Measles and Measles Containing Vaccine

Progress in Global Measles Mortality Reduction

Vaccine Supplier Meeting Copenhagen, 3 - 4 April 2008

Edward Hoekstra, MD, MSc Senior Health Specialist Co-ordinator Global Measles Program UNICEF / New York

Overview
Goal

Strategy
Achievements

3 - 5 year agenda
Future

Measles kills

Malnourished girl hospitalized with post - measles encephalitis Kratie, Cambodia, 2001 (Photo: Keith Feldon) Estimated 1,700 children died in Cambodia of measles in 2001

Measles disables

Corneal scarring causing blindness

Encephalitis

Pneumonia & diarrhea

Causes of 1.7 million global vaccinepreventable deaths among children, 2000

Measles
Pertussis

HIB
Diphtheria

MNT
YF
Source: World Health Report 2001

Polio

We knew WHERE 757,000 deaths from measles in 2000

98% of all measles deaths

No second opportunity for measles immunization (47)
Data year 1999

We knew HOW

1. Strong routine immunization of > 80%

2. Provide a 2nd opportunity for measles immunization

3. Surveillance 4. Improved measles case management

Measles Control Goals by WHO Region, 2008

Americas, Europe, E. Mediterranean, W. Pacific have elimination goals

2010 2010 2000 GIVS Goal: 90% reduction in deaths by 2010 (vs. 2000)

2012

Africa and SE Asia have mortality reduction goals

From 2001 - - 47 countries BEGAN

Success To Date

1st Dose Measles Coverage in 47 Measles Priority Countries, 2000 - 2006

Percent

80 %
80% 75% 70% 65% 60% 55% 50%
2000 2001 2002 2003 2004 2005 2006

72 %

Global Coverage 1st dose 67 %

56 %

Source: WHO / UNICEF coverage estimates, 1999 - 2006 as of August 2007

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2000

94 % of all measles deaths

No second opportunity 2005 (47)

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2006

Nationwide second dose of measles introduced (42)

Partial implementation of second dose of measles introduced (3)

No second opportunity 2005 (2)

Estimated measles deaths, 2000, 2006

2000 757 000 deaths

2006 242 000 deaths

= 500 deaths Dots are randomly distributed in countries.

74%

Data source: WHO/IVB, November 2007

Estimated Measles Deaths, 2000-2006

Global Measles Deaths 1,000,000 800,000 600,000 400,000 200,000 2000 2001 2002 2003 2004 2005 2006

68% reduction
2005 Goal 2010 Goal

Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.

Reduction in Estimated Measles Deaths by WHO Region, 2000 to 2006

0 -10

AFR

SEAR

WPR

EMR

GLOBAL

-20

26 %

-30

% reduction

-40

-50

91%

81%

78%

68%

-60

-70

-80

90% 2010 reduction goal

-90 -100

Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.

Integrated Campaigns

Vitamin A

Polio Vaccination

Deworming Tablets

Bednets

> 87 million

> 29 million

> 30 million

> 31 million

In 2007, 84% of the 37 campaigns were integrated with at least one other intervention

MR or MMR introduction
Higher income countries

One large scale introduction campaign

Followed up by 2 dose routine immunization

Not for Sub - Saharan Africa and South Asia

Will see most activities in East Asia

MR Supplementary Immunization Activities (2007-2008)

Country Armenia Turkmenistan Uzbekistan Georgia Dates 1-13 Oct 07 12-25 Nov 07 12-25 Nov 07 Sep-Oct 08 Target Age 6-27 yrs 7-23 yrs + 24-40 yrs 11-29 yrs 5-26 yrs Target population 942,767 2,264,026 8,143,635 1,100,000 Coverage (reported) 96,8% 96.4% 99.8%

Ukraine

08

15-29 yrs
IFFIm

9,000,000

IFFIm IFFIm

IFFIm

Looking ahead

Where we are going

Planned Measles SIAs, 2008

Measles Measles - Rubella

Figure 2: Measles Initiative Annual Donations (2001-2007) Financial Annual Donor Expenditure and and Financial Resource Requirements, Contributions, & Funding Gap (2008-2010)* Resource Requirements, 20012010*
250
2001-2007 Total donations: US$ 635 million

200

2008: Funding gap US$ 23 million 2009: Funding gap US$ 76 million

$ US Million

150

2010: Funding gap US$ 102 million

100

50

0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Donations

Funds from 2007

Funds projected or pledged

Funding Gap

* Excluding anticipated country contributions for catch-up and follow-up SIAs for 2008-2010

External Contributions since 2001, and Figure 3: External contributions since 2001, and Funding Gap for 2008-2010 Funding Gap for 2008 - 2010
GAVI CIDA IFFIm 2008-2010 funding gap $202 million

CDC

Japan UNICEF ARC** UNF*

Total: $973 million (excluding country contributions)

* includes UNF and partners: The Bill & Melinda Gates Foundation, Izumi, Vodafone, The Church of Jesus Christ of Latter-Day Saints ** includes ARC and The Church of Jesus Christ of Latter-Day Saints

Estimated Measles Vaccines Shipped by UNICEF 1999 2007 and projections - 2020
260 240 220 200 180 160 140 120 100 80 60 40 20 0
19 99 20 01 20 03 20 05 20 07 20 09 20 11 20 13 20 14

India Needs

Doses Millions

20 16

20 18

20 20

Summary

Most ambitious measles goal

Less than 3 years to go

The strategy works

Africa already reached 2010 goal South East Asia accounts for 74% remaining deaths Secure funding for 2009 and beyond

Measles Initiative
Working Together to Save Lives

Melinda and Bill Gates Foundation

Vodafone

IFFIm
Japanese Government

Thank You