Post00353 GAVI UPDATE 22 June 2001 CONTENTS 1. UPDATE ON COUNTRY-LEVEL GAVI & GFCV RELATED ACTIVITIES *Technet Forum thanks to Gill Mayers, WHO/V&B/EPI, who has prepared and posted the very informative GAVI update for the last year and is now moving on to Accelerated Vaccine Introduction project. Welcome to Hemanthi Dassanayake, WHO/V&B/EPI, who is now responsible for the GAVI Updates and has posted the latest GAVI Update below. Opinion, comments and additions please: [log in to unmask] or use your reply button ___________________________________________________________________________ From: [log in to unmask] To: [log in to unmask] Subject: GAVI Information Update Date: Fri, 15 Jun 2001 Now that the GAVI Task Force on Country Coordination has recruited an additional Technical Officer, the coordination of information on country- level activities, GFCV application status, etc., previously managed by me, will now be the responsibility of Ms. Hemanthi Dassanayake. To this end, may I ask that with immediate effect, any information you wish to share or questions you need answered, be directed to Hemanthi on e-mail [log in to unmask] I would like to take this opportunity to thank those of you who have been active in keeping me informed of your organization's country level activities, thus enabling me to provide as much information as possible to the 350 of you who receive the Information Update. As I will now be concentrating my efforts on the Accelerated Vaccine Introduction project, I will not be far away from the excitement of the "GAVI Process"! Gill Gill Mayers Technical Officer HTP/V&B/EPI [log in to unmask] Tel: 00.41.22.791.4674 Fax: 00.41.22.791.4193 ___________________________________________________________________________ From: [log in to unmask] To: [log in to unmask] Subject: Information Update Date: Wed, 20 Jun 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 29 June, 2001. Hemanthi Dassanayake Technical Officer GAVI Task Force on Country Coordination [log in to unmask] Tel: 00.41.22.791.1312 Fax: 00.41.22.791.4193 ___________________________________________________________________________ UPDATE ON COUNTRY-LEVEL GAVI & GFCV RELATED ACTIVITIES 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. The last (4th) round was 1 May, and the 5th round deadline is 1 October. REVIEW PROCESS: 18/06 from WHO/HQ: The results of the Independent Review Committee's decisions on Round 4 country applications should be available after the 21 June GAVI Board meeting. 11/05 from WHO/HQ: * 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: 18/06 from the Task Force on Country Coordination: 5th June Conference Call: Interim Review:The proposals for the GAVI Interim Review (formerly mid-term review) and national annual reporting process were discussed. The following points were agreed to: * In terms of annual reporting, there should be a convergence and harmonization of reporting mechanisms in order to increase efficiency, decrease paperwork and minimize burden on countries. It was suggested that the country annual reporting process be timed with the WHO-UNICEF Joint Reporting Form (April 15). * For GAVI purposes, the data-set for the annual reporting process should be standardised to complement the WHO/UNICEF Joint Reporting Form and match country needs. * Field visits should be encouraged in areas of weakness, but not mandatory for every Review * Coordination with the Financial Sustainability Task Force (FTF) on integrating their input to the Interim Review needs to occur shortly. Action Points: The Interim Review proposal will be revised and submitted to the GAVI Global Working Group for initial feedback on direction of ideas. Immunization Advisors: It was agreed that the general TORs for Immunization Advisors need to be more flexible to reflect country specific situations, such as length and place of assignment. It should also be clarified that these general TORs are a basic 'menu' of tasks that could be performed, and duties should be country specific. Capacity Building Strategy: The Global Working Group found the conceptual framework sensible, but believed a more practical approach with definitive action steps still needed to be defined. The Inter Task Force will define the process for next steps, and the RWGs will propose 1-2 countries in which this CB approach could be fielded in the next 4-6 months. 18/06 from the Task Force on Country Coordination: The meeting of the Core Group of the Task Force was held in Geneva from 22-23 May. Country Coordination: The workplans and budgets submitted for the TFCC and the RWGs raised awareness on: (a) limited financial resources available for activities requested by the RWG; (b) the need for the TFCC and RWGs to identify priority activities for the forthcoming months; and (c) the need for standardisation of requests from RWGs for funding support. Action Points: Create standardised template for RWG budget requests and distribute to RWGs focal points for completion. * RWGs to use standardised template to submit financial support requests for 2001 and 2002. * Prepare draft of basic TORs for Immunization Advisors for discussion. Capacity Building: The Capacity Building Strategy was endorsed by the TFCC. Its successful implementation requires that system strengthening is addressed at the district level and adequate resources are available at the country level. Common Assessment Tool should be finalised immediately, including all four health system functions (financing, resource generation, management and service delivery). Action Points: * Present Capacity Building Strategy to the Working Group for feedback to the Inter-Task Force group. * Complete benchmarking process to supplement indicators in Common Assessment Tool and define process to agree on 4-6 global targets for assessing impact. * Review the proposed Capacity Building Strategy during the next RWG scheduled meetings (post GAVI Board). Comments to be provided to the TFCC for incorporation into the action plan. * Each RWG should nominate 1-2 countries where the Capacity Building Strategy can be initially implemented. * Produce Annecy training manual on CD and send to all members of the TFCC Core Group. Monitoring and Evaluation: * With regard to the DQA, three substantive developments have occurred: a) A tendering procedure was carried out, and the DQA will be implemented by a consortium headed by the Liverpool Associates in Tropical Health (LATH) UK, in association with the Euro Health Group (EHG) from Denmark and the Deloitte & Touche Emerging Markets Group, USA. b) The tool has been adjusted to provide a random sampling frame to allow a representative and statistically based adjustment of DTP3 numbers. c) After the initial round of pilot DQA's, an evaluation of how the DQA will be used will be carried out for the adjustment of shares. The audit will initially be implemented during the period May-September 2001 in the nine countries that were awarded the highest immunization services support in 2000/early 2001. The countries to be audited this year will be IVORY COSTE, Haiti, Kenya, Liberia, Mali, Pakistan, Rwanda, Tanzania and Uganda. These experiences will guide subsequent audits. * The initial proposal on the process of the mid-term review was discussed at length and revisions made. It is suggested that the midterm review be called the 'Interim Review'. 18/06 from the Task Force on Country Coordination 8th May Conference Call: 'Interim' Review: * In terms of wording for the Review, 'Interim Review' is considered preferable, since the mid-term review is not a process at the mid term of the 5 year funding (only one year of fund utilization) * The review is of the immunization services in the country, looking at progress made by the country, aiming to validate and guide the country to assess priorities and localise problems in order to strengthen country immunization services * The review should look at processes rather than outcomes given the countries are still in early stages of GFCV funding 11/05 from Molly Mort, PATH/CVP: Inter-Regional Immunization Strengthening Workshop, Annecy, France: * Workshop objectives were to build a common understanding about GAVI and the process to strengthen immunization systems at the regional and country levels. * The workshop modules included: an introduction to GAVI, Country Coordination, Assessments, Multi-Year Plans, Financing of Multi-Year Plans and the Global Fund. * There were 22 participants compiled of regional and national immunization experts. * Preliminary lessons from the workshop were: (i) value of professional workshop facilitators, (ii) usefulness of "adult learning" methods where peers share experiences and have many opportunities for interaction, (iii) importance of small break-out sessions, but also the challenges of successfully processing them during the plenary. (iv) challenge of reconciling clearly defined objectives with the participatory approach to the workshop. * GAVI training sub-group will contact the RWGs to discuss how and what kind of assistance they would need to implement appropriate workshops. * The workshop modules will be revised to reflect the activities of the Annecy workshop and provide a report on certain break-out sessions. When updated, they will be distributed widely. FINANCING 18/06 from Violaine Mitchell, GAVI Financing Task Force: On June 4-6, 2001, the FTF convened a WHO-CVP-USAID sponsored Workshop on Financial Sustainability with country teams that included representatives of the MoH, MoF, and in-country partners from Bangladesh, Benin, Ukraine, and Zimbabwe. The objectives of the meeting included: development of a consensus definition of financial sustainability, preliminary financial sustainability plans, and an initial exploration of financial indicators and targets. Traditionally, financial sustainability has been synonymous with 'self-sufficiency'. Although recognising self- sufficiency to be the ultimate goal, the meeting participants moved away from this definition toward how to enable countries to mobilize and efficiently use domestic and supplementary external resources on a reliable basis to achieve target levels of immunization performance. Meeting participants outlined key elements to be included in financial sustainability guidelines, proposed a number of financial indicators for consideration, and proposed a process to develop global financing targets for countries and for donors. For more information on the meeting, please contact Brenda Candries ([log in to unmask]). For information on on-going FTF work in the area of financial sustainability, please contact Violaine Mitchell ([log in to unmask]). Meeting notes will be posted on the GAVI website: http://www.vaccinealliance.org The FTF Forum will be held in September 24-25 with an FTF Core Meeting on September 26th at the World Bank in Washington D.C. 11/05 from Violaine Mitchell, GAVI Financing Task Force: The first draft of the paper "Financial Sustainability of Childhood Immunizations: Issues and Options", is now available in English, French, and Russian. This paper is intended to provide a framework for discussion of financial sustainability issues with relevance to both Fund and non-Fund eligible countries. Please contact Violaine Mitchell ([log in to unmask]) for copies of the draft. Alternatively, the paper can be downloaded from the GAVI website (http://www.vaccinealliance.org). 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 18/06 from Eric Mast, WHO/HQ: The meeting for Strengthening Immunisation Systems and Introduction of Hepatitis B in Central and Eastern Europe and the Newly Independent States is meeting in St. Petersburg, (Russian Federation) from 24-27 June. The main purpose of the meeting is to: * Provide participants with an overview of the current epidemiological situation of viral hepatitis infection world-wide and in the European region of WHO. * Provide participants with an overview of GAVI and the GFCV * Provide an overview of the current status of HepB vaccination globally and in WHO/EURO * Discuss HepB prevention strategies in the broader context of viral hepatitis prevention and control (including injection safety, blood safety, and treatment of chronic HepB and C infection) * Discuss country experiences with viral hepatitis prevention and control programmes, programme planning, and develop meeting conclusions and a plan of action for future activities * Provide participants with general principles and strategies on the introduction of new antigens, with a special focus on HepB and Hib * Discuss mechanisms for strengthening national immunization systems, including in-country coordination, assessments, multi-year planning, financing, advocacy and communication * Provide a special training session for participants from GFCV-eligible countries on procedures and technical aspects of activities related to GAVI and the GFCV 18/06 from Chris Nelson, WHO/HQ: The first meeting of the AFRO Hib/Pediatric Bacterial Meningitis Surveillance Network was held on 4-8 June 2001 at the South African Institute for Medical Research (SAIMR) in Johannesburg, South Africa. The objective of the meeting was to introduce the Hib/PBM network to participants, review materials and activities, and provide surveillance, data management and laboratory training to the participants. The goal of this activity is to establish national and regional bacterial meningitis surveillance systems that can document the burden of disease related to bacterial meningitis and the success of the vaccination programmes in reducing this burden. The meeting was attended by over 120 participants from 25 anglophone countries as well as representatives from participating agencies: WHO, CDC, and PATH. A meeting for AFRO francophone countries is being planned for November 2001. 11/05 from Chris Nelson, WHO/HQ: The launch of the AFRO Hib/Pediatric 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. 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. STRENTHENING IMMUNIZATION SERVICES 18/06 from Tom O'Connell, WHO/HQ: The WHO/UNICEF/WHO-AFRO management strengthening project has begun a biweekly newsletter to discuss project activities and goals. Those interested in being placed on the mailing list can send a request to ([log in to unmask]). Training workshops based on a five-step problem solving approach, will be designed over the next two months. National staff will be assisted in customising the basic 'problem solving' workshop to be consistent with national goals for the health sector. National trainers will actually run the workshops, with project staff being present as facilitators to both the national trainers and the participants. Initial field testing of the resource manual and reference guide for immunization managers, as well as the accompanying problem- solving workshop for managers is planned for early September. A meeting of the project advisory panel, with WHO and UNICEF representatives and other partners, is planned for 23-24 August in Geneva. 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 18/06 from Carole Francis, WHO/HQ: A final version of the assessment tool will be produced at the end of June. It will be translated into French and made available on CD-ROM and diskette. This will be distributed widely for use in conducting EPI assessments. 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. 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. ALBANIA 18/06 from Denis Maire, WHO/EURO: Application for support for new vaccines (Hib) was resubmitted in the 4th round. 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 18/06 from South East Asia Regional Working Group: * Immunization Advisor expected in July and a HepB vaccine introduction workshop is planned for September 2001. * A local consultant has been requested for nine months to assist in the implementation of GAVI activities in the initial nine months of funding. 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 18/06: from West and Central Africa Regional Working Group: Technical assistance given by WHO and CVP in May 2001 to help with New Vaccines Introduction, stock capacity and AD syringes. 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 18/06 from South East Asia Regional Working Group: EPI review conducted by a consultant in May 2001. Technical assistance is needed to assist with strengthening the ICC, reviewing the multi year plan, conducting a Hib burden study and drafting the new vaccine introduction plan. 23/02: Application for support for New Vaccines approved. BOLIVIA BOSNIA & HERZEGOVINA 18/06 from European Regional Working Group: Technical assistance scheduled by WHO/EURO for late June, early July 2001 for Hepatitis B vaccine introduction plan. 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 18/06 from from Rudi Eggers, WHO/AFRO: The mission to assist in building an injection safety plan in preparation for the GAVI application will be in June. 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. CAMBODIA 18/06 from Osman Mansoor, WHO/WPRO: * Dr. Rosemary Lester (WHO/WPRO Consultant) visited to assist in the planning for the country's Immunisation Services Strengthening application. * Drs. Richard Duncan and Gordon Larsen visited to advise on cold chain needs. 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 18/06 from West and Central Africa Regional Working Group: Technical assistance scheduled in late June, early July 2001 for EPI review. 22/08: Requested to resubmit proposal. CHAD 18/06 from West and Central Africa Regional Working Group: Need EPI review and multi year plan. 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. COMOROS CONGO 18/06 from West and Central Africa Regional Working Group: Technical assistance by WHO scheduled in October 2001 for EPI review. IVORY COSTE22 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 18/06 from South East Asia Regional Working Group: * A consultant from Pakistan will visit for three months, starting May 2001 to assist with writing the multi year plan and GFCV application. The RWG are in the process of identifying a consultant to review the existing data on HepB and draft a plan of action for its introduction into the EPI routine programme. Planning to apply for both sub-accounts before the end of 2001. * A short term consultant/medical officer is expected in July for assistance with the HepB plan of action. * Hib rapid assessment is scheduled for October 2001 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 18/06 from Rudi Eggers, WHO/AFRO: Injection safety analysis to be carried out from 2 to 7 July 2001. 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. 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 18/06 from Denis Maire, WHO/EURO: Aiming to resubmit applications for Immunization Services and New Vaccines for the 5th round of applications in October 2001. 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 18/06 from South East Asia Regional Working Group: Need long-term consultant to assist in the implementation of phased introduction of hepatitis B vaccine into routine EPI. India will apply only for the New Vaccines sub-account, but will use World Bank funds to strengthen its immunization services. A HepB vaccine introduction advisor is expected in August 2001. INDONESIA 18/06 from South East Asia Regional Working Group: * Coordinated by PATH/CVP, a team of international and local consultants conducted the national level EPI review and assisted in the drafting of MYPoA in June. * Provincial level review of an initial two provinces is scheduled for July/August. * Expected to submit a GFCV application in October 2001. 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 18/06 from European Regional Working Group: Technical assistance scheduled for June 2001 for Cold Chain and Injection Safety review. 27/10: Application for support for New Vaccines approved. LAO PDR 27/10: Application for support for New Vaccines approved. LESOTHO 18/06 from East and South Africa Regional Working Group: Technical assistance scheduled in July 2001 to review multi year plan. 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 18/06 from Osman Mansoor, WHO/HQ: A meeting of partners and EPI met on 15th June In Mongolia and agreed to recommend to the Ministry to establish an ICC. They will also make an application for Hib disease burden assessment. 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 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 18/06 from South East Asia Regional Working Group: * Two consultants are in place for nine months to assist with the GFCV application. Expected to apply for both sub-accounts before end 2001. International consultant identified to help the local consultant for six months, but currently awaiting government clearance. Need long-term consultant to assist in the implementation of GAVI activities in the initial phase of funding. * Four teams of international and local consultants are currently conducting an EPI review in four different regions of the country. * An Immunization Advisor will be in place by July 2001. NEPAL 18/06 from South East Asia Regional Working Group: * Two consultants have been identified to work on the financial sustainability plan and assist in finalizing the EPI review and the multi year plan of action for resubmission. They are currently awaiting government clearance. Need long-term consultant to assist with the implementation of GAVI activities for the initial few months of funding. Planning to apply for the ISS sub-account to improve its EPI. Re- submission planned for October 2001. * A short term consultant is expected in July 2001 to finalize the Plan of Action and review. An Immunization Advisor is expected in September 2001. NICARAGUA NIGER 18/06 from West and Central Africa Regional Working Group: Need technical assistance for multi year plan and injection safety assessment. 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. PAKISTAN 18/06 from Ezzeddine Mohsni, WHO/EMRO: An STC (Dr. Steve Hadler) has been recruited from 1-29 July, to assist the MoH in introducing HepB vaccine, as well as in preparing to receive and utilize GAVI funds for strengthening routine immunization. Still seeking a longer term consultant for assistance in HepB vaccine introduction, immunization services improvement, and Hib RAT disease burden assessment and introduction. 11/05 from WHO/HQ: Application for Immunization Services Strengthening support Approved. 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 18/06 from Robert de Wolfe, PATH/CVP: Drs. De Wolfe and Da Silva visited in May for technical assistance to help complete GAVI application. 11/05 from GAVI Secretariat: Technical assistance has been requested by Senegal to assist with the reformulation of their application. 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 18/06 from Ezzeddine Mohsni, WHO/EMRO: Planning to send 1-2 consultants during the fourth quarter of 2001 in order to assist in preparing the documentation for the GAVI application. 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 18/06 from South East Asia Regional Working Group: * Need advocacy workshop on introduction of Hepatitis B vaccine for the scientific community and policy makers. * Dr. Susan Goldstein from CDC will visit Sri Lanka from 3-17 August to assist the MoH with drafting the HebB introduction plan for the GFCV application. She will be joined by Dr. Xu from the EPI office in the Chinese Academy of Preventive Medicine in Beijing. 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. TAJIKISTAN: 11/05 from WHO/HQ: Application for Immunization Services Strengthening support Approved. 16/03: 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. 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. 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. ZAMBIA 18/06 from Rudi Eggers, East and South Africa Regional Working Group: Drs Rudy Eggers and Emmanuel Taylor visited in April tp incoroporate final touches to the GAVI re-application. 11/05 from WHO/HQ: Application for Immunization Services Strengthening Support resubmitted and New Vaccines (DTP-HepB-Hib) submitted in 4th round. 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 18/05 from West and Central Africa Sub-Regional Working Group: West and Central Africa RWG met for the first time as a Sub-Regional Group on 19 May in Abidjan, IVORY COSTE. A brief summary of proceedings and recommendations follows: * The joint feedback analysis on the countries' monthly reports prepared by the Inter-Country EPI and EMC teams was presented to the group. The group recommended that countries table this report for discussion by their Inter- Agency Committees. * Given the lack of information on implementation of social mobilization activities in countries, it was decided that a workshop should be organized with experts from different agencies working at country level in the sub- region i.e. WHO ICP, UNICEF regional office, BASICS, CVP, Red Cross. * The group recommends that clear guidelines and the basic principles as they apply to those able to benefit from GFCV funds should be disseminated and adhered to. * In the previous meeting, it was noted that there were possible negative effects from excluding countries with high vaccine coverage from benefiting from the GAVI initiative. The coverages were by far lower than those usually declared by the country from administrative data. The AMP/CVP team is invited to review the quality of the current analysis with the national responsible to guarantee the reliability of results. * Following the presentation on the plan of training on GAVI process, the group recommends: i) that the current tools be used in their present form, for training to take place as soon as possible ii) two workshops are to be organized, one in GIMPA (Ghana) for Ghana, Liberia, Sierra Leone and The Gambia, and the other one in the IIAO BASSAM, Ivory Coast, Mali, Burkina Faso, Senegal, Togo, Cameroon and Benin iii) that these workshops take place during the first two weeks of August. The partners (CVP, WHO and UNICEF) will share costs temporarily. Modibo Dicko should present the budget to the TFCC for possible financing. * The group decided to work towards the common objective of supporting the construction of incinerators in countries * The lead country project was presented to the participants who supported the concept, and expressed the wish for the group to be increasingly consulted on the implementation of these initiatives * The idea of conducting an evaluation of the GAVI Process in one or two countries of the block was shared. It was suggested that the TFCC leads this evaluation during the training to be held on the GAVI process during the first two weeks of August 2001. * The next meeting will be held on 9 June in Abidjan . 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 with 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 18/06 from Julie Milstien, WHO/HQ: The Eastern Mediterranean Regional Working group will be meeting on 28 June in Dubai (UAE). Their agenda includes updates about GAVI initiatives and process, briefing on the conclusions of the TFCC Core Group and Immunization Finance Sustainability meetings, country EPI experiences (from Pakistan, Yemen and Sudan), strategies for Measles and MNT elimination and a brief regional overview on new vaccines introduction. 18/06 from Eastern Mediterranean Regional Working Group: Meeting of the RWG for GAVI EMRO region - the GAVI initiative was strongly supported by the EMRO region since it will permit a strengthening of the EPI programme in six countries which have been lowering the regional coverage figures for the area, since they account for 47% of the total population of the region. Of these countries, three have submitted proposals for GFCV support last year (Pakistan, Yemen and Sudan). Only one of these (Pakistan) has been approved for HepB vaccine introduction. The RWG members raised three issues: i) How to support countries that are not eligible for the GFCV and which do not need external resources? And how to address the issue of some vaccine-preventable diseases such as meningococcal meningitis which is highly prevalent in some member states? ii) What will happen to countries which have support for immunization services sub-account and who rapidly succeed in reaching coverage figures of more than 80%? Will the support go on or will it be terminated? iii) How to monitor sustainability and assess achievements? Other points discussed include: * the RWG should play an active role in dissemination of information about GAVI to all members states and not only the GFCV eligible ones * the role of, and relation between, the RWG and the regional ICC needs to be clarified. These two regional bodies are likely to merge in the future, but participants recommended keeping them separate for the time being * the RWG members indicated some concern regarding the methods for monitoring activities supported by GFCV and future sustainability of these activities after the termination of GFCV support. They stressed the point that one of the major roles of WHO and UNICEF country offices is to assist nationals to take the steps necessary to ensure sustainability. They also recommended developing guidelines and indicators related to this issue. * WHO and UNICEF country office staff are responsible for briefing all bilateral partners at the country level about GAVI initiatives to ensure optimal coordination between them and effective participation in the process at country level. 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 18/06 from European Regional Working Group: The next EURO GAVI Working Group meeting will take place on June 28th in St. Petersburg (Russian Federation) after the EURO meeting on HepB organized jointly with WHO, VHPB, CVP, CDC, and UNICEF. The agenda will cover updates on country support activities including the results from the 4th applications, future plans for support, specific country activities, and presentation of the Inception Report Template for follow up on HepB introduction. 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 18/06 from Abdulaziz Adish, WHO/SEARO: WHO-SEARO had its Quarterly RWG meeting and the following meeting objectives were covered: * Briefing on injection safety assessment planned in Bangladesh, Myanmar, Nepal and India * Briefing on the development of the Joint SEA/WP RWG concept paper on Japanese Encephalitis * Review of the TFCC core-group meeting report and responding to two action points concerning RWGs * Discussion on the strategic framework for assessing strengthening capacity of NIP * Discussion on the ToRs and assignment of Immunisation Advisors * Identifying and securing government concurrence from two countries to take part in the implementation of the strategic framework for Capacity Building: Bangladesh and Nepal * Status of GAVI applications in member countries * Mapping out GAVI activities for the 3rd quarter of 2001 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. The next meeting 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. ____________________________________*______________________________________