New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges

1. New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges Global Vaccines 202X: Access, Equity, Ethics Philadelphia, USA 2 May 2011 Jon Kim Andrus, MD Deputy Director

2. Number of childhood vaccines routinelyused industrialized countries and inLatin America and the Caribbean, 1975-2010 Current GAP HPV Varicela Hepatitis A Meningococcal Seasonal flu - 2006 Rotavirus - 2006 Pneumococcal- 2006 Haemophilus Influenzae b Rubella Mumps Measles, DPT Poliomyelitis, BCG Hepatitis B**

3. Accelerating Policy

4. Taking advantage of new technologies while enhancing approaches to screening to reduce mortality of this disease of poverty Reducing the developing country uptake time lag >2 decades PrioritiesHPV vaccine and cervical cancer Cervical Cancer Disease Burden 77,000 new cases per year 33,000 deaths per year Source: IARC 2004 estimates

5. 47th Directing Council, September 2006 Urged Member States to: Expand legal and fiscal space and identify new revenue sources to sustainably finance the introduction of new vaccines against rotavirus, pneumococcus, influenza, and human papillomavirus; Support the mortality reduction targets, consistent with GIVS and the MDGs, for HPV, RV, influenza, and pneumo associated disease; Utilize the PAHO Revolving Fund for Vaccine procurement to purchase new and underutilized vaccines

6. ProVac Policy Framework Technical criteria Programmatic criteria Financial criteria www. paho.org/immunization Andrus et al. Public Health Reports 2007;122(6):811-19

7. Tools for Economic Analysis Vaccine Intro Costs Tool Burden of Disease Tools Costs Health Gains Cost Effectiveness Studies Rotavirus Cost Effectiveness Studies HPV Economic Analysis Cost Effectiveness Studies Pneumococcus Cost Effectiveness Studies Influenza

8. Number of Countries with Seasonal Influenza Vaccination Programs in the Americas, 1975-2008 42 Countries

9. Accelerating Deployment

10. Congenital Rubella Syndrome Pro-Vac Workshop, September 2006

11. Strategies Strategies always rely on: Immunizing susceptible population Conducting effective surveillance Sustaining the gains

12. Rubella Vaccination Coverage in Selected Countries of the Americas,1997-2006 Coverage (%) Vaccination of men and women Vaccination of women only * Source: Country reports Andrus JK, et al. Vaccine 2008

13. Rubella elimination and primary health care PAHO. Changing lives: The EHDI experience in Costa Rica. EPI Newsletter August 2007;29(4):1. Castillo-Solorzano C, Andrus JK. Rubella elimination and improving health care for women. Emerging Infectious Diseases 2004;10(11):17-21.

14. Rubella and Measles Elimination,The Americas, 1980–2009 Measles Elimination Accelerated rubella control Rubella Elimination Source: Country reports

15. Future Challenges

16. Uptake of Pentavalent Vaccine in the Americas 31 Countries, 35 $8 10.5 million Doses $7.20 $7 30 $6 25 $5 20 $3.94 Number of Countries Price ($) $4 15 $3 10 4 Countries, $2 3.9 million Doses 5 $1 0 $0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year Pan American Health Countries Purchasing Price per dose Organization Pro-Vac Workshop, September 2006

17. A urban cluster of human YF cases, Asunción Metropolitan area*. 10 deaths Median of age: 24 years (11-39) Female: 55% Infestation Index by Ae. Aegypti: 23% Urban cluster of yellow fever cases in Paraguay, 2008 *Laurelty, Central Department

18. In summary, there is no magic bullet to ensuring equitable and sustainable introduction of new vaccines into developing countries. Ultimately, the solution requires a strategic vision grounded in long-term goals, not short-term fixes. www. paho.org/immunization Pan American Health Organization