PHM-Exch> [PHM News] Statement to the WHO Executive Board on Global Vaccine Action Plan by PHM and MMI

[Claudio Schuftan]

From: David Legge <dlegge at phmovement.org>

PHM/MMI Statement to the WHO Executive Board on Global Vaccine Action Plan
(presented by Alice Fabbri)

The SAGE report highlights the difficulties experienced in involving the
private sector in both monitoring and surveillance and in delivering high
levels of coverage. This provides cause for a reconsideration of the
Organisation’s construction of UHC as including mixed public-private
systems.

The SAGE report emphasizes the importance of locating vaccination programs
within broader programs of disease control and note that GAVI expenditure
on health systems has lagged behind budget. The disadvantages of vertical
funding programs are well known in this room and continue to present
challenges with respect to coordination.

The SAGE report emphasizes the role of NITAGs  but comments that many
countries are still lagging behind in the establishment of such a body.
National vaccination strategies should respond to local epidemiology, to
institutional capability and to local health system priorities.

The case of HPV vaccination points to the importance of precise knowledge
of local epidemiology in giving priority to new and expensive vaccines.
Rotavirus vaccination, which WHO is recommending for inclusion in all
vaccination schedules illustrates the importance of considering delivery
capacity. In health care systems which cannot deliver DTP3 to more than 50%
of infants it might make more sense to allocate additional resources to
strengthening Primary Health Care, including the effective treatment of
diarrhoea. Likewise, the case of rubella points to the need for flexibility
in strategy. In countries where infant immunisation coverage is low, there
is a risk that partial population immunity will push the age profile of new
cases into the child bearing years. In such circumstances a strong case can
be made for focusing on adolescent immunisation rather than young child.

The issue of opportunity costs should be central in decision making at the
national level. In countries with very low per capita health expenditure,
introducing new and expensive vaccines, even if initially supported by
GAVI, may cause distortions in health system expenditure for years to
come.

(The assistance of a number of high level experts in the preparation of
this statement is gratefully acknowledged)
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