Post00342 GAVI UPDATE 15 May 2001 CONTENTS 1. GAVI INFORMATION UPDATE Moderators Note: The moderator is on the road again. Technet posts will be irregular but will continue during this period. Send your contributions to: [log in to unmask] or use your reply button! ____________________________________*______________________________________ 1. GAVI INFORMATION UPDATE This GAVI Information Update comes from Gill Mayers, WHO/V&B/EPI. Posted with thanks to Gill for the useful updates. Additional information to: Gill Mayers ___________________________________________________________________________ From: [log in to unmask] To: Technet Moderator Subject: Information Update Date: Fri, 11 May 2001 Please find herewith the latest Information Update on GAVI and GFCV-related country activities. If you have any information or modifications you would like included in the next issue, please send it to me before Friday 8 June, 2001. Gill Mayers Technical Officer HTP/V&B/EPI [log in to unmask] Tel: 00.41.22.791.4674 Fax: 00.41.22.791.4193 ___________________________________________________________________________ GENERAL NOTE ON THE GFCV APPLICATION PROCESS * The country activities listed below are those that have been initiated by various Partners of the Alliance. * The application process is an ongoing one throughout the year with the following timing: 1 May, 4th round; 1 October, 5th round. REVIEW PROCESS: 11/05 from WHO/HQ: * The final results of the Independent Review Committee's deliberations on the 21 applications from the 16 countries that applied in round 3 show: three were Approved, three received Approval with Clarifications, five received Conditional Approval, nine were requested to be resubmitted and two were not eligible for the sub-account for which they applied. * At present, after the 1st, 2nd and 3rd rounds, 72 applications for GFCV assistance from 47 countries have been reviewed with the following results: 36 applications for a variety of assistance from the two sub-accounts have been approved from 25 countries. Eight countries were approved for Immunization Services support, six for New Vaccines support and 11 for support from both sub-accounts. COUNTRY COORDINATION: 11/05 from the Task Force on Country Coordination: Update from last two Core Group conference calls follows: 24th April Call: Immunization Data Quality Audit tool (DQA): * Sampling methodology now modified to be based on representative sampling. * DQA will facilitate the calculation of a correction factor which may be used to revise the reported data. * The audit tool takes two weeks to conduct. The bid process for a firm to conduct the audits is almost complete. Nine GAVI countries are scheduled for auditing by October 2001. The first two field tests will take place in Pakistan and Uganda. There are plans to develop a self-assessment tool by the end of the year. * Meeting scheduled end September to discuss necessary revisions to the tool. * Initial discussion on overall GAVI M&E process and TORS for mid-term review held. Proposal for TFCC to draft larger M&E framework to facilitate linkage and consistency among each of the reporting components, i.e. inception, mid-term, annual, and ensure measurable progress is being made towards reaching GAVI milestones. * Need expressed for consistent, clear messages to send to countries on the review process, timing of reviews and length of GAVI/Fund involvement and commitment. * General agreement that it is important to approach reviews as a way to correct poor performance or as continual assessment process, rather than to stop funding or be punitive. Action Points: > Questions remain on using solely DQA to adjust shares, as well as cost of exercise, particularly if repeated annually. > TFCC to request more information on the tool modifications and discuss at May Core meeting. > Need to specify more clearly when the clock for assistance starts running to allow for meaningful assessment of progress. CVP training in Annecy: * Twenty-two participants attended the CVP training workshop held in Annecy, France. Participation was made up of 9 AFR, 5 Central Europe, 4 South Asia, 2 Western Pacific, 2 Middle East. * Main comments clearly suggest that human resources to mobilise activities at country level are inadequate and partners at the local level still do not uniformly understand GAVI. Raises urgency to move this type of training to the regions as quickly as possible. * Next workshop session will be in mid-June in St. Petersburg, where all NIS countries with GNP ). 11/04 from Amie Batson, World Bank: The Bank is working with McKinsey & Co. to help find win-win approaches for public-private partnerships to accelerate the development, production and scaling-up of near-term vaccines. The study examines the incremental costs and risks inherent in vaccine production and delivery to developing countries and explores where the public sector may have an arbitrage opportunity in financing these costs. The end goal is the development of concrete proposals for public- private partnerships with specific manufacturers for specific vaccines - pneumococcal conjugate vaccine, meningococcal A/C vaccine for Africa and rotavirus vaccine. These proposals will identify and quantify the incremental costs and explore the mechanisms by which the public sector can most efficiently offset some of these costs. The first phase of the project is nearing completion. NEW AND UNDERUTILIZED VACCINES 11/05 from Chris Nelson, WHO/HQ: The launch of the AFRO Laboratory-Based Bacterial Meningitis Surveillance Network is planned for 4-8 June 2001 at the South African Institute for Medical Research (SAIMR) in Johannesburg, South Africa. Participants will include paediatricians, microbiologists and MoH surveillance officers. The meeting will focus on the primary components of a successful surveillance system, i.e. clinical, laboratory and reporting activities, and include laboratory training focused on the identification of bacterial meningitis pathogens (Hib, meningococcus and pneumococcus). The objective of the meeting is to establish national and regional bacterial meningitis surveillance systems that can identify bacteria causing meningitis and document the success of vaccination programmes in reducing this burden. This first meeting will focus on 25 anglophone countries in the region. A meeting for AFRO Francophone countries is being planned for October 2001 in Dakar, Senegal. 11/05 from Chris Nelson, WHO/HQ: Harare - Zimbabwe - AFRO South Block Training (10-11 April 2001): The third Hib Disease Burden Rapid Assessment Tool training workshop was held for AFRO South Block WHO & MOH EPI personnel on 10-11 April in Harare, Zimbabwe. The training activities, which included small group exercises and a 1/2 day visit to a local paediatric ward and microbiology laboratory, were very well received by the participants. Although many South Block countries are not eligible for GFCV funds, participants emphasized that GAVI partners can play a role by providing technical assistance and advocacy support to all countries. Bamako, Mali - AFRO West Block Training (5-6 March 2001): The second in a series of Hib Disease Burden Rapid Assessment Tool training workshops was held for AFRO West Block WHO personnel on 5-6 March in Bamako, Mali. Subject to improved vaccine coverage and infrastructure development, West Block countries are expected to include Hib vaccine in their amended GAVI/GFCV applications as from 2002. Harare, Zimbabwe - AFRO East Block Training (15-16 February 2001): The first in a series of Hib Disease Burden Rapid Assessment Tool training workshops was held for AFRO East Block WHO & MOH EPI personnel from 15-16 February in Harare, Zimbabwe. The objective of the workshop was to introduce and train participants in the use of the Tool. In addition to presentations describing the global and regional burden of Hib disease, Hib vaccine effectiveness and safety, and clinical and laboratory factors affecting the accurate measurement of Hib disease burden, participants also took part in small group exercises and a 1/2 day visit to a local paediatric ward and microbiology laboratory that allowed them to gain experience using the Tool. Other topics that were covered included establishing sentinel bacterial meningitis surveillance and prospects for including Hib vaccine in amended GAVI/GFCV applications. The training activities were very well received and most countries have plans to proceed with available data to prioritize the use of Hib vaccine in their national immunization programmes and to perform the rapid assessment in their countries. 11/05 from Chris Nelson, WHO/HQ: Jordan - Hib Disease Burden Rapid Assessment (18-27 April 2001): A team from WHO's Eastern Mediterranean Region, including Dr Salah Al- Awaidy (EPI Manager, Oman) and Dr Selma Khamassi (EPI Manager, Tunisia), visited Jordan on 17-27 April 2001 to assist the MOH in the assessment of Hib disease burden. Using WHO's Hib Disease Burden Rapid Assessment Tool as a guide, the team reviewed local studies, MOH surveillance data and travelled to numerous hospitals in different parts of the country to collect primary data and estimate the local burden of Hib disease. This mission follows several others in the region, e.g. Oman, Egypt, Iran, Syria and Yemen, that also used WHO's Hib Disease Burden Rapid Assessment Tool to assess the local burden of Hib disease. In addition to these activities, Tunisia is scheduled to complete their first year of population-based surveillance for Hib disease in June 2001. 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 11/05 from Tom O'Connell, WHO/HQ: GAVI strategic framework for strengthening national capacity: A GAVI inter-task force sub-group is developing a capacity building strategy, for strengthening the long-term capacity and sustainability of national immunization programmes. A one-day meeting was held at UNICEF, New York on April 23, in which participants debated various methodologies. A working definition of "capacity building" was formulated, to guide development of benchmarks which can describe key aspects of quality immunization programmes. This was based on previous efforts which had defined the components of each major supporting element of immunization services: management; financing; and institutional and human resources development. Some specific indicators were discussed for each element, and these will be refined over the next few weeks. The subgroup agreed on a plan of action, with milestones, to guide activities over the near future. Agreement was reached on the overall framework, with work on a revised draft of the framework and a strategy for its implementation to be ready in the first half of May. Management Strengthening Project: A CD-ROM containing all current V&B and UNICEF documents relevant to managing immunization services is under development, and is scheduled to be released by August 2001. A second version, with several different interfaces and containing more resources for managers, is planned for release by November. In addition, a moderated e-mail forum for national and sub-national immunization managers and field staff will be launched by the fall of this year. It will concentrate on management issues, such as developing and implementing national strategies on injection safety, new vaccine introduction and management of human resources. The forum will serve as a peer-to-peer network, helping disseminate best practices and other work experiences between various national programmes. All staff involved in immunization services delivery will be welcomed and encouraged to use the forum. IMMUNIZATION SERVICES COMMON ASSESSMENT TOOL 11/05 from WHO/HQ: An informal workshop for the review and revision of the immunization services assessment guidelines was held in Geneva from 9-10 April. Twenty-five participants from international partner agencies and country-level representatives met to revise the assessment tool based on experiences they have had using it in the field. A final version will be produced by the end of May which will then be translated into French, available on CD-ROM and diskette, and distributed widely for use in conducting EPI assessments. Available on: http://www.who.int/vaccines-diseases/service/ immsystemassess. COUNTRY-SPECIFIC INFORMATION AFGHANISTAN 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support submitted in 4th round. 11/04 from Ezzedine Mohsni, WHO/EMRO: Dr Abdallah Bchir (STC) visited Islamabad in mid April to assist Afghanistan in reviewing the documentation they have prepared and in finalizing their GFCV application for a May submission. Their application will be submitted by the Partners as there is currently no recognized government. ALBANIA 11/04 from Denis Maire, WHO/EURO: MoH has put much effort in supplying additional information to comply with GAVI requirements. USAID sub- contracted Abt Associates to examine the financing mechanisms for immunization and to assist MoH in providing a multi-year budget. MoH have agreed in principle to increase their financial participation on a yearly basis. Cold chain was evaluated for measles campaign (November 2000) without major concern. Immunization safety is to be improved. MoH agreed to conduct in-depth evaluation before end 2001 with support from partners. A mission to develop Hib introduction plan still pending. ANGOLA ARMENIA 16/03: Application for HepB was approved. Application for Hib has not yet been resubmitted. 8/12: Application for Immunization Services Approved. Application for Hib is to be re-submitted. AZERBAIJAN 23/02: Applications for Immunization Services and New Vaccines approved. BANGLADESH 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support and New Vaccines (DTP/HepB) submitted in 4th round. 11/04 : Sterilization of needles is currently carried out at the sub- district level. MoH to investigate with GAVI Secretariat possibility of continuing this practice. Still planning to apply for New Vaccines in May 2001. BENIN 11/04 from Jay Wenger, WHO/HQ: Meeting held with WR at WHO/HQ. Technical assistance may be requested to draft plan for reducing vaccine wastage. Clarification of information required for Conditional Approval provided. 16/03: Application for New Vaccines (HepB and YF) received Conditional Approval in January 2001 reviews. BHUTAN 23/02: Application for support for New Vaccines approved. BOLIVIA BOSNIA & HERZEGOVINA 11/05 from WHO/HQ: Application for New Vaccines (HepB monovalent) submitted in 4th round. BURKINA FASO 16/03: Application for Immunization Services Approved BURUNDI 11/05 from EPI Managers Meeting: ICC recently created. MYP under preparation. EPI Review scheduled for June 2001. Need new vaccines introduction plans. Expect to submit an application in October 2001. 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 11/04 from Osman Mansoor, WHO/WPRO: Dr Rosemary Lester (WHO/WPRO Consultant) to visit at beginning of April 2001 to assist with planning their Immunization Services Strengthening application. 22/08: Application for support for New Vaccines approved. CAMEROON 11/05 from WHO/HQ: Application for Immunization Services now approved. 16/03: Application for New Vaccines received Conditional Approval in January 2001 reviews. CENTRAL AFRICAN REPUBLIC 22/08: Requested to resubmit proposal. CHAD 16/03: Immunization Services application requested to be resubmitted after January 2001 reviews. CHINA 11/05 from WHO/HQ: Application for New Vaccines (HepB, Hib and YF) submitted in 4th round. 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. COMOROS CONGO IVORY COSTE 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 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support submitted in 4th round. DPR KOREA 11/04 from SEAR Immunization Working Group: A draft application has been completed and circulated to Regional Working Group for review. ICC established and three meetings have been held. Using AD syringes for all routine immunizations. Consultant may be requested to assist with further developing the proposal for Immunization Services. Hope to be locally producing HepB vaccine by 2006 and propose to request assistance from R&D sub-account to develop local production of rotavirus vaccine. Would be interested in receiving support for JE instead of Hib and YF. DEMOCRATIC REPUBLIC OF CONGO ERITREA 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support and New Vaccines (DTP/HepB combo) submitted in 4th round. 11/05 from EPI Managers Meeting: Interested in introducing DTP-HepB by 2002. Targeting 90% routine coverage by 2005. EPI Review recently conducted. MYP developed. HepB disease burden assessment conducted. ICC functioning. Need consultants to help with training in new vaccine introduction, injection safety, etc. Need communication experts to design special programmes for nomadic populations. 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 ETHIOPIA 11/05 from EPI Managers Meeting: Interested in ISS sub-account and in introducing DRP-HepB and yellow fever by 2003. Strong ICC. Recent EPI Review. MYP to be prepared soon. Need assistance with GAVI Application process. GAMBIA 8/12: Application for New Vaccines to be re-submitted. Applied but not eligible for support for Immunization Services. GEORGIA 16/03: Applications for support for Immunization Services and New Vaccines requested to be resubmitted. GHANA 27/10: Both applications for support for New Vaccines and Immunization Services approved. GUINEA 22/08: Requested to resubmit proposal. GUINEA-BISSAU 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: Applied but not currently eligible for Immunization Services support. INDIA 11/05 from Alan Brooks, PATH/CVP: Visited Delhi to work with the Government of India and partners on finalizing a draft application. INDONESIA 11/05 from John Lloyd, PATH/CVP: A mission is scheduled from 14 May-2 June 2001 to formulate the five-year strategic plan for immunization services in Indonesia based on the recent national level assessment. The mission will be composed of two consultants from PATH and WHO (Allan Bass and Cecilia Bioediono), and representation from UNICEF, CDC, MoH Planning Division, Surveillance Division and a financing economist consultant 16/03 from John Lloyd, PATH/CVP: A two-week national-level assessment of immunization services, based on the WHO assessment protocol, is scheduled for 9-20 April 2001 to enable Indonesia to apply to the GFCV for the reimbursement of locally purchased, locally manufactured hepatitis B or DTP-HepB combination vaccine. It is envisaged that the multi-year plan will be prepared during the month of May, and, as Indonesia is one of the "special case" countries, a submission date for assistance under the new and under-used vaccines sub-account in June for Indonesia has been requested from the GAVI Secretariat. A subsequent provincial-level assessment is scheduled between June and August for four provinces, and an application for support for these four provinces from the immunization services sub-account is expected for the 1st October 2001 deadline. KENYA 11/05 from EPI Managers Meeting: Need assistance with: carrying out baseline coverage survey, strengthening EPI supervision, and establishing disease burden on yellow fever. 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 11/05 from WHO/HQ: Application for New Vaccines Introduction (Yellow Fever) submitted in 4th round. 23/02: Application for Immunization Services Approved. MADAGASCAR 16/03 from Tarande Manzila WHO/AFRO: In response to a request from the Malagasy Government, Dr L. Shodu visited in March 2001 to assist with putting in place a detailed plan for HepB introduction. The Government has also requested assistance with conducting a Hib assessment. 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 Conditional Approval. Application for support for Immunization Services approved. MAURITANIA 11/04 from Jay Wenger, WHO/HQ: Meeting held with WR at WHO/HQ. Technical assistance to be requested with revising five year plan. Plan to resubmit Immunization Services request in October 2001. 16/03: Application for support for Immunization Services was requested to be resubmitted. MOLDOVA 11/04 from Denis Maire, WHO/EURO: GFCV application postponed to October 2001 due to delayed activities on disease surveillance evaluation. MoH will carry out EPI evaluation with local UNICEF support in April/May. MONGOLIA MOZAMBIQUE 11/04 from Amie Batson, World Bank: The first vaccines financed by the GFCV were delivered on 6 April in Maputo, Mozambique. Ms. Carol Bellamy, Executive Director of UNICEF, William Gates, Senior, Jacques-Fran�ois Martin, GFCV President and Dr Tore Godal, Executive Secretary, GAVI Secretariat, witnessed the event. 27/10: Both applications for support for New Vaccines and Immunization Services approved. MYANMAR 11/04 from SEAR Immunization Working Group: Plan to apply to the GFCV for both sub-accounts in October 2001. UNICEF currently funding cluster surveys in 55 townships. NEPAL 11/04 from SEAR Immunization Working Group: Expected to apply for assistance for both sub-accounts in May 2001. Clarifications on reasons for resubmission of New Vaccines application being sought. Technical assistance may be requested to assist with finalizing applications. 16/03: Application for New Vaccines requested to be resubmitted. NICARAGUA NIGER 16/03: Application for support for Immunization Services requested to be resubmitted. NIGERIA 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support and New Vaccines (DTP/HepB & Yellow Fever) submitted in 4th round. 11/04 from WHO/HQ: Dr Manzila Tarande and Rachel Seruyange from the MoH Uganda spent three weeks in Nigeria to assist with GFCV application issues and Hepatitis B introduction plan. PAKISTAN 11/05 from WHO/HQ: Application for Immunization Services Strengthening support Approved. 16/03: Application for support for Immunization Services submitted in third round received Approval with Clarifications. 8/12: Application for New Vaccines approved. PAPUA NEW GUINEA RWANDA 11/05 from EPI Managers Meeting: Active and committed ICC. Need HepB and Hib disease burden assessments. Need training for new vaccines introduction. Need an injection safety assessment. 23/02: Application for New Vaccines approved. 27/10: Application for support for Immunization Services approved. SAO TOME & PRINCIPE 8/12: Application for Immunization Services approved. Application for support for New Vaccines to be re-submitted. SENEGAL 11/05 from GAVI Secretariat: Technical assistance has been requested by Senegal to assist with the reformulation of their application. WHO is identifying suitable candidates. 16/03: Application for support for Immunization Services received Conditional Approval. Application for New Vaccines requested to be resubmitted. SIERRA LEONE 16/03: Application for Immunization Services Approved. SOLOMON ISLANDS SOMALIA 24/11 from Ezzedine Mohsni, WHO/EMRO: Three consultants 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 11/04 from Dr Adish Abdulaziz, WHO/SEARO: Sri Lanka has requested a consultant for late June/early July 2001, to help review existing HepB burden studies and help with introducing HepB into its EPI routine. An application for New Vaccines Introduction expected before the end of 2001. SUDAN 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support submitted in 4th round. 11/04 from Ezzedine Mohsni, WHO/EMRO: Drs Bchir and Antoune Nakhla visited from 19 February to 3 March 2001 to assist with conducting an EPI Review, completing the multi-year plan and preparing the application for immunization services support. 16/03 from Ezzedine Mohsni, WHO/EMRO: Gordon Larsen from WHO/HQ visited from 6-21 December to conduct the cold chain review. TAJIKISTAN: 11/05 from WHO/HQ: Application for Immunization Services Strengthening support Approved. 16/03: Application for Immunization Services received Approval with Clarifications. Application for New Vaccines received Conditional Approval. TANZANIA 11/05 from EPI Managers Meeting: New vaccines to be introduced in January 2002. Pre-introduction activities of advocacy and social mobilisation to be carried out from May-December 2001. DPT stocks to be used up prior to switching to DPT-HepB. Hib rapid assessment planned. DQA scheduled for July 2001. Request assistance with monitoring progress and report writing and with training. 27/10: Both applications for support for New Vaccines and Immunization Services approved. TOGO 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support and New Vaccines (DPT-HepB-Hib & Yellow Fever) submitted in 4th round. 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, IVORY COSTE: 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 May deadline for Round 4. TURKMENISTAN 11/05 from WHO/HQ: Application for New Vaccines (HepB monovalent) submitted in 4th round. UKRAINE 16/03: Application for New Vaccines received Conditional Approval. UGANDA 11/05 from EPI Managers Meeting: Need support with DQA, and support with HepB population survey as baseline data to evaluate new intervention. 8/12: Applications for Immunization Services and for New Vaccines approved. UZBEKISTAN 11/05 from WHO/HQ: Application for New Vaccines (HepB monovalent) submitted in 4th round. 11/04 from Denis Maire, WHO/EURO: Mission with Dr Balasanian and Mr Denis Maire took place from 26-31 March to review the application and assess further support needed. A consultant on waste disposal management will join the team from 28 March to 4 April to carry out a rapid assessment and give recommendations to MoH on the most appropriate technologies to be used at each administration level. VIET NAM 11/05 from WHO/HQ: Application for New Vaccines being re-reviewed in 4th round following provision of additional information. 8/12: Application for New Vaccines received Conditional Approval. YEMEN 11/05 from WHO/HQ: Application for Immunization Services Strengthening and New Vaccines (HepB and Hib) submitted in 4th round. 11/04 from Ezzedine Mohsni, WHO/EURO: Two consultants, Drs Bchir and Mahoney visited from 3-22 January 2001 to assist the MoH in preparing the GFCV application for both sub-accounts for submission in May. 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. ZAMBIA 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support resubmitted and New Vaccines (DTP-HepB-Hib) submitted in 4th round. 11/05 from EPI Managers Meeting: Plan to train health workers in new vaccine introduction and injection safety. 23/02: Application for Immunization Services received Conditional Approval. ZIMBABWE 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support and New Vaccines (DPT-HepB-Hib) submitted in 4th round. REGIONAL ACTIVITIES AFRICA 11/05 from Modibo Dicko, WHO/AFRO: Main points of AFR RWG meeting held in Harare, 28-29 March 2001: * Modibo Dicko is replacing Dr Shodu as the Coordinator for the AFR RWG, as Dr Shodu is moving to the Global Fund in Lyon. * The AFR RWG has been split into 2 sub-regional groups: West/Central now lead by Deo Nshirimirimana and East/South by Rudi Eggers. It is planned that coordination between the 2 sub-groups will remain at regional level. Both sub-groups will be conducting monthly regional-level partner meetings, and quarterly meetings involving a broader range of partners. The entire group will meet once or twice a year. One meeting just before or after the Task Force for Immunization (TFI). West/Central African RWG has just had its first meeting will all regional partners present. They will be meeting the 2nd Saturday of each month, up through December 2001, at which time they will assess the need to continue in the same format. They have developed a work plan on how to support countries, particularly in area of technical assistance. 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. EUROPE 11/04 from Denis Maire, WHO/EURO: The 1st meeting of the European Working Group of Global Alliance for Vaccines and Immunization (GAVI) was held in Copenhagen on 27 February 2001. The meeting was attended by representatives from: GAVI Secretariat, GAVI Global Working Group, WHO, UNICEF, Government of Norway, MoH Moldova, PATH/CVP, CDC and the WHO Collaborating Center for Prevention & Control of Viral Hepatitis. Conclusions and actions points from the meeting included: * Terms of reference agreed to with some minor modifications. WG to focus initially on GFCV-eligible countries, expanding later to others. * WHO/EURO & UNICEF Geneva named as the Working Group Secretariat. * Each Partner to identify a focal point for information and communications. * The WG will keep its reports short and informative, comprising one-page summaries of meetings and a spreadsheet on status of countries. * Development of a web page to be considered. * RWG meetings will be held when considered necessary, normally being added to other regional meetings and held in GFCV-funded countries where possible. Next meeting tentatively for June in combination with the GAVI training and Hepatitis B meeting. * The draft work plan to be expanded to include additional consultancies to support development of country applications following results of 3rd round of reviews. Workplan should also include visits to funded countries to strengthen ICCs, assess implementation needs and identify long-term support needs. SOUTH ASIA 11/05 from Abdulaziz Adish, WHO/SEARO: The 3rd meeting of the RWG was held in Nepal from 19-20 March 2001. A total of 62 participants attended including representatives from eight member countries, UNICEF, WHO, World bank, PATH-CVP, regional partners (USAID, DFID, IOCH, JICA) and regional consultants. The objectives of the meeting were: (1) exchange technical and strategic information on immunization; (2) brief a group of nine potential regional consultants on GAVI and its application process; and (3) facilitate country applications to GAVI through individual meetings with country representatives. Main points: * RWG and TFCC representatives held side meetings with participants from each country and discussed country needs for technical assistance. * Meetings were also held with each country to discuss status and country needs on injection safety. * SEA RWG and AP RWG partners held a side meeting to discuss importance of Japanese Encephalitis as a priority vaccine for the region and to explore common strategies for its advocacy. Action points: > Julie Jacobsen of CVP/PATH to prepare an agenda for JE with mid- term targets in coordination with RWGs. > RWGs to request countries for data, such as number of cases, existing disease control strategies and whether JE is a disease of public health concern. > Ms. Siddiqua to send official invitation to Bangladesh, Nepal and Thailand to act as rotating country representatives for the next RWG meeting. > Ms. Siddiqua to obtain nominations for the CVP Annecy training from government representatives and other partners. RWG Secretariat to submit names of final nominees to training organisers. * Next SEA RWG meeting is scheduled for 9 June in Delhi, India. WESTERN PACIFIC 11/04 from Osman Mansoor, WHO/HQ: The 4th meeting of the RWG of GAVI Partner Agencies was held in Bangkok on 16 March 2001. The meeting was attended by representatives from WHO, UNICEF, ADB, PATH/CVP, World Bank, CDC, Aventis, GAVI FTF, MAVI, UCSF, USAID and potential GAVI consultants. A summary of the action points follows: * Secretariat to: > Continue to develop consultant database; > Develop terms of reference for evaluation of the RWG briefing and processes; > Revise information sheet on RWG; > Develop with WHO/HQ a process for developing country fact sheets. * RWG Members to continue to encourage bilateral participation in the RWG process. * All Agency staff to continue to encourage bilateral participation in the GAVI process. * WPRO to arrange for international consultant on cold chain in Cambodia. * UNICEF to arrange for regional consultant on cold chain in Cambodia. * World Bank to fund evaluation of RWG and its briefing (correction from last issue). * ADB to provide further details of the Japanese Fund for Poverty Reduction. Next meeting is tentatively scheduled for 15 June to be held in Mongolia as part of the establishment of that country's ICC. The meeting after that will be held in conjunction with the WPRO TAG on 13-15 August in Manila. 11/04 from Osman Mansoor, WHO/WPRO: The Asia Pacific RWG held a Regional Briefing on GAVI & Associated Tools in Bangkok from 14-16 March 2001 for partner Agencies' field staff, bilateral partners and potential new GAVI consultants. The purpose of the briefing was to increase understanding about GAVI and to familiarise participants with several new tools. Key issues addressed included: * GAVI & the GFCV: Countries not responding to GAVI as an "Alliance". The Alliance must be operational at country and regional level. Speed is valuable, but the "dash-for-cash" is not necessarily in the interest of sustainability. The application process should be a developmental, capacity building exercise, not just form-filling, and must be in the context of other activities and with flexible deadlines to reduce time pressures. Communication appears to be a major problem, informal and formal channels need to be used to recognize and reach local expertise. Process for local ownership of assessment and MYP more important than content. Need to develop local staff to strengthen capacity. Importance of a well-supported and functioning ICC. * Financing immunization services: Need to understand distinction between financial sustainability and self-sufficiency. Need for high-level political advocacy for priority of immunization. Need for closer cooperation between MoH and MoF. EPI managers need to develop financial and economic literacy. * Strengthening immunization services in practice: Safe injection policies and practice needed for all vaccines; Safe disposal lacks attention; New tools available for assessing injection safety (Tool C); Need for sufficient planning and attention to details of logistics, especially when introducing a new vaccine; HepB vaccine very susceptible to inactivation by freezing - cold chain, training and monitoring needed to ensure vaccine retains potency; Surveillance for and response to AEFIs likely to become increasingly important. * New vaccines: Policy gap between demonstrated efficacy of HBV out of cold chain and current WHO Policy; Hib disease burden in Region remains uncertain, although tool for rapid assessment available if laboratory with defined catchment area; pneumococcal conjugate vaccine likely to be available, planning for Hib should include this; Decision to add a new vaccine is complex and as much political as technical. ____________________________________*______________________________________