Vaccine Preventable Diseases and Immunization

24^th Inter-Country Meeting of National EPI Managers & 21^st Meeting of EPI Regional Technical Advisory Group 

RECOMMENDATIONS

RTAG noted with satisfaction the substantial progress made in several areas of work of EPI in several countries, such as routine immunization coverage, measles elimination, vaccine preventable diseases surveillance and polio eradication. However, more efforts are needed in order to meet the regional and national targets of eradication, elimination and control of vaccine preventable diseases. Accordingly, the following is recommended

General Recommendations

1. In order to make sure that meeting recommendations reach the national EPI managers within three weeks after the meeting, it is recommended that:
    

   • Meeting recommendations should be sent officially to the national health authorities within 2-3 weeks after the meeting. Meanwhile, VPI/EMRO is to share a soft copy of the meeting recommendations with national EPI managers by e.mail. As well, VPI/EMRO is to post the recommendations on the VPI web site within a week after the meeting.

   • VPI/EMRO is to seek all possible opportunities in order to support national EPI managers to implement those recommendations for which a policy change might be needed (e.g seeking RC resolution or RC actions).
      

2. In order to ensure timely follow-up of EMRO on implementation of the recommendations:

   • EPI managers are to send to VPI/EMRO, a biannual progress report on implementation of the recommendations. The first progress report should be submitted by end November 2007.

   • VPI/EMRO is to communicate directly with the EPI managers for continuous monitoring of implementation of the recommendations. VPI staff members should utilize the countries’ visits for following up on implementation of the recommendations.

   • VPI/EMRO is to develop a tracking tool of recommendations of EPI managers meetings and measles intercountry meetings
      

3. RTAG appreciated EMRO proposal to actively involve national EPI managers in drafting the meeting recommendations through a small core group (4 EPI managers representing the 4 sub-regions). This participation is expected to have a positive impact on formulation and implementation of the recommendations. RTAG recommends that arrangements be made for the core group to meet during the next measles inter-country meeting (October 2007) together with the secretariat (WHO & UNICEF) and the RTAG, to agree on suitable ToRs and functioning mechanism.
    

4. RTAG welcomed the newly appointed EPI managers in several countries. Taking into consideration the high turnover of EPI managers and to ensure continuous updating of current EPI managers,

   • EMRO is to develop/revise guidelines for EPI program management

   • EMRO is to organize training courses on the different aspects of EPI and provide all available materials. 
      

5.  EMRO to contact the countries, requesting establishing national immunization advisory committee in each country and propose prototype composition, scope of work and Terms of Reference. EMRO is to organize a meeting of the chairpersons of the committees and the EPI managers of all countries during the next EPI managers meeting.

New vaccines 

6. RTAG noticed with satisfaction the substantial progress made in the Region in the area of HepB and Hib vaccine introduction. The RTAG acknowledged the regional efforts aiming at building country capacity for decision making on new vaccines introduction (Regional networks for Hib, Pneumococcal and Rotavirus diseases surveillance). However, RTAG expressed great concerns about the current prices of these new vaccines, which constitutes a major constraint against their early uptake by middle income countries in particular. Accordingly, RTAG recommends that:
    

   • Current new vaccines surveillance networks be expanded to be more representative through covering more sites, in particular in the big countries.

   • WHO and UNICEF Regional Directors to send clear messages to decision makers in countries of the Eastern Mediterranean Region, emphasizing the importance of introduction of these new vaccines for saving children’ lives and achieving the MDG4 and encouraging taking the necessary steps in order to accelerate introduction of the new vaccines whenever possible.

   • MOHs of the middle-income countries, are to officially write to GAVI board, with a copy to WHO and UNICEF,  stating their need for introducing Hib, and/or Rota and/or Pneumococcal vaccines, requesting GAVI board to consider the possibility of supporting them in introducing these vaccines, and stressing on their readiness for a higher co-financing rate and shorter support period and highlighting the  high burden of diseases potentially preventable by Hib, pneumococcal and rotavirus vaccines and the strong national EPI programmes reaching more than 95% of infants as well as their capacity to sustain vaccine introduction within their program.

   • RC/EMR is to discuss this issue and send a similar letter to GAVI, through WHO/DG, supporting the request of the middle income countries of the EMR. 
      

7. To ensure availability of the new vaccines for EMR countries at reasonable cost:

   • WHO/UNICEF are to negotiate with the manufacturers  affordable costs of the new vaccines for middle income countries

   • Countries producing vaccines should be encouraged and supported to produce these vaccines at a reasonable cost. WHO is to provide all possible support to EMR countries that have the capacity for vaccine production in order to ensure regional vaccine security.

   • Regional capacity for vaccine production is to be discussed in the EMR/RC.

Recommended vaccination schedule

8. RTAG recommends adoption of the EPI schedule recommended by VPI/EMRO. Countries are to adopt it.

9. The RTAG endorses the recommendations of the polio TAG in order to achieve the eradication target, including the schedule of OPV.

10. RTAG emphasizes implementation of administration of HepB vaccine at birth in all countries. Countries are to seek all possible means to reach all newborns with HepB vaccine (TBAs, LHWs, etc).

11. EPI managers should review the national immunization schedules and have oversight over all aspects of the national immunization program including vaccines that are given at all ages and by the different sectors of health care providers.   

Measles elimination

12. RTAG recognized with concern occurrence of measles outbreaks in several countries in the region, which stems from the gap in immunity. RTAG is particularly concerned about outbreaks occurring in countries reporting high measles vaccination coverage. Accordingly:

    • RTAG re-affirms recommendations of measles intercountry meeting, December 2005

    • Request each country to ensure implementation of the regional strategy for measles elimination 2006-2010, in particular implementation of second dose of measles vaccine.

    • Countries should strengthen their EPI monitoring and evaluation systems including independent evaluation of vaccination coverage and development of susceptibility profiles at district level and among high risk groups to identify gaps in immunity.

    • Countries are to strengthen their measles surveillance system including laboratory testing of all patients and characterizing circulating genotypes.

    • All countries should conduct an in-depth evaluation of susceptibility profiles at the district level and be prepared to present this evaluation at the next intercountry meeting on measles elimination.

    • Countries are encouraged to use supplemental immunization campaigns to address gaps in measles immunity. 

Injection safety:

13. The RTAG recognizes the concern about medical waste management in the region, including EPI waste management.  Recognizing the ongoing work of other units in EMRO and at the country level and involvement of other countries’ participants in this area of work, EMRO is requested to send WHO meetings reports on waste management to all EPI managers to update them and allow them link their activities with other departments/sectors. EPI managers will be asked to provide a progress report on EPI waste management related activities at the next EPI program managers meeting.   

Vaccine management and vaccine procurement

14. The RTAG welcomed the computerized system of vaccination supply stock management (VSSM). Countries that don’t have a computerized system for national vaccine store are encouraged to adopt VSSM. EMRO is to provide the necessary technical support in this regard.
     

15. In order to strengthen the current vaccine procurement system in EMR countries:

    • EPI managers should be aware of the system for vaccine procurement in their country and including registration, procurement of pre-qualified vaccines, quantities needed, and related technical issues (storage, distribution, etc).  

    • EMRO is to develop a regional vaccine supply strategy.

    • EMRO is to explore organizing group procurement system for different sub region, based on the experience of GCC. EMRO is to organize a regional consultation to study the feasibility of group procurement in the region.