POST 00278 : GAVI GUIDELINES FORMS + VAX INTRO + UPDATES

Post00278 GAVI GUIDELINES FORMS + VAX INTRO + UPDATES 20 September 2000 CONTENTS 1. REVISED GAVI APPLICATION FILES AVAILABLE FOR DOWNLOAD 2. WHO & ACCELERATED VACCINE INTRODUCTION 3. DOWNLOAD GUIDELINES AND FORMS: ASSESSMENT OF IMMUNIZATION SERVICES 4. GAVI & GFCV INFORMATION UPDATE 8 SEPTEMBER 2000 Moderators Note: Welcome to all subscribers! The moderator is back from the field and beginning to catch up. This post should have gone out a few weeks ago but field activities took priority. Apologies! * In the field I've seen the all too usual mix of unsafe injection practices and frozen DPT vaccine. GAVI partners and grant applicants should take note of the risks of not fully addressing these critical aspects of immunization systems. Please send your contributions to: [[email protected]][email protected][/email] The moderator will be on line for a long time now, and will deal with subscriber email with the usual online promptness! regards and best wishes, allan ____________________________________*______________________________________ 1. REVISED GAVI APPLICATION FILES AVAILABLE FOR DOWNLOAD Go to the website ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/GAVI/ GAVI-CVF-GuidelinesDirectivesAugust2kFRENCH.doc 462kb GAVI-CVF-ProposalFormAugust2kFRENCH.doc 219kb GAVI-Form Rev1august15.doc 195kb GAVI-Form Rev1august15.doc.doc 195kb GAVI-FormsRev1august15English.PDF 165kb GAVI-GuidelineAugust2000-French.zip 165kb GAVI-GuidelinesAugust2000English.zip 96kb GAVI-GuidelinesRev1august15.doc 113kb GAVI-GuidelinesRev1august15English.PDF 84kb or send an email to: [[email protected]][email protected][/email] with the message: get technet GAVI-GuidelineAugust2000-French.zip get technet GAVI-GuidelinesAugust2000English.zip Rev 1. 15 August 2000 Global Alliance for Vaccines and Immunization (GAVI ) and the Global Fund for Children's Vaccines (The Fund) Guidelines on Country Proposals for Support to Immunization Services and New and Under-used Vaccines 1. Executive summary * The Global Alliance for Vaccines and Immunization (GAVI) is hereby inviting proposals from countries for support from the Global Fund for Children's Vaccines (the Fund). * National governments of countries with GNP/capita equal to or below US$1,000 are eligible for support from the Fund, according to the non- competitive terms outlined in this document. * Current Fund resources have been budgeted to reach the objective of providing all eligible countries with five years of funding support from the start of funding of the country proposal. The Partners of the Alliance recognise the need for sustained support and will work with countries to find additional resources to improve immunization services that contribute to better overall health systems. In addition, GAVI Partners are taking steps to extend the Fund beyond five years to enable new vaccines that are currently under development, to be introduced. * GAVI will invite country proposals for support from the Fund in successive rounds for the next two years. Closing dates for country proposals for the next rounds will be 15 October 2000, 15 January 2001 and 1 April 2001. Further rounds will follow. * The three basic conditions for support are: a functioning Inter- agency Co-ordination Committee (ICC) or equivalent collaboration mechanism; an assessment of immunization services during the three last years; and a multi-year plan for immunization. Efforts to improve the safety of immunization and to plan for sustainable financing of immunization also need to be documented. It is anticipated that the role of national ICCs will grow to provide support to governments in their immunization planning and monitoring efforts. * Currently the Fund provides support from two sub-accounts: for immunization services and for new and under-used vaccines. * Countries with DTP3 coverage below 80% will be considered for funding from the sub-account for immunization services. A strict and transparent system of performance monitoring with output indicators at district level will be applied. * Countries with DTP3 coverage above 50% will be considered for support from the sub-account for new and under-used vaccines. In this initial phase, vaccines for hepatitis B (hepB), Haemophilus influenzae type b (Hib), and yellow fever will be available from the Fund, together with related safe injection equipment. * Countries with current DTP3 coverage below 50% that wish to introduce the new vaccines are encouraged to initially focus on improving their systems for delivering vaccines by seeking support from their country Partners, and from the sub-account for immunization services. * Country proposals should be developed in close consultation with technical and financial Partners committed to health and immunization programs, following the guidelines in this document and be forwarded to the GAVI Secretariat on the enclosed form, with selected documentation attached. ____________________________________*______________________________________ 2. WHO & ACCELERATED VACCINE INTRODUCTION From: http://www.who.int/vaccines/aboutus/newweb/accelerated_vaccine_introduction.htm Contributions, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ ACCELERATED VACCINE INTRODUCTION Important vaccines, which could prevent millions of deaths a year, are not being used in the developing world. In this project, the WHO Department of Vaccines and Biologicals (V&B) will pursue a series of critical activities to accelerate the introduction of specific vaccines, thereby developing the infrastructure, capacity and collaborations necessary to make new vaccine introduction an integral part of global immunization practice. The ultimate goal is the timely introduction of vaccines of public health importance into the developing world. CHALLENGES The biotechnology revolution is providing us with a number of new vaccines to prevent infectious diseases. However, while these vaccines are being rapidly adopted in the developed world, they are only slowly being introduced into developing countries. The gap in protection provided by vaccines between developed, and developing countries is widening. Several major obstacles currently impede the rapid introduction of import vaccines in developing countries. 2.1. Efficacy data on several new vaccines exists for developed, but not for the developing world. 2.2. The burden of disease caused by certain infections is unknown in much of the non-industrialized world. 2.3. The cost effectiveness of many vaccines is unclear for many regions and countries 2.4. The demand for new vaccines, especially in the developing world, is not well quantified, and thus supply may lag. 2.5. Recommendations for production and control of new vaccines are not available. 2.6. Funding sources and funding mechanisms for additions to national immunization programs are not available or have not been identified. 2.7. Plans to prioritize new vaccine introduction have not been developed for several regions and most countries. 2.8. Technical assistance and guidelines for new vaccine introduction is limited. Failure to address these issues effectively will lead to further delays in introduction of a series of vaccines. Four vaccines which either are already available (hepatitis B and Haemophilus influenza type b) or will soon be available (pneumococcal and rotavirus vaccines) can prevent between three and four million deaths a year worldwide if used widely. Most of these deaths occur in the developing world. Every year lost in introduction directly leads to a staggering number of deaths. STRATEGY WHO's unique position enables it to influence new vaccine introduction at several critical points. The goal of the project is to develop the infrastructure necessary to facilitate introduction of new vaccines for important public health problems into the developing world, thereby making the process of introduction a routine part of immunization systems. An effective infrastructure will be built to address critical problems along the continuum of vaccine development and introduction. These include activities in the following areas: 3.1. Coordinating vaccine development and implementation for developing countries. 3.2. Establishing efficacy of new vaccines in developing country settings. 3.3. Clarifying disease burden and vaccine cost-effectiveness 3.4. Developing recommendations for the production and control of new vaccines 3.5. Identifying and promoting new mechanisms and sources of financing. 3.6. Providing technical expertise to support regional and country planning and introduction. OBJECTIVES The specific objectives of the project can be categorized within the following strategic areas: Coordination of vaccine development and implementation Vaccine introduction requires the involvement of a wide range of partners, including industry, international organizations, national immunization personnel, and others. Global coordination of immunization efforts for specific diseases will be effected in a collaborative process with partners. For major new vaccines explicit agendas for action will be developed. 4.2. Vaccine efficacy Efficacy of pneumococcal conjugate vaccines for pneumonia morbidity and mortality will be evaluated by 2003. 4.3. Disease burden and cost effectiveness Disease burden estimates for pneumococcal, Hib, rotavirus and hepatitis b will be available for use by regions and countries by 2000, and revised estimates based on ongoing burden studies by 2002. Cost effectiveness data and methods will be made available to regions and countries for prioritization of vaccine needs by 2000. 4.4. Recommendations on production and control of Hib conjugate vaccines will be available by 1999. Recommendations on production and control of Hib conjugate vaccines will be available by 1999. The process of development of recommendations on pneumococcal will be initiated by 1999. Financing and supply National vaccine supply plans will have been developed in 30% of all band A and B countries by 2000. New financing mechanisms will be in place in A and B band countries by 2000. Hepatitis b vaccine will have been introduced in 40% of band A and B countries with 70% coverage by 2000. Hib conjugate vaccine will be introduced in five band A and B countries by 2000. INTRODUCTION Develop five and ten year prioritization plans for new vaccine introduction (including hepatitis b, Hib, pneumococcus and rotavirus vaccines) for regions by 2000, and countries by 2001. Provide technical support to countries by: developing generic introduction guidelines developing introduction and financing plans monitoring impact Reaching out New vaccine introduction requires action of a wide variety of partners in immunization, including industry; international organizations such as UNICEF, the World Bank, WHO and IVI; PATH; Bill and Melinda Gates Children's Vaccine Program (CVP), national development agencies including JICA; USAID, CIDA and others such as CDC. Most critically, the countries involved must make the essential decisions to adopt, and implement additional vaccines on a national level. WHO will play both a coordinating role, and in the areas noted above, provide technical input and guidance, but must work closely with its partners if the ultimate goal of timely introduction of vaccines is to be achieved. ____________________________________*______________________________________ 3. DOWNLOAD GUIDELINES AND FORMS: ASSESSMENT OF IMMUNIZATION SERVICES The Guidelines and Forms for the assessment of immunization services are available for download on the web at: http://www.who.int/vaccines-access/Restructuring/Vaccines/vaccinesindex.html * If Technet Forum subscribers request copies via the Technet Forum, the moderator will make them available via email and ftp. Please let us know! Contributions, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ ASSESSMENT OF IMMUNIZATION SERVICES PURPOSE OF THE GUIDELINES The purpose of these guidelines is to describe a methodology for collecting data on the strengths and weaknesses of immunization services, how they can be improved, and how improvements can be sustained. These data can be used in planning to: Increase the accessibility and use of routine immunization services, especially for people who are not now reached; Improve the quality of immunization services; Introduce new vaccines and new technologies in countries that have the capacity to integrate them; Ensure adequate and reliable financing of immunization services; and, Support health system development. Assessments carried out under these guidelines should provide sufficient information to develop or update national plans or to prepare proposals for securing the support of partners. INTENDED USERS The guidelines are primarily for: National managers who are responsible for planning, implementing, and evaluating immunization services. Partners that provide financial, technical, or other assistance. With adaptation, local health workers and sub-national staff can use them for assessing day-to-day operations and resource management in their areas of responsibility. WHY THESE GUIDELINES ARE NEEDED * The environment in which immunization services operate is changing. Health system structure, the location of authority and responsibility, and the mix of public and private participation are changing significantly in many countries. The methodology proposed in these guidelines examines the health system and the external environment in which immunization services operate as well as the services themselves. * New vaccines and technologies are available. As new vaccines and technologies become available, the need increases to assess the readiness of existing services to introduce and sustain such innovations. * Disease control goals must be met. Polio eradication, neonatal tetanus elimination, and yellow fever and measles control goals require new strategies and improved execution of old ones. The capacity of existing services must be assessed to determine whether disease control plans can be implemented. * A common assessment tool is needed. Health sector officials, managers of services, development partners, and non-governmental organizations have asked for a common assessment tool to identify where improvements are needed. They seek agreement on what the needs are in order to plan individual and joint inputs. Download the documents (in MS Word format) on methodologies without the Health Systems component Booklet 1 - Methodology Booklet 2 - Advance Team Instructions Booklet 3 - Data Collection Worksheets (National Level) Booklet 4 - Data Collection Worksheets (Sub-national Level) Booklet 5 - Data Collection Worksheets (Service Delivery Level) Booklet 6 - Basic Questions (Service Delivery Level and Sub-national Level) Download documents (in MS Word format) on methodologies with the Health Systems component Booklet 1 and HSR - Methodology Booklet 2 and HSR - System approach to immunization assessment and plan of action Booklet 3 and HSR - Data Collection Worksheets (National Level) Booklet 4 and HSR - Data Collection Worksheets (Sub-national Level) Booklet 5 and HSR - Data Collection Worksheets (Service Delivery Level) "The Immunization Services Assessment Guidelines now have two forms, with and without a Health Systems Component. * We would therefore appreciate your comments and feedback. Please contact Carol Francis, e-mail: [[email protected]][email protected][/email]. Thank you." ____________________________________*______________________________________ 4. GAVI & GFCV INFORMATION UPDATE 8 SEPTEMBER 2000 Contributions, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ From: [[email protected]][email protected][/email] Date: Thu, 14 Sep 2000 13:24:51 +0200 Subject: GAVI & GFCV Information Update Please find herewith the Information Update on country-level GAVI and GFCV-related issues. Please send any information you would like included in this fortnightly update directly to me. Gill Mayers Technical Officer World Health Organization HTP/V&B/EPI Tel: 00.41.22.791.4674 Fax. 00.41.22.791.4193 [email protected] ___________________________________________________________________________ UPDATE ON COUNTRY-LEVEL GAVI & GFCV RELATED ACTIVITIES As at 8/9/00 Update since last issue highlighted *** with date of update GENERAL NOTE ON THE GFCV APPLICATION PROCESS The country activities listed below are those which have been initiated by various Partners of the Alliance. The application process is an ongoing one throughout the year, the 1st July deadline was for the first round of application reviews. Applications received by 15 October will be reviewed during November. An additional application and review session has been scheduled for the end of January to review those applications submitted by the 15 January deadline for, amongst others, those countries in West Africa participating in the coordinated Polio NIDs in September/October to ensure their attention is not diverted from the Polio Eradication Initiative by efforts to meet the 15th October deadline. REVIEW PROCESS: 22/08 from WHO/HQ: Of the applications reviewed, following is a summary of the results of the requests for assistance. Those applications that received "Approval with Clarification" need to provide accurate coverage data and other information by 1 September 2000, upon satisfactory receipt of which approval will be granted. Those that received "Conditional Approval" need to provide extensive additional information by 1 October 2000 and an independent review committee will then reassess these proposals. Immunization Services - 8 Approval with Clarification New Vaccines - 10 Approval with Clarification, and 4 Conditional Approval. A total of 10 other applications were requested to be resubmitted by 15.10.00 or 15.1.01. 18/07from WHO/HQ: Applications for assistance from the GFCV were received from a total of 24 countries: Bhutan, Cambodia, Central African Republic, Chad, C?d'Ivoire, Ghana, Guinea, Guyana, Haiti, Kenya, Kyrgyzstan, Lao PDR, Liberia, Madagascar, Malawi, Mali, Mozambique, Pakistan, Rwanda, Sierra Leone, Sudan, Tanzania, Yemen, Zimbabwe. The GAVI Secretariat and GAVI Working Group learned through the review process that amendments need to be made to the Guidelines for Applications, and to the Application Forms themselves in order to clarify certain aspects that led to problems in the application process. These are being distributed during August and can be obtained from [[email protected]][email protected][/email]. Letters were sent at the beginning of August to all those countries that applied in the 1st tranche informing them of the Review Committee's recommendations, and the GAVI Task Force for Advocacy will be scheduling official announcements at the country level. COUNTRY COORDINATION: *** 08/09 from GAVI Secretariat: At the 7-8 September consultation with countries approved for immunization services support (detailed below), consensus was reached on the following: The preferred option is that immunization services support be channelled directly to the respective government/ministry of health, with subsequent disbursements to district-level operations. For those countries without systems for this type of financial management of funds already in place, WHO and UNICEF country offices will assist in the channelling of funds and in supporting the countries to establish the required capacity. These countries should approach the appropriate partners to agree on the required assistance and consequent mechanism for channelling the financial support Subject to the approval of the GAVI Board on 11 September 2000 a formal letter will be forwarded to the Ministers of Health of the countries concerned. All countries should formally communicate the requested channel as well as necessary administrative information. 22/08 from WHO/HQ: The GAVI Secretariat is organising the "Consultation with ICC, WHO and UNICEF on GAVI Cooperation" to be held in Geneva from 7-8 September. Invitations have been issued to WHO and UNICEF Representatives and the ICC Chairpersons from the eight countries whose applications for support for strengthening immunization services were approved. Objectives of the consultation include: ensuring that all partners involved in the GFCV application process for support for immunization services understand and work together on the best solution for disbursement of funds on a country-by-country basis; ensuring close collaboration at the country level between ICC members to facilitate optimal implementation of funds; and fostering high-level political links at the country level to contribute to the overall objectives of the project. 18/07 from the Task Force on Country Coordination: A meeting of the TFCC is scheduled for 21-22 September 2000 in Geneva. The objective of the meeting will be to develop the group's workplan. Focal points have volunteered to prepare background materials for the meeting in the areas of country coordination, national capacity building and monitoring & evaluation. FINANCING 22/08 from Julie Milstein, WHO/HQ: The Financing Task Force, co-chaired by Amie Batson, World Bank, and Steve Landry, USAID, and coordinated by Violaine Mitchell, will meet in an expanded group in Washington from 20-21 September. The agenda will include updates on the Global Fund, the other GAVI Task Forces, Financing Task Force activities, the GAVI application process, and reports on the key work of the Task Force, i.e. UNICEF procurement of fund vaccines, immunization database to be housed at WHO, financial sustainability, selected financing mechanisms, new financing options, capacity building, and accelerating R&D of new vaccines. These discussions will be followed by break-out groups in three priority areas: financial sustainability; capacity building; and pull, which will then report back for a wrap up discussion of next steps. ASSESSMENT TOOL 18//07 from WHO/HQ: A Meeting entitled "Briefing on GAVI Operations & Country Support for Immunization" is scheduled for approximately 50 participants for 29-30 August in Geneva destined to brief prospective consultants on GAVI operations, the GFCV application process and provide them with an update on the common immunization programme assessment tool and other materials for planning new vaccine introduction. It is anticipated that this meeting will lead to the creation of a roster of prospective consultants who can provide technical assistance in the areas of performance of reviews, introduction of specific new vaccines and the preparation of GFCV applications and be deployed in response to requests for technical assistance from national programmes. 30/06 from WHO/HQ: An updated version of the "Immunization Services Assessment Guidelines" for use in conducting EPI Assessments is now available on the world wide web - www.who.int/vaccines- diseases/service/immsystemassess. Alternatively, if internet access is not an option, copies can be obtained from WHO/EPI. Comments from people using the Guidelines are welcome and will be incorporated into a revised version in 2001. AFGHANISTAN 30/06 from Dr. Mohsni, WHO/EMRO: Afghanistan is preparing to submit an application for assistance for immunization services improvement in the 3rd tranche of applications (15 January). The authorities will be coordinating with EMRO the kind of assistance needed to finalize their application. Taking into consideration their political situation, some technical issues will need to be clarified. ALBANIA 22/08: Second tranche application expected. 16/06 from Denis Maire WHO/EURO: Dr. Stanislava Popova undertook a consultancy in mid-July to assess the status of the EPI Programme, review the epidemiological situation, identify the programme needs for the five coming years, and develop a 5-year plan, 2001-2005. The plan will include measles and HepB components of the EPI Programme, since a plan of action on measles elimination has been developed and Hep B has already been introduced. ARMENIA 22//08 from Denis Maire, WHO/EURO: Dr. Stanislava Popova undertook a consultancy from 19 June - 11 July to assist in the development of a 5-year plan, and in the preparation of the first draft of the plan for measles elimination. 18/07: Application will be submitted by will be submitted by 15 October deadline. *** AZERBAIJAN 08/09 from WHO/HQ: A four-person CDC consultancy will take place to coincide with the National EPI Review being carried out from 25 September through 6 October. Dr Ching and Ms Kolasa will be assisting with the EPI Review, development of a five-year plan and facilitating the establishment of an ICC. Drs Bell and Buffington will undertake the HepB component of the assessment in addition to that component of the five-year plan. BANGLADESH *** 08/09 from David Sniadack, WHO Bangladesh: An application for introduction of HepB will be submitted in 2001. The World Bank is assisting in conducting the EPI review and preparing the GFCV application. There is an ICC for polio that needs to be strengthened to include all EPI activities. There is ongoing discussion with WHO to conduct a Hib burden study. 22/08 from WHO/HQ: Roland Sutter, CDC, and Ann Levin, PHR, will visit in early September to assist MoH with developing a 5-year plan. Two other consultants, Eric Mast, WHO, and Ian Williams, CDC, will visit 10-15 September to assist in developing an introduction plan for HepB. 18/07: Application will be submitted by will be submitted by 15 October deadline. 18/07 from Abdulaziz Adish, WHO/SEARO: The WHO Representative in Bangladesh is in the process of hiring two consultants to assist the country with the EPI Review and preparation of its application for assistance from the GFCV. BHUTAN 22/08: Application for support for New Vaccines received Conditional Approval. *** BOSNIA & HERZEGOVINA 08/09 from Denis Maire, WHO/EURO: Technical assistance has been requested with conducting the EPI assessment, and WHO will provide a consultant once the timing of the visit is confirmed. BURKINA FASO 30/06 from Deo Nshimirimana, WHO/AFRO: Application will be submitted by 15 October deadline. CAMBODIA 22/08: Application for support for New Vaccines received Approval with Clarification. 26/05 from Andy Tucker, WHO Consultant: MoH and TWG rescheduled the immunization assessment for 22 May - 6 June. Grace Chee is the health economist to be provided by Abt Associates. CVP/University of Melbourne participated, providing one person, and assisted throughout the process, including with the formulation of the five-year plan of action. CAMEROON *** 08/09 from WHO/AFRO: WHO/AFRO and a consultant from CDC plan to visit 2nd week of October to assist with HepB introduction plan and preparation of GFCV application. 30/06: Application will be submitted by 15 January deadline. CENTRAL AFRICAN REPUBLIC 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. CHAD 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. CHINA *** 08/09 from GAVI Secretariat: Request received from MoH for GAVI for a visit, tentatively scheduled for 11 December. The following issues will be discussed: General China/GAVI collaboration; possibility of conducting large-scale studies with the new pneumococcal vaccine; discussions on the use and policy of HBV in China; and specific studies relating to Hib disease burden and vaccine testing. 26/05 from WHO/HQ: During the World Health Assembly, a meeting was held with Wang Zhao, Director General, Department of Disease Control, and Liu Peilong, Director General, Department of International Cooperation. The general concept of GAVI was discussed and supported. Additional discussion centred on the interest for the MOH and GAVI partners in evaluating impact/burden for several new vaccines, specifically Hib and pneumococcus. The concept of a burden study using vaccine impact on pneumonia to clarify the usefulness of these vaccines was discussed, as well as having a meeting with MOH and GAVI partners to discuss this issue. The government was positive about the meeting, and suggested it follow the meeting on polio certification in October. Finally the impact of the imported case of polio on polio certification was clarified. CÔ”E D'IVOIRE 22/08: Application for support for New Vaccines received Conditional Approval and their application for support for Immunization Services received Approval with Clarification. *** DPR KOREA *** 08/09 from Bjorn Melgaard, WHO/HQ: An invitation for a GAVI visit has been received. During the visit, the importance of addressing the three requirements for GFCV funding prior to submitting an application should be stressed. *** 08/09 from Drs Lyabo Olusanmi, UNICEF and Du Yuping, WHO: A draft proposal is ready and an application will be submitted in 2001. The ICC has been organized and will work on all EPI activities. There is a recent review (1999) which might need some additional work. There is a 5-year plan of action for EPI. The current polio surveillance activities are encouraging and have to be further strengthened and the laboratory made ready for accreditation. Historically, DTP3 coverage has varied according to vaccine availability, thus coverages over several years have to be considered to determine actual coverage. It is strongly recommended that GAVI tie strengthening of polio surveillance and eradication activities to funding from the GFCV. DJIBOUTI 30/06 from Dr. Mohsni, WHO/EMRO: Djibouti is very interested in requesting assistance for immunization services improvement and is planning to submit an application by 15th October. They are also requesting technical assistance in preparing their application. In the interim, EMRO is managing to ensure some immediate support from other sources. *** ETHIOPIA *** 08/09 from Ivone Rizzo, GAVI Secretariat: In light of the country's interest in applying for support from the GFCV, steps are beginning to be taken to prepare the country for submitting an application. Ethiopia's application to the GFCV has to be supported and documented with a multi- year immunization plan that specifically includes goals for polio eradication, increased access to routine immunization and introduction of new vaccines. It is important for an EPI review to be carried out in order to identify fully the areas of need, and the constraints and opportunities for improving EPI coverage and services in the context of the decentralization process and health sector reform currently taking place. GHANA 22/08: Both applications for support for New Vaccines and Immunization Services received Approval with Clarification. 16/06 from WHO/HQ: Beth Bell, CDC, visited from 6-10 June to review progress in preparing the GAVI application for hepatitis B vaccine introduction. Also reviewed other issues such as the ICC and financing. GUINEA 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. GUINEA-BISSAU 30/06: Application postponed to 15 October deadline. GUYANA 22/08: Application for support for New Vaccines received Approval with Clarification. HAITI 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. **** INDIA *** 08/09 from Dr. Kim-Farley, WHO: Discussions were held in Calcutta on 25 August between WHO, UNICEF, World Bank and MoH on "Immunization and GAVI-related Issues". Salient points included: A proposal for $7 million to support a large HBV introduction field trial will be submitted to the GFCV for review by the 15 January deadline. Other proposals for strengthening routine immunization, injection safety and introduction of HepB may be submitted in future depending upon the needs identified in the five-year plan. Disease burden studies have been noted as other activities for potential support from the GFCV. In order to satisfy the three GFCV pre-requisites for provision of support the following actions will take place: The current "Polio" ICC will expand its TORs to include all EPI. Information from recent EPI reviews carried out by the WHO, World Bank and UNICEF will be compiled into a composite review. The current multi-year EPI plan will be developed for three years taking advantage of the World Bank-supported project. An ICC will meet at the end of this year to endorse the MYP and the GFCV proposal. MoH&FW will develop a 5-year plan for EPI with support from UNICEF, World Bank and WHO, with UNICEF supporting a national officer and WHO/HQ supporting an external short-term consultant and a national officer. 22/08 from Brent Burkholder, WHO/SEARO: At the request of the GoI, Dr. Craig Shapiro, CDC, visited Delhi from 19-28 July for a consultation on the introduction of HepB into the national immunization programme. The resulting disease burden analysis and recommendations have been forwarded to the GoI. At the latest TCG and ICC, Calcutta, 24-26 August, there will be several sessions dedicated to discussing the introduction of new vaccines and financing these initiatives. The discussions on organizing the Regional Task Force on Immunization will also be furthered. The next ICC for India will be held in Delhi on 15 September. Prior to the meeting, SEARO will hold discussions with high-level GoI officials on their plans for new vaccines, particularly HepB. INDONESIA *** 08/09 from Sarah England, WHO/HQ: A draft proposal has been presented to the GAVI Secretariat for possible assistance with a number of different initiatives: production of quadravalent rHepB-DTwP; combined packaging of HepB and DTwP; and HepB in Uniject. The proposal will be reviewed and recommendations forwarded to the GAVI Working Group. 16/06 from Sarah England, WHO: Joint WHO/CVP visit took place as planned from 25-27 May. Indonesia will be requesting assistance for Hepatitis B vaccine production, equipment for filling and finishing UniJect prefilled injection devices and for Hib and pentavalent vaccine development. KENYA 22/08: Both applications for support for New Vaccines and Immunization Services received Approval with Clarification. 16/06 from WHO/HQ: Susan Goldstein, CDC, visited 16-26 June to assist in formulating the plan for the introduction of Hepatitis B. KYRGYZSTAN 22/08 from Denis Maire, WHO/EURO: Dr. Sergei Deshevoy, WHO/EURO, visiting 28-31 August to provide support for new 5-year plan and HepB introduction plan. 22/08: Application for support for New Vaccines received Approval with Clarification. 16/06 from WHO HQ: Michael Favarov, CDC, reviewed the hepatitis B proposal and the GFCV application. LAO PDR 22/08: Application for support for New Vaccines received Approval with Clarification. LESOTHO 30/06: Application will be submitted by 15 October deadline. LIBERIA 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. MADAGASCAR 22/08: Both applications for support for New Vaccines and Immunization Services received Approval with Clarification. 16/06 from WHO/HQ: ICC Meeting held 31 May to complete the application. Dr. Manzila visited 21-23 June to assist in its finalization. MALAWI 22/08: Application for support for New Vaccines received Approval with Clarification. 16/06 from WHO/HQ: Robin Biellik visited 19-21 June to review application. ICC held during his visit. MALI 22/08: Application for New Vaccines received Conditional Approval. Application for support for Immunization Services received Approval with Clarification. MOZAMBIQUE 22/08: Both applications for support for New Vaccines and Immunization Services received Approval with Clarification. 16/06 from WHO/HQ: Ivone Rizzo, Eric Mast and Amadou Fall (WHO/AFRO) visited 29 May - 2 June. A summary of the findings follows: ICC has been constituted, but functions mainly for Polio NIDs. MoH and GAVI Partners identified the need to strengthen its role and expand its membership. Last assessment of immunization services was in 1998. All Partners agree present coverage data is an overestimate, due to difficulties in assessing the denominator after the war. An immunization coverage survey and assessment of immunization safety status are planned in the next few months. Although recent floods damaged infrastructure, emergency aid has adequately responded to the needs. MoH plans to introduce routine DTP-Hep B vaccination schedule in the whole country. Hepatitis B vaccine is planned to be introduced in 2001, but more details need to be developed and documented. MYANMAR *** 08/09 from Jos Vandelaer, WHO Myanmar: Myanmar will apply for support from both sub-accounts during 2001. Assistance will also be requested to improve local production of HepB. PATH has identified two consultants to work on the EPI review and assist in preparing the GFCV application. NEPAL 22/08 from Tirtha Rana, World Bank: The Government of Nepal is currently working on its tenth 5-year (medium-term 2002-2007) health programme to be financed jointly by HMGN and its external development partners. Its focus on essential health care services (EHCS) which contains EPI as a critical element opens up opportunities for synergy with potential GFCV funds under the GAVI immunization initiative. 22/08 from WHO/HQ: Two consultants, Alasdair Wylie and Rachel Feilden have been recruited by WHO/SEARO and USAID/BASICS respectively, to assist in conducting the EPI field assessment. Additionally, Dr. Craig Shapiro, CDC, is available for a HepB visit in the near future. Specifically this will include assessing available study data, making recommendations on the need for additional studies, and outlining issues related to a HepB introduction plan. It is hoped that the EPI Assessment, HepB introduction plan and multi-year plan resulting from the EPI Assessment will lead to an application for assistance from the GFCV by the 15 January deadline. 18/07 from Abdulaziz Adish, WHO/SEARO: At the present time, Nepal has not had a recent EPI Review, its ICC is currently mainly oriented towards the Polio Eradication Initiative, and the country does not have a comprehensive 5-year plan. Efforts are being made to recruit a consultant to assist in the EPI Review. The WHO Representative and other partners in Nepal are working on strengthening the ICC which, once strengthened, will hopefully assist in formulating a 5-year plan. 30/06: Application will be submitted by 15 October deadline. NIGERIA *** 08/09 from Bjorn Melgaard, WHO/HQ: The ICC, which is very active, has established a sub-committee for GAVI. It is currently collecting additional information from selected state sites to prepare an assessment of the NIP due for completion mid-September. A National Plan exists through 2003 which will be updated to 2005 based on the results of the assessment. An application for strengthening immunization systems will be submitted by 15 October deadline. In addition, Nigeria has been encouraged to make enquiries to the GAVI Secretariat about the benefits of being included in the "big country" group and to request a special visit from GAVI as the situation is unique in this country. Current population is estimated at 120 million. 18/07 from WHO/HQ: An informal GAVI Working Group has been set up in- country. It currently comprises representatives from UNICEF, WHO, USAID, DFID and other partners. It is effectively an ad hoc sub-committee of the ICC, convened to coordinate the development of the application to the GFCV. However, before any proposal is submitted, it will have to be presented to the National ICC for approval. PAKISTAN 22/08: Application for support for New Vaccines received Conditional Approval. 16/06 from Steve Hadler, CDC: From 3-24 May, two consultants, Dr Steve Hadler (CDC) and Dr. Frank Mahoney (WHO Consultant) visited Pakistan to assist Dr. Rehan Hafiz in developing a national 5-year plan for immunization and in preparing a request for GAVI funding to introduce hepatitis B vaccine during 2001. Dr. Rehan is planning to submit GAVI proposals for hepatitis B funding by 1st July and for infrastructure support by 15th October. Pakistan plans to introduce the combination DTP- Hep B vaccine nation-wide by July 2001. A National ICC meeting was held on 20 May that endorsed the draft national plan and GAVI funding strategy. An additional international consultant and several national consultants will complete the 5-year immunization plan and GAVI proposal during June 2000. RWANDA 22/08: Application for support for Immunization Services received Approval with Clarification. Requested to resubmit proposal for support for New Vaccines by 15.10.00 or 15.1.01. SIERRA LEONE 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. SOMALIA 30/06 from Dr. Mohsni, WHO/EMRO: Somalia is very interest in submitting an application for assistance in immunization services improvement, however, their lack of recognised government is currently an obstacle to such a submission. It is planned that WHO and UNICEF in-country staff will work towards submitting an application by 15 October deadline, and that the GAVI Board will take a decision by that time on this, and other applications, received from countries with no formally recognised government. SRI LANKA *** 08/09 from Dr. Kulatilaka, EPI Manager: Sri Lanka is planning to conduct a HepB burden study with assistance from WHO, and will apply for introduction of HepB in April 2001. Although it does not qualify for infrastructural support, there is great need to improve the cold chain, and in collaboration with the ICC, the World Bank and JICA were approached to assist in funding improvements to the cold chain. A meeting was conducted to strengthen the ICC. Rabies is a major problem and enormous amounts of funds are diverted from general EPI to vaccines, enquiries will be made into the possibility of funding rabies vaccine not through the GFCV but through GAVI Partners. 22/08 from Ivone Rizzo, GAVI Secretariat: Intend to hire a local consultant to assist in conducting an EPI Review. Planning for a Review meeting in February 2001, a strategy formulation and planning exercise for March 2001 and a proposal submission for April 2001 for the introduction of HepB and possibly Hib. 30/06: Application will be submitted by 1 April 2001 deadline. 30/06 from Jay Wenger, WHO/HQ: Abdulaziz Adish (WHO/SEARO) and Jay Wenger, (WHO/Geneva) visited Sri Lanka from 22-26 June to discuss the GAVI initiative with MOH and immunization partners. In light of the high coverage levels, direct assistance from the GFCV is not being considered, however, several gaps in the programme (cold chain improvement, assessment of injection safety, and clarification of burden of diseases for which new vaccines are available (specifically, HepB)) were identified by the MOH, and ways in which to address them with GAVI partners were discussed. It was agreed that taking steps towards an expanded ICC, and preparation of a multiyear plan were ways to promote solutions to these issues. In addition, a subgroup of the ICC and MOH will evaluate the need for an overall EPI review. SUDAN 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. TANZANIA 22/08: Both applications for support for New Vaccines and Immunization Services received Approval with Clarification. 22/08 from Abt Associates: Ms. Bryn Sakagawa, Abt Associates Inc., will provide technical assistance in immunization financing in Tanzania and Zanzibar during the period 21 August - 1 September. The work is a follow- up to the immunization programme assessment that was conducted in February 2000. This assignment is being conducted under Abt Associates' sub- contract with the Bill & Melinda Gates Children's Vaccine Program implemented by PATH. 16/06 from WHO/HQ: Dr. Manzila (WHO/AFRO) and Dr. Seward (CDC) visited 14-22 June to assist with preparation of application. TURKMENISTAN 22/08 from Denis Maire, WHO/EURO: Dr. Stanislava Popova will visit 11-21 September to carry out the preparatory work in reviewing existing documentation and identifying needs. UKRAINE 22/08: Second tranche application expected. 22/08 from Denis Maire, WHO/EURO: Dr. D. Mercer, PATH/CVP, to visit 10-22 September, Drs. A. Battersby and R. Fielden, CVP, to visit 9-22 September. UGANDA 22/08 from Eva Kabwongera, UNICEF Uganda: External assistance is being requested for the last week of August/first week of September to analyse the additional cold chain requirements in the event of introducing new vaccines, and to assist UNEPI in finalising the Hepatitis B introduction plan. 30/06: Application will be submitted by 15 October deadline. 16/06 from WHO/HQ: Ivone Rizzo visited 10-15 June to assist in preparation of application. Final proposal planned for October. UZBEKISTAN 22/08: Second tranche application expected. 22/08 from WHO/HQ: CDC to provide consultants to participate in the joint GAVI, World Bank, Asian Development Bank mission to take place 4-15 September. The consultants will assist with developing a five-year plan for routine immunization, and with developing a plan for HBV. VIET NAM 30/06: Application will be submitted by 15 October deadline. YEMEN 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. ZAMBIA 30/06: Application will be submitted by 15 October deadline. ZIMBABWE 22/08: Requested to resubmit proposal by 15.10.00 or 15.1.01. REGIONAL ACTIVITIES AFRO *** 08/09 from Tarande Manzila, WHO/AFRO: AFRO is planning a workshop on the introduction of New Vaccines to be held in the region at the beginning of next year. An Experts Briefing on the same subject is tentatively scheduled for the beginning of October 2000. A retreat of regional office staff and WHO country officers is being held from 13-16 September in Victoria Falls, Zimbabwe. *** 08/09: The next meeting of the AFRO Regional Working Group will be held late - October. Actual dates and agenda to be advised. 30/06 from the African GAVI Working Group: At its recent meeting in Nairobi, 26-27 June, the following tasks were completed or initiated: Prepared draft workplan and TORs for the working group Identified country contact persons Developed more detailed TORs for country visits Drafted ideas on strengthening national ICCs Drafted TORs for the Working Group Coordinator More news on these will follow later. SEARO *** 08/09 from Abdulaziz Adish, WHO/SEARO: The recent WHO/SEAR EPI TCG meeting, Calcutta, 24-26 August 2000, was characterized by attendance by more than 200 participants, from all countries in the region, often at Secretary/Director level, accompanied by the EPI managers and with increasing partner presence. A number of GAVI issues were discussed most notably: *** * A presentation of GAVI, its history and basic principles. * An explanation of the GFCV including guidelines for eligibility of countries. * The GFCV application process was explained, including an update on the revisions made following the first round of applications. * The TCG endorsed the organization of the Regional Ad Hoc Working Group for Immunization with the following recommendation: "The initiation of GAVI has created wide opportunity for countries to introduce new vaccines and improve immunization systems. In response to this opportunity, WHO and UNCIEF have proposed to form a regional ad hoc Working Group to determine an appropriate mechanism to facilitate identification of consultants, coordinate scheduling of GAVI activities, disseminate current information on vaccine development, assist in strengthening ICCs and liaise on behalf of member countries at the global level" 22/08 from Brent Burkholder, WHO/SEARO: The WHO/SEARO office, in collaboration with several partners, organized a workshop in Delhi from 24-27 July on Financing Immunization and Introduction of New Vaccines. The workshop included representatives from throughout the region and focused on practical issues of financing and preparation of GAVI applications. This was an initial step in efforts to formalize a Regional Task Force on Immunization. WPRO *** 08/09 from Dr. Mansoor, WHO/WPRO: The WPRO Regional Working Group of GAVI Partners was held in Manila from 4-5 September. It was agreed that a person, based in Manila, should be recruited to act as focal point, coordinate the activities of the WG and provide the "Secretariat" function, which would include preparation of position papers for GAVI at the global level, coordinate country activities, etc. A meeting may also be held in the region with the aim of briefing officials on GAVI, sharing experiences to date and to talk about improving different aspects of the quality of programmes. ____________________________________*________________________