“ I like deadlines. I like the whoozing sound they make as they fly by.”

1. “ I like deadlines. I like the whoozing sound they make as they fly by.” Douglas Adams.

2. Vaccine Preventable Diseases Are we doing enough?

3. Better food. • Better housing. • Clean water. • Vaccination.

5. Smallpox “Few escape love or smallpox”-a popular saying in the middle ages in England • Cowhands who contracted cowpox became immune to Smallpox; • in 1780, English doctor Edward Jenner found inoculation with cowpox was effective in immunizing against Smallpox …Jenner predicted his innovation would lead to the eradication of Smallpox. The First Vaccination - Dr. Edward Jenner, by Georges-Gaston Mélingue, 1894

6. Progress in smallpox eradication Slide courtesy of Dr. M. Santosham Fenner , “Smallpox and its eradication” 1988, WHO

7. Benefits of vaccination Measles - US Polio - worldwide 60 40 Reported cases (000s) EPI implemented Vaccine introduced 20 1960 1980 2000 1950 1970 1990 1980 1990 2000 Diphtheria – England & Wales 60 40 Reported cases (000s) Vaccine introduced 20 1940 1960 1980 2000 Source: WHO Database 2007. Poliomyelitis global annual reported incidence and Pol3 coverage, 1980-2006. Source: Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Source: Dept of Health. Immunisation against infectious disease (The Green Book) 2006 edition. Chapter 15

8. Incidence of Pertussis in Japan Start of whole-cell pertussis vaccination 100,000 Temporary discontinuation of whole-cell DTP Introduction of acellular DTP 10,000 No. of case notifications 1,000 100 1980 1990 1950 1970 1960 Year Statistics of Food Poisoning and Infectious Diseases, the Ministry of Health and Welfare

9. Incidence* of Hib and non-Hib Invasive Disease, ABCs Sites, Children <5 years,1990-2006 Rate per 100,000 Slide courtesy of Dr. M. Santosham *Rate race-adjusted to general U.S. population

10. Impact of pneumococcal vaccines on IPD in the USA Pneumococcal vaccination reduced IPD in the whole population by direct and indirect effects of vaccination CDC MMWR 2005; 54: 893–7.

11. POLIO “How can we continue to tolerate polio when we have the technical expertise to get rid of it?” Dr. Harry Hull

12. INTRODUCTION Approximately 2.5 million children under 5 years of age die every year as a result of diseases that can be prevented by vaccination.

13. ANNUAL DEATHS 2002

14. Prevention • Pain • Permanent damage and disfigurement, • Death • Emotional suffering • Protects others

15. “The function of protecting and developing health must rank above that of restoring it when impaired” Hippokrates

16. “I am hard-hearted enough to let the sick die if you can tell me how to prevent others from falling sick” Mahatma Gandhi

17. Promotes health. Individual Wellbeing Learn better More productive More joy Community Development Cost-effective and cost-saving Education Productivity Money saving Investment

20. ““D””” “Dis beter om gesond en ryk te wees, as siek en arm.” “It is better to be healthy and rich, than sick and poor.”

21. More people New Vaccines Linking with others Global interdependence

22. GAVI’s mission To save children’s lives and protect people’s health by increasing access to immunisation in poor countries WHO/Jim Holmes

23. The GAVI Alliance: an innovative partnership

24. M.O.H.S.S. • Main goal of immunization: • Reduction of morbidity and mortality rates in children under 5 years • Achieve vaccine coverage - 85% Districts • Achieve 90% coverage on National level • Maintain coverage rates • Drop-out rate less than 5% • Elimination of poliomyelitis • Elimination of measles by 2015

25. Immediate goals: • Reverse declining immunization coverage • DPT 3 coverage from 85% - 90% • TT2+ coverage from 65% - 90% (child bearing women) • TT2+ coverage from 75% - 90% (pregnant women)

26. Successes of vaccination • Immunization programme is an integral part of Primary Health Care – 1990 • Supplemental Immunization Activities– 1996 • Elimination of maternal & neonatal tetanus – 2001 • “Polio free” – 2009 • Decline in vaccine preventable diseases • Hepatitis B and Hib was added to EPI schedule – 09/2009 • Introduction guidelines for new vaccines are in place • 271 Primary Health care clinics, 43 health centres, 35 hospitals and outreach posts provide immunization services to reach every child. • All injection are given one needle and one syringe per child. • Continuous training for staff • EPI Surveillance Committees • Close co-operation between private and state sectors • NB! – programme 100% funded by government

27. Taking stock: the immunisation gap 129 million surviving newborns in 2008: Source: Johns Hopkins Bloomberg School of Public Health; UN,DESA, Population Division; WHO/UNICEF

28. So are we doing enough? No! But are we doing bad? NO!!!

29. Let's never forget… Vaccination is by far the best thing that has ever come out of medical science for reducing the burden of human suffering and premature death, especially among children.