Vaccine-preventable Diseases and Immunization: a WHO/EURO Update Robb Butler, Programme Manager Vaccine-preventable Diseases and Immunization Programme WHO Regional Office for Europe Copenhagen, Denmark IAIM Joint Regional Meeting Madrid February 1-2, 2017 1
WHO Region of Europe 53 Member States 15 time zones (capital cities -2 to +5 hr from Copenhagen) 4 official languages Population 900 Million Infants 11 Million < 5yr 55 Million <15yr 157 Million DPT3+Pol3: 94%, MCV: 94% 2
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Sustainable immunization financing Significant progress toward self-sufficiency: Overall government funding for vaccines in the Region continues to increase (MDA to achieve self-sufficiency in 2017; ARM, AZE and GEO in 2018) All countries receiving GAVI support fulfilled their cofinancing requirements in 2015 (ARM, AZE, GEO, KGZ, MDA, TJK and UZB) All (five ARM, AZE, GEO, MDA, UZB) graduating countries received support to assess challenges related to graduation from donor support and have plan to address them to enable smooth transition.
Trends of Immunization Coverage of Major Antigens in European Region, 1980-2016* *Data source: WHO/UNICEF Estimates (WUENIC) Data as of 28-Sep-2016 5
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MCV1 and MCV2 coverage Reported Measles and Rubella cases Thousands MCV1/MCV2 coverage and Measles/Rubella cases, 1980-2015, EURO Region 100 90 80 70 60 50 40 30 20 10 900 800 700 600 500 400 300 200 100 0 0 Measles cases Rubella cases MCV1 MCV2 *Data source: WHO/UNICEF Estimates (WUENIC) Data as of 28-Nov-2016 6
MCV1 and MCV2 Coverage in WHO European Region, 2015 Data source: WUENIC Data as of 21-Aug-2016 *Countries with No data for MVC2 in 2015 Finland, Ireland and Monaco 7
Measles Incidence Rate in WHO European Region, 2012-2015 Data source: CISID Data as of 01-Nov-2016 *Countries with No data: 2012 San Marino and Bosnia & Herzegovina; 2015 Monaco, San Marino and Turkmenistan 8
Number of measles in the WHO European Region, 2007-2016* 35,000 2535 cases in 33 countries 30,000 25,000 20,000 15,000 Bulgaria 24 410 10,000 5,000 France 19 997 Ukraine 14 079 Georgia 11 060 Kyrgyzstan 18 097 0 32174 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* Data extracted 01 November 2016 *First 3 quarters 2016 9
Rubella in the WHO European Region, 2000 & 2010-2016* 98% REDUCTION Number of reported rubella cases 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Other POLAND ROMANIA 0 2010 2011 2012 2013 2014 2015 2016 * *First 3 quarters 2016 10
All six WHO Regions have measles elimination goals 11
European Regional Verification Commission (RVC) To demonstrate interruption of endemic measles and rubella transmission, countries are requested to provide evidence in a standardized format that: endemic measles and rubella cases have not occurred for 3 consecutive years, the disease surveillance system is sufficiently sensitive, specific, timely and complete to detect cases if they occurred, and the absence of endemic cases is supported by genotyping evidence. The 5 th Meeting of the RVC 24 to 26 October 2016 12
2016 2015 Number of countries and their measles elimination status based on data for 2012-2014 (n=50) and 2015 (n=51) Conclusions of the 4 th (2015) and 5 th (2016) Meetings of the European Regional Verification Commission for measles and rubella elimination. Eliminated Interrupted 24 months Interrupted 12 months and Interrupted* Endemic No reports 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 21 2 9 18 3 24 9 4 14 2 * Interrupted transmission in 2015 13
2016 2015 Number of countries and their rubella elimination status based on data for 2012-2014 (n=50) and 2015 (n=51) Conclusions of the 4 th (2015) and 5 th (2016) Meetings of the European Regional Verification Commission for measles and rubella elimination. Eliminated Interrupted 24 months Interrupted 12 months Endemic No reports 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20 3 9 18 3 24 9 2 16 2 14
WHO EUR Risk Assessment 2016 The boundaries and name shown and the designation used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimination of its frontiers of boundaries. Tajikistan, Israel, Ukraine The RCC assesses the risk of importation and circulation of wild poliovirus or emergence of a vaccine-derived poliovirus. Risk is assessed focusing on surveillance, population immunity and outbreak preparedness Member States at high-risk: Bosnia-Herzegovina, Romania and Ukraine. 15
WHO/Europe inventory summary and containment progress Countries with WPV/WPV2* Countries without WPV Countries without any PV 2014 # 2015- EU countries 2016 @ 2015-2016 22 18/13 12/10 29 35 16-15 2 Sites in inventory 289 218 & 118 Sites with WPV/WPV2 69 61/38 52/34 Sites with Sab/Sab2 Countries planning PEFs No of planning PEFs - 167/72 89/58-14 11 (BEL, CRO, DNK, FRA, HUN, ITA, LTU, NET, ROM, SWE, UNK) - 32 28 (BEL (5), CRO, DNK, FRA (4), HUN, ITA, LTU, NET (9), ROM, SWE, UNK(3)) Phase I part a containment procedures toward WPV2 materials (to destroy/transfer or to nominate PEF/NAC) * WPV starting from 2015 this definition includes WPVs, VDPVs, WPV-PI # Data from official statements provided by 51 Member States in their APR for 2014 @ Data from official statements provided by 53 Member States as of November 2016 & This number includes all facilities holding WPV and/or Sab materials and registered in regional inventory 16
POSE New Developments National for self-delivery a scenario-based discussion exercise complete with suggested list of key questions Available online: http://tinyurl.com/zz9bm6j One country conducted national POSE in Nov 2016 Regional inter-country Inter-Regional EURO+WPRO 17
% coverage DTP3 coverage in the WHO European Region, 2006-2015 97 96 95 94 93 92 91 90 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 18
DTP3 coverage in the WHO European Region, 2006-2015 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Change in 2015 (Ref:2014) Albania 97 98 99 98 99 99 99 99 99 Andorra 93 96 99 99 99 99 99 96 97 97 0 Armenia 87 88 89 93 94 95 95 95 93 94 1 Austria 83 85 83 83 98 Azerbaijan 95 95 95 94 93 95 93 93 94 96 2 Belarus 99 95 97 97 98 99 98 98 97 99 2 Belgium 98 98 99 98 98 98 99 99 99 99 0 Bosnia and Herzegovina 87 95 91 90 89 88 92 86 82-4 Bulgaria 95 95 95 94 94 95 95 95 88 91 3 Croatia 96 96 96 96 97 96 96 96 95 94-1 Cyprus 97 97 97 99 99 99 99 99 99 97-2 Czech Republic (the) 98 99 99 99 99 99 99 97 Denmark 93 87 89 90 91 94 94 94 93-1 Estonia 95 95 95 95 94 93 94 94 93 93 0 Finland 97 99 99 99 99 99 98 0 France 99 98 98 98 99 99 99 99 99 Georgia 88 98 92 88 92 94 92 96 91 94 3 Germany 98 97 98 97 96 96 96 96 0 Greece 99 99 99 99 99 99 99 Hungary 99 99 99 99 99 99 99 99 99 99 0 Iceland 97 97 98 96 96 95 89 91 90 92 2 Ireland 91 92 93 94 94 95 95 96 96 95-1 Israel 96 96 96 96 95 94 0 Italy 96 97 96 96 96 96 97 96 95 93-2 Kazakhstan 99 93 99 98 99 99 99 98 95 98 3 Kyrgyzstan 92 94 95 95 96 96 96 97 96 97 1 Latvia 96 94 94 94 92 92 91 94 92 95 3 Lithuania 94 95 96 98 95 92 93 93 93 93 0 Luxembourg 99 99 99 99 99 99 99 99 99 99 0 Malta 85 74 72 73 76 96 99 99 99 97-2 Monaco Montenegro 90 92 95 92 94 95 94 94 91 89-2 Netherlands (the) 96 97 97 97 97 97 97 97 96 95-1 Norway 94 93 94 94 93 94 95 94 93 95 2 Poland 99 99 99 99 99 99 99 99 98 98 0 Portugal 97 97 97 96 98 97 98 98 98 98 0 Republic of Moldova 97 92 90 94 90 93 92 90 90 87-3 Romania 97 94 94 89-5 Russian Federation 98 98 98 98 97 97 97 97 97 97 0 San Marino 95 92 87 92 79 86 96 69 80 76-4 Serbia 92 94 95 95 91 94 91 95 93 95 2 Slovakia 99 99 99 99 99 99 99 98 97 96-1 Slovenia 97 97 97 96 96 96 96 95 95 95 0 Spain 98 96 97 96 97 97 97 96 97 97 0 Sweden 98 98 98 98 98 98 98 98 98 98 0 Switzerland 94 94 95 95 95 96 96 96 96 97 1 Tajikistan 96 86 86 93 93 96 94 96 97 96-1 The former Yugoslav Republic of Macedonia 93 95 95 96 95 96 95 98 95 91-4 Turkey 90 96 96 96 97 97 97 98 96 97 1 Turkmenistan 98 98 96 97 96 97 97 98 98 99 1 Ukraine 98 98 90 52 50 76 23 United Kingdom 92 92 92 93 94 95 95 95 95 96 1 Uzbekistan 96 96 98 98 99 99 99 99 99 99 0 Region 95 95 95 95 94 95 96 96 95 93-2 Bosnia and Herzegovina -4% Bulgaria +3% Georgia +3% Kazakhstan +3% Latvia +3% Republic of Moldova -3% Romania -5% San Marino -4% FYRM -4% 19
Number of reported diphtheria cases Reported diphtheria in the WHO European Region, 1980-2015 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Number of reported diphtheria cases 2000 2001 2002 2006 2003 2007 2004 2005 2008 2006 2009 2007 2010 2008 2009 2011 2010 2012 2011 2013 2012 2013 2014 2014 2015 2015 Diphtheria is now a rare disease in the Region 58 cases reported in 2015 (35 cases in 2014) 60,000 50,000 40,000 30,000 350 300 250 200 150 100 50 0 20,000 10,000 0 20
Countries reporting cases of diphtheria in 2015 Number of reported diphtheria cases 0 2 4 6 8 10 12 14 16 France Germany Latvia Netherlands Belgium Norway Russian Federation Ukraine Denmark Georgia Ireland Italy Spain Sweden United Kingdom Rare reports of fatal toxigenic cases: Spain 2015 6-year-old boy Latvia 2015 one death Belgium 2016 3-year-old boy 21
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Number of reported pertussis cases Reported pertussis in the WHO European Region Thousands of cases of pertussis continue to be reported Recent large outbreaks in Spain, Denmark and Austria 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 22
HPV introduction in WHO European Region: now also in middleincome countries Introduced (29) Plan intorduction 23
Pneumococcal and Rotavirus Vaccine Introduction Status in WHO European Region Pneumococcal Rotavirus Data source: WHO/UNICEF JRF Updated on 11-Aug-2016 24
Regional Viral Hepatitis Action Plan Endorsed by at 66 th session of Regional Committee for Europe, 14 September 2016 Includes hepatitis B immunization priority activities and targets: o 95% coverage with three doses of HBV vaccine o 0.5% HBsAg prevalence in vaccinated cohorts o 80% of health-care workers vaccinated against HBV o 90% coverage with timely HBV birth dose vaccination OR o 90% coverage with screening in pregnant women and 95% coverage with post-exposure prophylaxis in infants born to infected mothers
Strengthening NITAGs NITAG (41 contries) ## Participation of NITAGs in SAGE meetings Study tour to JCVI for Albanian NITAG, October 2016 Evaluation of NITAGs; discussion of results at regional meeting, 14 October 2016 26
U5 mortality in all MICs Nigeria MICs facing the biggest challenges are getting donor support through a wellcoordinated strategy Angola Gavi status Non-Gavi MIC Gavi-graduating Gavi-eligible LMIC 63 non-gavi MICs are not meeting GVAP targets and would benefit from a unified international strategy. Equity is a concern for people living in countries without sufficient support. India Philippines Morocco Iran China
There are 63 non-gavi MICs: a heterogeneous group
Conclusion of the initial EURO analysis Performance of the Middle-income Countries (MICs) with no donors support are lagging behind the other groups in the European Region of WHO (green light for further analysis) Number of antigens accommodated by national immunization programmes Number of new vaccines introduced (out of 3 made available for use, namely PCV, rota and HPV vaccines) by national immunization programmes Coverage for the third dose DTP containing vaccines Coverage for the first dose Measles containing vaccines 29
WHO Euro countries sharing pricing information 24 Member states (2013) 28 Member states (2014) 30 + Member states (2015) Participating EURO Member states by income level 24 28 30 30
V3P Euro - 3 years data snapshot (I): Any trends in the price paid? MMR Hepatitis B (pediatric) 31
V3P Euro - 3 years data snapshot (II): Any trends in the price paid? HPV PCV 32
V3P Euro - 3 years data snapshot (III): Any trends in the price paid? DTaP-Hib-IPV-HepB DTaP-Hib-IPV 33
In summary Characterized by high national but sub-optimal coverage sub-nationally Resurgence of some forgotten diseases Measles and rubella: job not done Polio: containment and transition focus Hep b control goal set and verification underway MIC challenges HMIC paying highest prices Demand and acceptance variable 34
Thank you 35