONAL ACTIVITIES AFRICA 22/01 from WHO/AFRO: * The 3rd meeting of the AFRO Regional Working Group on Immunization was held in Pretoria, from 31 October to 1 November 2000. The meeting provided for productive discussion on ways to support countries moving into the implementation phase. Preliminary profiles were developed on country status and areas to follow-up when inquiring on technical assistance needs. A calendar was developed on measures needed to respond to new vaccine introduction, including scheduling brifings during the sub-regional meetings in February 2001 with all countries planning to introduce new vaccines, and planning a meeting in the 4th quarter of 2001 of AFRO countries intending to introduce new vaccines and countries that have already introduced new vaccines. * During the Experts Briefing on GAVI Operations and Country Support for New Vaccines Introduction held from 2-4 November 2000, presentations and discussions were held on the GAVI process, Hib and HepB vaccine introduction plans, ICC strengthening, capacity building and health systems development. The technical briefing included about 30 participants, including country, UNICEF and WHO staff. It was a good initial training on aspects of the application process to the GFCV. Technical presentations on new vaccine introductions were also useful and countries shared their relevant experiences. EASTERN MEDITERRANEAN 23/02 from Julie Milstien, WHO/HQ: The first meeting of the Eastern Mediterranean Regional Working Group on GAVI was held in Cairo on 28 January 2001 and was attended by representatives from WHO, UNICEF, the Regional Technical Advisory Group (TAG), the Gulf Cooperation Council (GCC), the African Development Bank and country EPI programme managers. One outcome of the meeting was the revision of the terms of reference of the Working Group, most notably to incorporate all countries in the region and not only those eligible for assistance from the GFCV. Additionally, the group's priority activities were also discussed. Another issue discussed was the policy of how countries such as Afghanistan and Somalia can benefit from the GFCV with no recognised Government to account for funds. Next meeting proposed for 24-27 June 2001 with EPI managers and the TAG. 24/11 from Dr. Z. Hallaj, WHO/EMRO: A regional working group on the Global Alliance for Vaccines and Immunization (GAVI) has recently been constituted in the Eastern Mediterranean Region. The first meeting will be held at WHO/EMRO, Cairo, on 28 January 2001. The objectives of the meeting are: * To review the current situation in the GFCV-eligible countries in the region and to discuss the main issues and progress towards GFCV applications. * To discuss the role of the Regional Working Group and finalize its terms of reference. * To identify the most appropriate work tools and ways for the group in the future. * To develop the regional workplan and related schedule. Nominations of one or two representatives from the GAVI Board to participate in this meeting have been requested from WHO/HQ. EUROPE 22/01 from Denis Maire, WHO/EURO: At its recent meeting, the EURO Regional ICC agreed that interested ICC members will designate representatives to a Regional Working Group for GAVI. The first meeting of this group is scheduled for 27 February 2001 with the following proposed agenda: * Briefing on the present status of GAVI applications * Terms of reference for the Working Group * Working mechanisms for the Working Group * Draft workplan including timeframe SOUTH ASIA 22/01 from Abdulaziz Adish, WHO/SEARO: The 3rd meeting of the RWG will be held in Nepal on 19 March 2001. The 2nd Regional Working Group meeting was held on 4 December 2000 with the following recommendations: * Initial duration of the SEA-RWG extended to four years, member country representation to be increased. * Activities on cold chain, immunization safety and quality control of vaccines to be included in TORs. * SEA-RWG will designate lead person for GAVI in each country from among WHO, UNICEF, World Bank and CVP. Member countries will also be requested to designate one focal point for GAVI issues from their EPI units. * The working relationship between the SEA-RWG and the ICC will be further discussed. * SEA-RWG to review a consultant to review existing data on Japanese Encephalitis and determine its public health importance in the Region. If justified, SEA-RWG will request GAVI Secretariat to consider JE a priority vaccine for funding by the GFCV. * All partners requested to provide names and resumes of at least two consultants to assist countries with their applications. Secretariat will prepare a roster of these consultants and arrange a GAVI briefing session for them. * All partners to keep Secretariat informed of GAVI-related travels and activities. * Budget for pre GFCV application activities presented to the countries for their input and understanding. Once finalized, will be sent to WHO/HQ for funding. * RWG to prepare guidelines on role of ICCs in GAVI activities. * Pharmaceutical companies to be invited as observers to RWG meetings as necessary. * Recommendation made that Bhutan, Indonesia, Maldives and Thailand attend Hib meeting organized by WPRO in Bangkok in March. WESTERN PACIFIC 23/02 from Osman Mansoor, WHO/WPRO: The Third Meeting of the East Asia/Western Pacific Regional Working Group meeting was held on 7 February in Bangkok. A summary of Action Points follows: * Secretariat to: develop the programme for the March briefing; seek clarification from GAVI on the Inception Report; finalize advice on Immunisation Services Sub-Account (ISS) for Cambodia and Laos; develop consultant database; prepare a short fact sheet on the RWG. * RWG members to: advise secretariat of possible consultants (for March briefing and database); encourage bilateral participation at future RWG meetings, including March briefing; advise Cambodia and Laos, through their country offices, on the Inception Report; provide final advice on ISS through country offices. 22/01 from Osman Mansoor, WHO/WPRO: * From 13-15 March in Bangkok, the RWG is hosting a briefing for partner agencies' field staff, bilateral partners, and potential new GAVI consultants to increase understanding about GAVI and to familiarise participants with several new or recently revised planning and assessment tools. The aim of the Briefing is to improve National Immunisation Programmes (NIPs) in the region in the context of the GAVI initiative by: * Developing shared vision and synergy among agencies' staff to realise GAVI goals * Developing information exchange, and clarifying goals, within and between GAVI partners at global, regional and country levels * Discussing the role of newly available tools for NIPs in GAVI context. The briefing will comprise short presentations outlining key issues to generate questions and discussion. The discussions will be focused on further enhancing active cooperation between agencies, as well as providing a forum for the exchange of ideas. ____________________________________*______________________________________