POST00395E GAVI UPDATE 27 November 2001 Hemanthi Dassanayake from WHO kindly shared with us the following GAVI update of 20 November 2001. ******************* ADVOCACY TASK FORCE ******************* 20/11/01 from Heidi Larson, GAVI Advocacy Task Force: The Advocacy Task Force had a productive joint meeting with the Polio and EPI Communications Advisory Group meeting in Harare, Zimbabwe, on 6-9 November. The objective of the joint meeting was to work towards integrated communications plans addressing polio, EPI and introduction of new vaccines. ****************************************** COUNTRY COORDINATION and TECHNICAL SUPPORT ****************************************** 20/11/01 from the Task Force on Country Coordination: 13 November Conference Call: TFCC Analysis: The recommendations of the TFCC Analysis were discussed and generally endorsed by the Core Group. The TORs for the TFCC will be revised before drafting the 2002 workplan. The following revisions will be reflected: * Devolution of country coordination activities to RWGs with strengthened capacity of TFCC as a 'think tank' * Shift of focus from issues related to application submission to implementation, with main areas of TFCC work addressing health sector reform, monitoring and evaluation and capacity building * TFCC renamed to better reflect its mandate * Membership of TFCC will be reviewed once TORs are revised to ensure that appropriate experience and skills set exists within the group to address new tasks * Full TFCC meeting to be discontinued and issues incorporated into GAVI partners meeting where appropriate * Co-chairing mechanisms of global Core maintained, supported by a well resourced secretariat and a full time TFCC coordinator * Activities organized through sub-committees assembled for specific short-term projects or to address strategic longer range issues (as in the case of Mid-Term Review, or Shares Option Group's position papers) * In the case where sub-committees are active on a project, Core bi-weekly phone calls will be discontinued with sub-committees reporting to the Core on a monthly basis * The "new" TFCC Core will meet routinely every six months GAVI Monitoring & Evaluation Calendar: A small sub-group met in November 2001 in Geneva to discuss overall M&E issues on the GAVI calendar, purpose of such instruments and linkages (core indicators, MTR, DQA, Annual Report). This topic will be discussed in the Working Group meeting to be held 29-30 November in Seattle. The sub-group has mapped out the existing M&E instruments, corresponding issues and drafted recommendations for consideration to move forward. Shares Options Group (SOGs) Paper: The SOGs paper has been completed and will be presented to the Working Group on 29-30 November 2001. ******************** FINANCING TASK FORCE ******************** 20/11/01 from Violaine Mitchell, GAVI Financing Task Force: The FTF Forum has been rescheduled for 23-24 January, 2002 in Washington D.C. If you are interested in attending and/or copied on meeting briefing materials, please contact Violaine Mitchell ([[email protected]][email protected][/email]). The FTF participated in the East and South African RWG meeting in Entebbe, Uganda, and had a full day session on financial sustainability. Meeting participants provided the FTF with valuable input on the draft GAVI guidelines for the preparation of financial sustainability plans and the proposed financing indicators. Based on feedback from the Entebbe meeting, plus comments received during the GAVI FTF's "Virtual Forum" (a web-based information exchange established), the draft GAVI guidelines for the preparation of financial sustainability plans have been revised and are now available for comment. A French translation of the guidelines will be available by the end of November 2001. Over the next few months, the guidelines will be pre-tested in two countries to determine if the guidelines are sufficiently comprehensive, flexible, practical, and clear; and whether the plans resulting from the application of the guidelines are likely to be feasible and adequate. The FTF proposes to submit final draft guidelines for the preparation of financial sustainability plans to the GAVI Board by April 2002. The revised guidelines and additional information from the FTF are currently available on the following site: http://www.gaviftf.com Click on FTF Forum User Name: forum Password: 001vac100 ****************************** NEW AND UNDERUTILIZED VACCINES ****************************** 20/11/01 from Gill Mayers, WHO/HQ: Presentations and documents from the meeting held in St. Petersburg, Russian Federation from 24-27 June 2001 on "Strengthening Immunization Systems and Introduction of Hepatitis B vaccine in Central and Eastern Europe and the Newly Independent States" are now available on the internet under the following site: http://www.vhpb.org The meeting was a joint initiative of Centres for Disease Control (CDC), Bill and Melinda Gates Children's Vaccine Program at Program for Appropriate Technology in Health (CVP/PATH), Global Alliance on Vaccines and Immunization (GAVI), United Nations Children's Fund (UNICEF), Viral Hepatitis Prevention Board) VHPB, and World Health Organization (WHO). The purpose of this web-site is to share information available in order to prolong and maximize the impact of the successful meeting. ******************************* IMMUNIZATION DATA QUALITY AUDIT ******************************* 20/11/01 from Olivier Ronveaux, WHO/HQ: The Data Quality Audit (DQA) Testing Evaluation Meeting took place on 23-24 October 2001 in Geneva, Switzerland. Conclusions from the meeting: * DQA is a strong tool, which is useful and well-accepted * DQA can be used by countries to strengthen their system * The use of DQA in the GAVI process should be endorsed as soon as possible, based on the TFCC proposal * The ways under which the DQA will be used (frequency, use of verifiability factors, etc) will determine the direction of some improvements needed * Improvements needed to the DQA include methodological issues (statistical simulations, improvement to tool design, tool output), operational issues (advocacy-type guide), development of self-assessment tool, and implementation of tool's recommendations. **************************** COUNTRY SPECIFIC INFORMATION **************************** ARMENIA 20/11/01 from European Regional Working Group: Dr. Kuulo Kutsaw visited from 13-26 October 2001 to assist the MOH in preparing and conducting a national consensus meeting on measles, rubella and HepB. As a result of this activity, recommendations on various aspects of reinforcing the national immunization programme, strengthening surveillance of vaccine preventable diseases, elimination of measles, control of rubella/CRS and prevention of HepB were prepared and submitted to the MOH. AZERBAIJAN 20/11/01 from European Regional Working Group: Nation-wide training on SIP has been held in October 2001. ERITREA 20/11/01 from Dr. Andemichael, WHO/Eritrea: * First round of NIDs took place on 10-11 November 2001. * Second round is scheduled to be held on 22-23 December 2001, with Vitamin A supplementation. Dignitaries were present in the launching occasion which was in the capital, Asmara. * Injection safety assessment has been completed in September 2001, and major findings and recommendations were discussed with the Minister of Health, Mr. Saleh Meki, other officials, and partners including UNICEF. GHANA 20/11/01 from West and Central African Sub-Regional Working Group: GAVI funds received in December 2000. To date, funds have been used to procure motor bikes, computers, photo copiers, and to finance training, microplanning and data management. Observations made include: * Vaccine Fund is for infrastructure strengthening and not for recurrent costs * Checks through Internal Audits (Government) and External Audits (Partners) KENYA 20/11/01 from East and South African Sub-Regional Working Group: GAVI funds received in February 2001. To date, funds have been used to finance mobile and outreach vaccinations, vaccine distribution and collection, and data collection. Observations made include: * Performance contract agreed upon with districts * Misplaced expenditures identified * Financial audit system established KYRGYZSTAN 20/11/01 from European Regional Working Group: In 1999, the National Measles Elimination Programme was endorsed. In 2000, the programme was supplemented with the congenital rubella syndrome prevention target. As part of this programme, a catch-up measles/rubella national immunization campaign is implemented from 12-25 November 2001. Over 1,850,000 children and young adults aged 7-25 are planned to be immunized with MR vaccine. Other components of the programme are a follow-up rubella campaign for women of child-bearing age, introduction of a two-dose MMR routine childhood immunization and establishing effective case based measles/rubella/CRS surveillance. MALAWI 20/11/01 from East and South African Regional Working Group: Visit by Dr. Rose Macauley (WHO/AFRO) has been rescheduled for January 2002, to assist with introduction of pentavalent vaccine. MALI 20/11/01 from West and Central African Sub-Regional Working Group: GAVI funds received in January 2001. To date, funds have been used to finance micro-planning workshops for 5 districts and operations budgeted in microplans of 13 districts. Observations made include: * District microplans approved by ICC * Report on use of funds made to ICC quarterly * Performance contract signed with districts PAKISTAN 20/11/01 from Eastern Mediterranean Regional Working Group: Consultant will be appointed for 11 months to assist with the proper management of GAVI allocated resources. PAPUA NEW GUINEA 20/11/01 from the Asia Pacific Regional Working Group: The EPI review is currently taking place (13-21 November) in 10 provinces. The EPI assessment team consists of 13 International Consultants and 10 national consultants. Each province will have at least one international consultant and a national consultant nominated by the province. RWANDA 20/11/01 from East and South African Sub-Regional Working Group: GAVI funds received in October 2000. To date, funds have been used to finance National level planning workshop followed by district microplanning, and a review of 39 district microplans by ICC and Regional Directors. Observations made include: * Districts received 50% of funds allocated * Financial and technical reports expected for review by ICC TAJIKISTAN 20/11/01 from European Regional Working Group: * Mid-Level management EPI training course was conducted with support from WHO/EURO from 16-26 October. * More than 1,000 health personnel trained on cold chain management, SIP and calculation of vaccine coverage * First round of polio NIDs targeted at children 0-4 years of age was implemented on 8-12 October and second round on 12-16 November 2001. TANZANIA 20/11/01 from East and South African Sub-Regional Working Group: GAVI funds received in November 2000. To date, funds have been used to finance 22 national supervisors trained to support low performing districts, advocacy, microplanning workshops and outreach. Observations made include that funds have been allocated for EPI by Government through HIPC/PRSP Initiative, between 2000-2004. TURKMENISTAN 20/11/01 from European Regional Working Group: * The National Measles Elimination Programme was drafted in September 2001 and distributed for comments and finalization * Mid-Level Management EPI training course was conducted with support from WHO/EURO on 9-16 September 2001 * 24 training workshops on Adverse Events Following Immunization were held * First round of polio NIDs was implemented on 1-6 October 2001. The country reported that 98% of children 0-4 years of age were immunized. Second round was implemented on 5-10 November 2001. UZBEKISTAN 20/11/01 from European Regional Working Group: * The National Measles Elimination Strategy was drafted and discussed in October 2001. The national Plan of Action on implementation of the strategy is under preparation. * Mid-Level management EPI training course was conducted with support from WHO/EURO on 1-9 November 2001. * First round of polio NIDs implemented on 10-12 October 2001. It was reported that 99.5% of children 0-4 years of age were immunized. Second round was implemented on 12-14 November 2001. VIETNAM 20/11/01 from Asia Pacific Regional Working Group: * Vietnam is currently undertaking a series of regional and provincial workshops, co-funded by WHO, UNICEF and GAVI, in preparation for the introduction of GAVI-supported HepB commencing early next year. A training consultant is being provided to the national EPI there by an AusAID-funded project, to work with national and provincial staff to assure a high quality program of information dissemination to levels beyond the provinces. * In October 2001, Vietnam conducted a pilot campaign of measles vaccination targeting children aged 9 months to 10 years in selected remote districts in northern provinces. This is the third such pilot campaign, the last having been conducted in 7 selected provinces in December 2000. The campaigns are aimed at getting experience for the future conduct of a sub-national campaign in 2002, the goal of which will be to reduce the number of non-immune older children who remain susceptible to measles due to missed or failed immunization in infancy. * A WHO consultancy to determine progress on the recommendations of an earlier assessment of Vietnam's National regulatory Authority on vaccines and biologicals is taking place at present. ZIMBABWE 20/11/01 from East and South African Sub-Regional Working Group: GAVI funds have not yet been received. Activities to be funded include 3 rounds of Local Immunization Days (LIDs) in low performing districts (to be held annually) and training on immunization. The MOH has advanced own money to EPI to commence preparation of LIDs. ******************* REGIONAL ACTIVITIES ******************* AFRICA REGIONAL 20/11/01 from Chris Nelson, WHO/HQ: The first meeting of the AFRO Francophone Hib/Pediatric Bacterial Meningitis Surveillance Network was held on 5-9 November 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. This activity brought pediatricians, microbiologists and data managers from the largest Pediatric ward in each Francophone country together with MOH EPI, WHO EPI and national public health laboratorians for bacterial meningitis surveillance training, including field and laboratory components. 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 100 participants from 15 Francophone countries. This follows the meeting in June 2001 of AFRO Anglophone countries. AFRICA EAST & SOUTH 20/11/01 from East and South African Sub-Regional Working Group: The next East and South African Sub-Regional Working Group meeting will be held in Lusaka, Zambia from 18-20 February 2002. 20/11/01 from East and South African Sub-Regional Working Group: The East and South African SRWG met in Entebbe, Uganda from 8-10 October 2001. The summary of recommendations from the meeting are as follows: Country, Regional and Global: * Countries planning to move from tetravalent to pentavalent vaccine are encouraged to submit their new applications to GAVI Secretariat, bearing in mid that the pentavalent vaccine will not be available till 2003. Significantly increased vaccine storage space is required for pentavalent vaccine. * Countries introducing new vaccines should collaborate in the regional effort to document country experiences with new vaccine in order to derive lessons that can be used by other countries and with future vaccine introductions * Care-givers should be fully informed on content and benefit of new vaccines that children receive * UNICEF and national EPI programmes should monitor the delivery of new vaccine supplies in national stores in order to avoid unforeseen under- or over-stock of DTP prior to introduction of new vaccines into routine schedule * WHO and UNICEF Regional and Sub-regional officers are requested to provide detailed guidelines to avoid vaccine wastage * WHO and UNICEF requested to provide guidelines on district level training on several topics including programme and financial management, logistics, etc. Countries are encouraged to use these guidelines to adapt their own training material to ensure improved quality of management at district levels Monitoring Implementation and Reporting Requirements: * ICCs are requested to review the need, recruitment, and TORs and placement of Immunization Advisors at the country level * GAVI Secretariat should copy all correspondence with MOH to country level partners * Countries should have the option of going for a full, traditional programme review at the same time of the Mid-Term Review, to promote country ownership * Requested that the group working on rationalization of indicators consider a communications indicator to be included among key indicators * In-country review missions should include a communications specialist * East and South African SRWG requested to attract participation and support of all EPI partners operating in this area. * Should also support implementation of EPI activities and disease control interventions in countries in support of local ICCs Advocacy & Social Mobilization: A Social Mobilization Technical Group should be created within the ESASRWG similar to the one established for the West and Central Africa Sub-Region. This group should work under the auspices of the ESASRWG and provide expert technical input on advocacy and social mobilization issues. Proposed Corrective Actions Policies, Technologies and Strategies: * Countries should adopt/implement policies that will facilitate good vaccine management practices that will result in reducing vaccine wastage as well as increasing access and immunization coverage. Can include the implementation of multi-dose vial policy, effective use of VVMs and better cold chain practices. * Cold chain equipment should be selected from standardized, approved catalogues such as WHO Product Information Sheets. EPI programmes must be involved in the choice and maintenance of cold chain equipment. * Partners should assist countries to conduct comprehensive cold chain and transport inventories as a preparatory step before training or equipment restocking Financial Sustainability Issues: * In countries that are undergoing Health Sector Reform and that are operating within Sector Wide Approach frameworks, efforts to improve and sustain programmes such as the GAVI support must be done in a manner that acknowledges existing in-country funding contexts * ICCs needs to provide more concerted advocacy of the value of immunization and vaccines and most particularly in Ministries of Finance * ICCs need to explore longer-term commitments to immunization rather than project-based financing, and mobilize financial resources within the country from the public and private sectors and additional partners * The FTF should revise global and national financial sustainability indicators AFRICA WEST & CENTRAL 20/11/01 from West and Central African Sub-Regional Working Group: The next West and Central African Sub-Regional Working Group meeting will be held in Abidjan, Cote d'Ivoire on 24 November 2001. The preliminary agenda includes: * Presentation on the financial sustainability of EPI * Strengthening social mobilization * Vaccination coverage data quality audit * Contribution of partners to the functioning of the Group 20/11/01 from West and Central African Sub-Regional Working Group: The West and Central African Sub-Regional Working Group met in Abidjan, Cote d'Ivoire on 27 October 2001. The summary of proceedings and recommendations from the meeting are as follows: Yellow Fever situation in Cote d'Ivoire/Sub-Region: * There is no longer a problem of vaccine availability. A Brazilian manufacturer has been pre-qualified by WHO and will be capable of producing approximately 20 million doses per year which can cover the required quantity. * Efforts need to be made for effective introduction and strengthening of Yellow Fever vaccine in routine EPI Training on GAVI Process: * Training programme should be made available as early as possible * Training to be discussed at the next GAVI meeting * Training programme be used to revisit discussion on the training of members of the ICC Preparations for Measles Campaigns: * A coordinator has been recruited in the federation to follow up on these activities in the 5 countries, and will focus attention on social mobilization using volunteers * The Group made recommendations on the flow of information to Red Cross Societies in countries regarding measles control strategies. The next meeting on Hib surveillance in Johannesburg will be used to discuss with the countries and develop daily plans of implementation of these campaigns. Partners are invited to participate. EASTERN MEDITERRANEAN 20/11/01 from Eastern Mediterranean Regional Working Group: The third Eastern Mediterranean Regional Working Group meeting will be held on 20 December 2001 in Cairo, Egypt. SOUTH EAST ASIA 20/11/01 from South East Asian Regional Working Group: The South East Asian Regional Working Group met in New Delhi, India on 22 October 2001. Meeting minutes will be available shortly. WESTERN PACIFIC 20/11/01 from Asia Pacific Regional Working Group: The next Asia Pacific Regional Working Group meeting will be held in Laos PDR on 3 December 2001, preceding the ICC meeting of 4 December 2001. The main aim of the RWG meeting is to meet and support the ICC and finalize workplan for 2002. 20/11/01 from Asia Pacific Regional Working Group: A regional immunization safety officer responsible for Vietnam, Laos, and Cambodia has recently taken up his post at the WHO office in Hanoi. -----------------------------------------------------------------------------