Meeting Report
Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop
19–22 November 2013 Nadi, Fiji
Participants of the Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop, 19-22 November 2013, Nadi, Fiji
(WP)/ICP/IVD/1.1/001-A Report series number: RS/2013/GE/60(FJI)
English only
REPORT EIGHTH PACIFIC IMMUNIZATION PROGRAMME STRENGTHENING (PIPS) WORKSHOP Nadi, Fiji 19–22 November 2013
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC AND UNICEF PACIFIC OFFICE
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines 17 February 2014
NOTE The views expressed in this report are those of the participants in the Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop and do not necessarily reflect the policies of the World Health Organization or United Nations Children's Fund.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific and UNICEF Pacific Office for the participants in the Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop, which was held in Nadi, Fiji, from 19 to 22 November 2013.
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ABBREVIATIONS
AEFI AFP ANSM AusAID cVDPV2 DFAT DPT EPI EVM FHSSP GIVS GVAP HBAS Hib HPV IPV JICA J-PIPS MMR MR NRA OPV PHIS PIPS PCV PPHSN REC RED REZ SIAs SPC SRCAC SRCC SRVC TAG Td UNICEF USAPIs US CDC VII WHO
Adverse event following immunization Acute flaccid paralysis Agency for Medicine and Health Products Safety (L’Agence nationale de sécurité du médicament et des produits de santé) Australian Agency for International Development Type 2 circulating vaccine-derived poliovirus Australian Government Department of Foreign Affairs and Trade Diphtheria-pertussis-tetanus (vaccine) Expanded Programme on Immunization Effective Vaccine Management Fiji Health Sector Support Programme Global Immunization and Vaccine Strategy Global Vaccine Action Plan Hospital-based active surveillance Haemophilus influenzae type B Human papillomavirus Inactivated polio vaccine Japan International Cooperation Agency Japanese support for Pacific Immunization Programme Strengthening Measles–mumps–rubella (vaccine) Measles–rubella (vaccine) National Regulatory Authority Oral polio vaccine Public Health Information System Pacific Immunization Programme Strengthening pneumococcal conjugate vaccine Pacific Public Health Surveillance Network Reaching Every Community Reaching Every District Reaching Every Zone Supplementary immunization activities Secretariat of the Pacific Community Subregional Causality Assessment Committee Subregional Certification Committee Subregional Verification Committee Technical Advisory Group Tetanus-diphtheria (vaccine) United Nations Children's Fund United States Affiliated Pacific Islands United States Centers for Disease Control and Prevention Vaccine Independence Initiative World Health Organization
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CONTENTS
Executive Summary ................................................................................................................................. 7 1. INTRODUCTION ............................................................................................................................... 8 1.1 Objectives ...................................................................................................................................... 8 1.2 Opening remarks ........................................................................................................................... 8 2. PROCEEDING .................................................................................................................................. 10 2.1 Global and regional overview of EPI .......................................................................................... 10 2.2 Strengthening routine Immunization ........................................................................................... 12 2.2.1 Development of Global Vaccine Action Plan (GVAP). ...................................................... 12 2.2.2 Status towards implementation of GVAP in Niue. .............................................................. 12 2.2.3 Status towards implementation of GVAP in Samoa. ........................................................... 13 2.2.4. Improving immunization service delivery in the Pacific. ................................................... 14 2.2.5 Country experience on maintaining high immunization coverage. ..................................... 14 2.2.6 Global Immunization Week and Child Health Week. ......................................................... 14 2.2.7 Country experience on Measles Supplementary Immunization Activities. ......................... 15 2.2.8 Verification of measles elimination- Lines of evidence. ..................................................... 15 2.2.9 Polio End Game Strategy .................................................................................................... 16 2.2.10 Country experience on certification process for Hepatitis B Control in Cook Islands. ..... 17 2.2.11 New vaccines in the Pacific-Progress and the way forward. ............................................. 17 2.2.12 Country experience on new vaccine introduction in Fiji ................................................... 18 2.2.13 Country experience on new vaccine introduction in Kiribati ............................................ 19 2.3 Improve vaccine procurement and supply chain management .................................................... 19 2.3.1 Vaccine Independence Initiatives beyond 2015 .................................................................. 19 2.3.2 US vaccine procurement system .......................................................................................... 19 2.3.3 Procurement vaccines outside of VII ................................................................................... 20 2.3.4 Effective Vaccine Management ........................................................................................... 20 2.3.5 International EPI review ...................................................................................................... 20 2.4 Adverse Events Following Immunization (AEFI) surveillance system ...................................... 21 2.4.1 Country mapping of AEFI surveillance system in the Pacific. ............................................ 21 2.4.2 AEFI system in New Caledonia .......................................................................................... 21 2.4.3 Causality assessment scheme and establishment of sub-regional causality committee for the Pacific. .......................................................................................................................................... 21 2.4.4 Regional surveillance .......................................................................................................... 22 2.5 Systems strengthening ................................................................................................................. 22 2.5.1 WHO/UNICEF Joint Reporting Form, data quality issues .................................................. 22 2.5.2 Immunization coverage survey in Fiji ................................................................................. 22 2.5.3 Immunization coverage survey in French Polynesia ........................................................... 23 2.5.4 Health information system in Fiji ........................................................................................ 23 2.5.5 JPIPS 2 terminal evaluation ................................................................................................. 23 2.6 Country consultations .................................................................................................................. 24 3. Recommendations and way forward .................................................................................................. 24 3.1 Pacific’s National EPI managers. ........................................................................................... 24 3.2 PIPS partners .......................................................................................................................... 25
ANNEXES Annex 1: Agenda Annex 2: Timetable Annex 3: Summary of participants’ evaluation of the eighth PIPS workshop Annex 4: Country needs Annex 5: List of participants, consultants, temporary advisers and representatives
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SUMMARY
The Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop was convened by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) at the Tanoa International Hotel in Nadi, Fiji from 19 to 22 November 2013. The workshop was organized by WHO, UNICEF, the Australian Government Department of Foreign Affairs and Trade (DFAT), Japan International Cooperation Agency (JICA), New Zealand Aid Programme, Secretariat of the Pacific Community (SPC), and the United States Centers for Disease Control and Prevention (US CDC). There were 28 participants from 18 Pacific island countries and areas, as well as a temporary adviser and a consultant. Progress on immunization was reviewed, and challenges in routine immunization, new vaccine introduction and surveillance were identified and discussed. Despite progress in achieving regional goals and improved coverage in some low-coverage countries, challenges remain in serving hard-to-reach children. Sustaining and building on successes requires even greater efforts, as failure to sustain high routine immunization coverage could result in vaccine-preventable disease outbreaks. The new Global Vaccine Action Plan 2011–2020 including the six strategic objectives that can guide immunization programmes in the Pacific, was discussed. The polio endgame strategy and introduction of inactivated polio vaccine (IPV) were also discussed. Pacific countries were reminded to make optimum use of existing programmatic tools such as micro-planning, improved coverage monitoring, strengthened cold chain system and vaccine management to further improve the performance of immunization service delivery systems and promote good management practices. Disease surveillance needs to be strengthened to generate information for decision-making and to monitor the impact of immunization. Pacific island countries discussed their needs in terms of new vaccine introduction. However, requests for support should be based on evidence of burden of disease, financial implications and reliable surveillance. Participants were updated on the future directions of the Vaccine Independence Initiative (VII), which will be reviewed by the Executive Board of UNICEF in 2015. Thirteen Pacific island countries are in favour of the continuation of VII and hope this mechanism is expanded to new vaccines as well. The eighth PIPS workshop was also important as an opportunity for sharing information among countries, and consultation with donors and technical agencies. PIPS partners will continue to provide technical support to the Pacific island countries to carry out recommendations. Communication between PIPS partners and Pacific countries will be enhanced to improve progress monitoring.
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1. INTRODUCTION
The Eighth Pacific Immunization Programme Strengthening (PIPS) Workshop was convened by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) at the Tanoa International Hotel in Nadi, Fiji from 19 to November 2013. The workshop was organized by WHO, UNICEF, the Australian Government Department of Foreign Affairs and Trade (DFAT), Japan International Cooperation Agency (JICA), New Zealand Aid Programme, Secretariat of the Pacific Community (SPC) and the United States Centers for Disease Control and Prevention (US CDC). There were 28 participants from 18 Pacific island countries and areas. Other participants included a temporary adviser and a workshop consultant. The programme agenda, timetable and list of participants are available at Annexes 1, 2 and 5 respectively. 1.1 Objectives (1) to review the status of national immunization programmes and develop recommendations for strengthening immunization systems and sustaining high-quality programme monitoring and vaccine-preventable disease surveillance; (2) to review the proposed establishment of a casualty committee for adverse events following immunization (AEFI) in the Pacific and discuss the terms of reference or functions and way forward; and (3) to identify the successes, challenges and lessons learnt from the Vaccine Independence Initiative (VII), discuss the way forward after VII ends in 2015, and develop a regional framework. 1.2 Opening remarks
Dr Sergey Diorditsa chaired the opening ceremony. An opening devotion was led by Ms Sela Paasi. Dr Metuisela Tuicakau welcomed all participants on behalf of the Minister of Health, Dr Neil Sharma. The speaker noted Fiji's strong immunization programme and maintenance of polio-free status. Despite limited resources, Fiji’s Expanded Programme on Immunization (EPI) has demonstrated good performance. Routine immunization coverage has been consistently high, and this coverage is being verified by WHO-recommended coverage surveys. A coverage survey was carried out in 2013. The results would be presented during the workshop. Though all Pacific island countries and areas have maintained their polio-free status, an outbreak of polio in 2011 in China and a recent outbreak in the Middle East were reminders of the need to maintain high coverage and strong surveillance. Fiji is committed to protecting children against fatal diseases, and had introduced three new vaccines in 2011. He thanked DFAT, JICA, New Zealand Aid Programme, SPC, UNICEF, US CDC, WHO and other partners for their continuous support to the immunization programme. Finally, he thanked the workshop organizers, and, on behalf of the Government of Fiji, he wished everyone a successful workshop and enjoyable stay in Nadi. Dr Diorditsa delivered opening remarks on behalf of Dr Shin Young-soo, WHO Regional Director for the Western Pacific. He highlighted that EPI has had great success in the Pacific over the past decade and that all WHO Member States have remained poliomyelitis-free. Furthermore, endemic measles virus transmission has likely been interrupted, and the regional
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measles elimination goal has been achieved. Chronic hepatitis B infection rates among children have been substantially reduced. Many Pacific countries likely have reached the interim goal of hepatitis B control; some have been verified as having reached it. Despite financial constraints, several Member States have added, or are considering the inclusion of, one or more new vaccines into their immunization schedule. Pneumococcal conjugate vaccine (PCV) and rotavirus vaccine, for example, will have a substantial impact on childhood mortality and morbidity, while human papillomavirus (HPV) vaccine will reduce cervical cancer rates in future. Sustaining these successes will require even greater efforts. Moreover, he said failure to sustain high routine immunization coverage would result in outbreaks of vaccine-preventable diseases. Member States need to make better use of programmatic tools such as micro-planning, improved coverage monitoring, strengthened cold chain and vaccine management to further improve the performance of immunization service delivery systems and promote good management practices. Sustained efforts are needed to improve the quality of surveillance for acute fever and rash and acute flaccid paralysis (AFP) to required standards. Maintaining vaccine safety and strengthening AEFI surveillance are very important to maintain public and health worker confidence in vaccines by minimizing the occurrence and impact of AEFI. Finally, he thanked Fiji for hosting the workshop and PIPS partners for their relentless efforts in providing financial, technical and logistical support to Pacific island countries and areas, and in supporting this workshop. Ms Karen Allen noted that PIPS meetings are an opportunity to exchange local and global knowledge, examine cutting-edge research, and share best practices in the Pacific. At this workshop participants would have to make decisions and recommendations regarding the future of immunization in the Pacific. The Pacific's progress has been impressive in maintaining polio-free status, reducing chronic hepatitis B infection and interrupting indigenous measles virus transmission. Challenges include ensuring all children are fully immunized, addressing risks of importation of diseases, and introducing two or three new vaccines that could further reduce the burden of childhood diseases and save lives. She also shared that UNICEF Executive Director, Mr Anthony Lake, has championed the equity-based approach on the premise that investing in the most vulnerable populations is the right thing to do, both morally and economically. All children need to be immunized, and barriers to immunization need to be identified and solved, including convincing mothers to seek health services and persuading nurses to deliver health services to the hard-to-reach populations. Regarding VII in the Pacific, Ms Allen explained that for 15 years UNICEF has been procuring high-quality vaccines for children in the Pacific, contributing to vaccine security and ensuring competition and fair market prices globally. This initiative has been instrumental in lowering the purchase, transaction and freight costs; introducing new vaccines; improving cold chain systems; and building technical and managerial capacity within countries. Since VII is due to expire in 2015, this workshop would provide an opportunity to discuss the future of vaccine procurement in the Pacific. In her conclusion, Ms Allen expressed her sincere gratitude to all the governments in the Pacific for their hard work and commitment to their immunization programmes, and to the partners for their support. Ms Paulini Sesevu, Senior Program Manager, Regional Health, DFAT, acknowledged the progress of the immunization programme in the Pacific. The Australian Aid programme has supported the immunization programme in the Pacific through UNICEF and WHO, and directly through bilateral country support. AusAID supported the Pacific Plan, but recognizes that one plan cannot fit all. She noted the importance of noncommunicable diseases in the Pacific but stressed the protection of children against vaccine-preventable diseases and nutrition. She encouraged the participants to share lessons learnt in protecting and improving child health.
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Dr Minal Patel explained that as a technical agency, US CDC contributes to the strengthening of surveillance, epidemiology, outbreak response, verification for hepatitis B and polio, data quality and routine immunization coverage. She emphasized that Pacific island countries should always be prepared for the possible importation of vaccine-preventable diseases by travellers to the Pacific. Mr Shumon Yoshiara recounted that for many years, the Government of Japan through JICA had contributed to the health sector in the Pacific and directly impacted the health of people. JICA's four missions are: addressing the global agenda, reducing poverty through equitable growth, improving governance and achieving human security. Phase two of Japan’s support for Pacific Immunization Programme Strengthening (J-PIPS2) is a collaborative project between the Ministry of Health Fiji and JICA. In the last three years, J-PIPS2 conducted four regional trainings on cold chain and vaccine management. Further, 15 in-country trainings were conducted in Kiribati, the Federated States of Micronesia, Samoa, Solomon Islands and Vanuatu. It is envisaged that an implementation system for cold chain and vaccine management in the Pacific will be developed and sustained through J-PIPS2. A JICA team would be conducting a final evaluation of J-PIPS2 this year. It is hoped that the evaluation of J-PIPS2 will be fruitful for JICA and for all people involved in EPI in the Pacific. He concluded by thanking the PIPS partners and country participants for their commitment to the EPI programmes in the Pacific. Dr Josaia Samuela thanked the partners for their support and for including SPC in collective efforts to strengthen EPI in the region. As one of the oldest intergovernmental organizations in the Pacific, SPC provides technical assistance to 22 Pacific island countries in many development areas like land resources, water and mineral resources, education, climate change, fisheries, disaster risk management and public health. The Public Health Division of SPC addresses disease surveillance (through the Pacific Public Health Surveillance Network (PPHSN)), monitoring and evaluation (M&E) and strategic health communication. The Statistics for Development programme of SPC also supports Pacific island countries and areas with data collection and research, e.g. the Demographic Health Surveys. These are interrelated areas that could be further strengthened and aligned to support national EPI programmes in the Pacific. Dr Samuela mentioned that over the years vertically aligned disease-specific programmes were not able to translate fully into health system-specific support to impact EPI activities and programming in a sustainable manner, e.g. programme monitoring, data collection and reporting, behaviour change communication and surveillance for vaccine-preventable diseases. He also noted that recently introduced regional programmes like HIV/AIDS have been heavily funded and disproportionately supported in comparison to national EPI programmes. He acknowledged the competing priorities in the health system, and that the evidence has shown that immunization is one of the most effective and beneficial public health interventions. 2. PROCEEDINGS
2.1
Global and regional overview of EPI
Dr Diorditsa presented a global and regional overview of EPI. In the Western Pacific Region, EPI objectives are: 1) maximize equitable access to vaccines of assured quality to control vaccine-preventable diseases, including pandemic vaccine; 2) achieve eradication, elimination and control of targeted diseases, including polio, measles and rubella, hepatitis B, and maternal and neonatal tetanus; 3) promote rational introduction of new vaccines;
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4) strengthen programme monitoring, vaccine-preventable disease surveillance systems, laboratory networks and data use; and 5) strengthen partnerships, advocacy and communication. EPI brings together various disciplines and partners to maximize public health benefits and efficiency. Inequitable access to immunization remains a major problem in several countries, with coverage gaps of up to 30%. The low reliability of reported administrative vaccination coverage data in many countries has not been resolved, and deprives programmes of an essential monitoring tool. In the Western Pacific Region most people live in middle-income countries that cannot access external support for new vaccines and cannot afford to self-finance them. Still there has been significant progress in the Region. Most notably, measles cases have reduced by 93% from 2008 to 2012 and by 82% reduction from 2009 to 2012. Measles incidence reached a historic low in 2012, dropping from 34.0 cases per 1 million population (in 2009) to 5.9 cases per 1 million population in 2012. Thirty-three out of 37 countries and areas in the Region are likely to have interrupted transmission of indigenous measles virus. Rubella control has been accelerated by synergizing measles- and rubella-related immunization and surveillance activities. In 2012 and 2013, at least two countries in the Region experienced large rubella outbreaks, resulting in an increase of children born with congenital rubella syndrome. Five countries and areas have not yet introduced rubella vaccine into their immunization programme. Maternal and neonatal tetanus is considered to be eliminated in 33 of 37 countries and areas in the Region. In December 2012, WHO and UNICEF validated that China had achieved elimination of maternal and neonatal tetanus. Cambodia, the Lao People’s Democratic Republic, Papua New Guinea and the Philippines have not yet validated elimination. Great achievements in hepatitis control have been made: at least 30 countries and areas in the Region have reduced chronic infection rates in children to less than 2%, which was a milestone set for 2012. Ten countries, including Palau, have verified achievement of the regional goal of reducing hepatitis B infection rates in children to less than 1%. If immunization coverage rates are maintained, almost 1 million chronic infections and 230 000 deaths related to hepatitis B would be prevented in each cohort born after 2012. The challenges of hepatitis B control are low birth-dose coverage, low three-dose coverage and low awareness. On the introduction of new vaccines, all countries except China have introduced Haemophilus influenzae type B (Hib) vaccine into their national schedules. Many countries have introduced PCV and HPV vaccine, and a few countries have introduced rotavirus vaccine. Introduction of Japanese encephalitis vaccine has been limited because of the absence of a WHO-prequalified paediatric vaccine. A systematic approach to making decisions on new vaccines requires disease-burden and cost-effectiveness data. Critical challenges for new vaccine introduction include capacity-building to support evidence-based decision-making (data analysis and interpretation, use of data for policy-making, communication of evidence) and communication with stakeholders, especially for the introduction of HPV vaccine. Vaccine pricing is highly variable. Financial sustainability planning is needed for GAVI-graduating countries and other lower-middle-income countries. For vaccine safety and quality, most countries in the Region have limited regulatory capacity or have not established a National Regulatory Authority (NRA). The quality of vaccine safety surveillance systems varies widely across the Region. The laboratory network provides support to countries for vaccine-preventable disease surveillance. The scope and functions of the laboratory network are in line with the requirements of the programme. The surveillance network for new vaccine-preventable diseases continues to expand; the rotavirus surveillance network was expanded to eight countries and continues to
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show high burden of disease. More than 30 countries participated in World Immunization Week 2013 with the theme “Finish the job, no more measles for anyone”. On scaling up the delivery of life-saving vaccines, China has prequalified to produce vaccine for encephalitis. Malaria vaccine is being developed with good results (efficacy can be seen in children at 6–12 weeks) and might be introduced at 6, 10 and 14 weeks when the vaccine becomes available. In some countries, HPV has been integrated into the deworming programme. Influenza maternal immunization is also now available for pregnant women. Finally, work will continue towards the Decade of Vaccines goals, namely: 1) achieve a world free of poliomyelitis; 2) meet global and regional elimination targets; 3) meet vaccination coverage targets in every region, country and community; 4) develop and introduce new and improved vaccines and technologies; and 5) exceed the Millennium Development Goal 4 target for reducing child mortality. 2.2 2.2.1 Strengthening routine immunization Development of the Global Vaccine Action Plan (GVAP)
Dr Yoshihiro Takashima explained WHO’s shift from Global Immunization Vision and Strategy (GIVS) to the Global Vaccine Action Plan 2011–2020 (GVAP) including the goals of the Decade of Vaccines, and the GVAP as adapted for the Western Pacific Region. GVAP has six strategic objectives: 1) all countries commit to immunization as a priority; 2) individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility; 3) benefits of immunization are equitably extended to all people; 4) a strong immunization system is an integral part of a well-functioning health system; 5) immunization programmes have sustainable access to predictable funding, quality supply and innovative technologies; and 6) country, regional and global research and development innovations maximize the benefits of immunization. In 2012, the World Health Assembly urged Members States to use GVAP to develop the vaccine and immunization components of their national health strategy and plans, and to report every year to the regional committees on lessons learnt, progress, challenges and updated actions. The World Health Assembly requested that WHO provide technical support to Member States to implement their plans and monitor impacts. In response, WHO in the Western Pacific Region prepared a draft regional framework for implementation of GVAP. The framework was drafted in consultation with national immunization programmes and submitted to the Twenty-second Meeting of the Technical Advisory Group (TAG) on Immunization and Vaccine-Preventable Diseases in the Western Pacific Region in June 2013. The TAG endorsed the draft regional framework, comprising eight regional immunization goals and 36 priority actions, and requested that the Regional Office finalize the draft in collaboration with national immunization programmes before submitting the final version to the Regional Committee in 2014. 2.2.2 Implementation of GVAP in Niue
Ms Mine Pulu presented the status of implementation of GVAP in Niue. With only 35 infants, in 2013 Niue was able to immunize everyone in the target group (>98%). Immunization is required by law for all children, especially Niue descendants and children born in Niue; a fee is applied for non-compliance. Niue provides all traditional vaccines, as well as PCV and flu
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vaccines. Niue has not used oral polio vaccine (OPV) since 2002. IPV is given in combination with diphtheria-tetanus-pertussis (DTP) vaccine, and that IPV3 coverage is 100%. Weekly surveillance of polio is in place, and no suspected polio case has been detected in the past several years. Regarding maternal and neonatal tetanus, all children born in hospitals and 98% of children overall have been vaccinated with three doses of DTP. Pregnant women are not given tetanus toxoid, but no neonatal tetanus case has been reported or identified. Coverage of measles vaccine is very high (>98%), and surveillance of acute fever and rash is in place. On hepatitis B control, all target children have been vaccinated with three doses of hepatits B vaccine, including the birth dose. Niue is expecting to conduct a serosurvey in 2014. All pregnant women receiving antenatal care are screened for hepatitis, rubella and measles antibodies, and that blood donors are also screened for hepatitis B. Most strategic objectives had been met; however, some technical assistance is needed to develop a multi-year plan and to introduce rotavirus and HPV vaccines. Discussion included whether Niue would introduce rotavirus vaccine similarly to New Zealand. Ms Pulu replied that since many Niue children visit New Zealand and vice versa, the New Zealand Government may consider supporting the introduction of rotavirus vaccine to children in Niue. The completeness of Niue's baseline data was also commended, with the shift from GIVS to GVAP, the data had confirmed significant achievements. 2.2.3 Implementation of GVAP in Samoa
Ms Fuapepe Manuleleua highlighted Samoa’s commitment to EPI and its sustainable access to funding, quality supply and innovative technologies. Secured funding for vaccine is included in the national annual budget, while vaccines and cold chain technology are procured through UNICEF. As a sign of its commitment, Samoa added an immunization coverage indicator in the health sector and in the Strategy for the Development of Samoa. Community demand for vaccines is high; Samoa has issued a “baby book” and maximizes community awareness during National Immunization Week. Ms Manuleleua also presented impressive progress on the achievement of coverage of all antigens since 2009, with last year’s coverage of pentavalent vaccine being greater than 90%. Samoa is sustaining its polio-free status, with coverage of OPV3 greater than 90% and no importations of polio cases. A shift from OPV to IPV is subject to approval by the Ministry of Health. Coverage of DPT-hepatitis B-Hib vaccine is greater than 90%. Tetanus-diphtheria (Td) vaccine is targeted to pregnant women; however, targeting women of childbearing age is under discussion (to be decided). On the progress of measles elimination, coverage of measles-mumps-rubella (MMR) vaccine has improved but is still not optimal (MMR1, 83%; MMR2, 67%). Major activities in 2012 included: nurses certification training, cold chain training, performance monitoring and data management improvement. In 2013, activities included the national EPI review, National Immunization Week, integrated EPI training and the multi-year plan exercise. Challenges include human resources, community mobilization and data management. Samoa has learnt that regular and frequent performance monitoring leads to sustainable performance improvement. Ways forward include: strengthening cold room, introducing new vaccines, strengthening data management, conducing coverage survey, finalizing EPI policy, and extending technical and financial support. In discussion, comments included that although Pacific island countries were not invited to the TAG meeting two years ago, Samoa and Niue had shown that they could deliver and have many achievements.
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2.2.4
Improving immunization service delivery in the Pacific
Dr Wang Xiaojun emphasized that the benefits of immunization should be expanded to all people, as recommended in GVAP. Countries may need to focus more on hard-to- reach populations. To do so, health workers need to know who the missed children are, where they live, why they have missed immunization, and how they can be reached. Missed children are often found from vulnerable and underserved communities. A Reaching Every Community (REC) strategy is under development to guide efforts for reaching the unreached. There are two key elements to be emphasized, including systematically mapping the underserved communities and adequately understanding the underserved communities. Approaches to mapping the underserved communities can include reviewing the immunization register to identify under-immunized children, conducting rapid coverage to assess coverage, and using social economic characters whenever applicable (urban or rural poor, new settlements and migrants). The aim of understanding the underserved communities is to define bottlenecks for service delivery to the communities concerned. Based on lessons learnt, Reaching Every District (RED) strategy is not enough to reach the most vulnerable children; support needs to go to health centre level. Classroom training is also not enough; on-the-job training at health centres is needed during supervisory visits. Given resource constraints, he proposed prioritizing underserved communities for action, including micro-planning and supportive supervision. Reaching the hardest-to-reach communities requires more investment of resources and hard work. Often second-dose measles coverage (MCV2) is much lower than first-dose measles vaccination. As such, some countries have developed a MCV2 strategy to turn the challenge into an opportunity. The REC strategy is used to improve MCV2 coverage, and to catch up other missed routine vaccination doses. The REC strategy has great potential as a platform for essential services to reach every last child. 2.2.5 Maintaining high immunization coverage in Tonga
Ms Sela Paasi presented Tonga’s experience in maintaining high immunization coverage. Tonga has achieved high immunization coverage of all antigens (above 98%), and around 65% of infants are exclusively breastfed until six months of age. Nonetheless, Tonga still has problems with low birth weight (58% in 2012) and malnutrition (8% in 2012). Intersectoral coordination and collaboration, with partners and within the Ministry of Health, assist to maintain high immunization coverage. All components of primary health care need to be backed by strong and stable political and health systems, and governed by appropriate legal frameworks and professional standard guidelines and policies. Primary health care should be looked after at national and operational levels, and supplemented by community partnership. Tonga has received strong support from partners – WHO, UNICEF, US CDC, UNFPA, JICA, AusAID, New Zealand Aid Programme and SPC. Priorities for Tonga moving forward include ongoing awareness programme, planning and evaluation, a standardized information system, and a strong communication and referral system. 2.2.6 World Immunization Week and Child Health Week
Dr Md. Shafiqul Hossain explained that EPI started in 1980 with six antigens but has grown to at least 11 antigens. Each year, around 109 million children worldwide are vaccinated, and 2.5 million deaths among children are prevented. However, more than 1 million children do not receive basic immunization services in the Western Pacific Region. The goal of World Immunization Week is for more people to be protected from vaccine-preventable diseases.
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The objectives of World Immunization Week are: 1) highlight the dangers of vaccine-preventable diseases, especially to infants and young children, and the importance and benefits of childhood immunizations; 2) educate parents and caregivers about the importance of vaccination in protecting their children from birth against vaccine-preventable diseases; 3) step up efforts to protect children against vaccine-preventable diseases and thereby give them a healthy start in life; 4) encourage better communication between parents and health workers; and 5) create events that attract community and media interest. Activities during World Immunization Week and Child Health Week would include: national and local launching ceremonies; seminars, workshops, trainings and round-table discussions; media breakfast meetings, press releases, press conferences, talk shows, public service announcements, radio and television spots, and information materials (pamphlets, reports, books, t-shirts, bracelets etc.); health education campaign, communication information session, routine immunization session and drama for immunization; and national immunization campaign, catch-up campaign and Child Health Week/Child Health Day outreach. He encouraged all Pacific countries to celebrate World Immunization Week every April and to add Child Health Week/Day, if needed, for other integrated health services (e.g. vitamin A distribution, deworming). 2.2.7 Measles supplementary immunization activities (SIAs) in Vanuatu
Mr Morris Willie Amos presented the progress of routine EPI and achievements of measles SIAs conducted in 2013. In 2013, Vanuatu completed its first combined measles-rubella (MR) SIA. During this campaign, 33 604 children under-5 were vaccinated against MR (102%); a rapid coverage survey also indicated high coverage (94%). Vitamin A coverage was 104% (n=4688) among children under one and 99% (n=32 691) among children aged 1–4years old. Meanwhile, 33 030 children under-5 received albendazole supplementation. Immunization coverage has improved in the past three years (except for penta3, 77%). The following activities have been undertaken in Vanuatu: installation of SolarChill (60), updated cold chain inventory, training of eight cold chain technicians on SolarChill installation, training of six EPI supervisors, and micro-planning training for health zone supervisors. Challenges include: geographical conditions, shortage of nurses (20% of health facilities do not have nurses), insufficient budget for operational costs (outreach services), insufficient planning and supervision, lack of money, insufficient community involvement due to shortage of nurses and community health workers, and lack of integration with other programmes. Current health reforms may add to human resources shortages and demand for other resources. Vanuatu will continue to strengthen routine immunization by enhancing routine immunization services through a Reaching Every Zone (REZ) strategy, improving data quality and management at all levels, improving regular supportive supervision at all levels, and celebrating Child Health Day (World Immunization Week). The Government of Vanuatu has to secure additional funding to cover the costs associated with introducing new vaccines. Vanuatu is considering introducing PCV by 2015 and conducting a post-introduction evaluation of pentavalent vaccine in 2014. Lastly, Vanuatu is considering training nurses’ aides to serve as vaccinators. 2.2.8 Verification of measles elimination: lines of evidence
Dr Jayaprakash Valiakolleri noted that there is considerable heterogeneity with regard to country land mass, population size and per-capita income in the Pacific.
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Many of the Pacific island countries experienced regular measles outbreaks prior to 1997. Thirteen Pacific island countries conducted measles SIAs between October 1997 and June 1998. Following the implementation of catch-up campaigns, measles outbreaks became infrequent. The organizational structure of regional verification, national verification and subregional verification for the Pacific island countries and areas. He informed participants that the responsibilities and the terms of reference of the existing Subregional Certification Committee (SRCC) for poliomyelitis eradication in Pacific island countries and areas were revised to include the responsibilities of serving as Subregional Verification Committee (SRVC) for measles elimination. The three criteria that are necessary for verification of measles and rubella elimination at the regional level, namely: (1) documentation of the interruption of endemic measles virus transmission for a period of at least 36 months from the last known endemic case; (2) the presence of verification-standard surveillance; and (3) genotyping evidence that supports the interruption of endemic measles virus transmission. There are five lines of evidence: 1) a detailed description of the epidemiology of measles since the introduction of measles in the national immunization programme; 2) quality of epidemiological and laboratory surveillance systems for measles; 3) population immunity presented as a birth cohort analysis with the addition of evidence related to any underserved and marginalized groups; 4) sustainability of the national immunization programme, including the resources for mass campaigns, where appropriate to sustain measles elimination; and 5) genotyping evidence that supports the interruption of measles virus transmission. In accordance with the global framework, the Pacific would no longer include “clinically confirmed cases” as confirmed cases. From 2013, confirmed cases would only be laboratoryconfirmed and epi-linked cases. In the setting of elimination, surveillance for measles needs to be sufficiently sensitive to detect endemic measles cases and have adequate capacity for timely and proper case investigation. The credibility of elimination depends on the quality of epidemiological and laboratory surveillance. Surveillance indicators and targets would be the main challenge for Pacific island countries and areas. Population immunity in Pacific island countries is generally high because of routine immunization coverage or SIAs. Finally, he described the regional guidelines on sustainability of measles elimination and on the genotyping evidence that supports the interruption of measles transmission. 2.2.9 Polio endgame strategy
Dr Adi Lisikoveni Tikoduadua explained that wild poliovirus type 2 has not been found since 1999. However, type 2 circulating vaccine-derived poliovirus (cVDPV2) has caused paralytic polio outbreaks in certain countries, especially where sanitation is poor and immunity is low due to poor immunization coverage. The polio endgame strategy is a way of preparing countries using only OPV to switch from trivalent (tOPV) to bivalent oral polio vaccine (bOPV) and then eventually to IPV. This shift requires strengthening routine immunization by giving the first dose of IPV together with the third dose of OPV (tOPV) by October 2015, and then six months later, giving a dose of IPV with a dose of bOPV. The potential benefits of administering at least one dose of IPV prior to type 2 OPV cessation, include: 1) prevent polio if exposed to a type 2 vaccine-derived polio virus or type 2 wild polio virus;
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2) improve response to monovalent type 2 oral polio vaccine (mOPV2) in an outbreak; 3) reduce transmission of a reintroduced type 2 polio virus; and 4) boost immunity to wild polio virus types 1 and 3. She emphasized the following recommendations: 1) All countries maintaining high population immunity with good coverage together with good surveillance must continue to do so. 2) For the 10 Pacific island countries using tOPV, it is recommended that each country write a national polio endgame strategic plan for 2013–2018 with emphasis on licensing/registration of bOPV, IPV and mOPV2, introduction of IPV by October 2015, and replacement of tOPV with bOPV by April 2016. The plan should include the financial resource requirements and a timeline and reporting system to monitor the implementation of the country plan. Finally, long-term financing for IPV should be secured. 3) Countries are asked to provide the Regional Certification Committee by July 2014 with a provisional schedule for IPV and dates for introduction of IPV and bOPV to facilitate regional vaccine forecasting, and a provisional estimate of resource requirements. 2.2.10 Certification process for hepatitis B control in Cook Islands
Ms Rangi Tairi presented hepatitis B control in Cook Islands. From previous studies approximately 10% of the Cook Islands population has chronic hepatitis B, which puts them at risk for liver cancer and cirrhosis. To help prevent future generations from getting the infection, Cook Islands has been using a four-dose vaccine schedule: birth dose within 24 hours and three more doses at six weeks, three months and five months of life. Since 1990, four-dose coverage has been consistently very high (>90%). A serosurvey in 2012 measured the prevalence of hepatitis B surface antigen among children in grade two (~6 years of age), to assess the impact of the hepatitis B vaccination programme on childhood chronic infection rates, to verify achievement of the regional hepatitis B control targets, to collect immunization coverage data, and to calculate the effectiveness of hepatitis B vaccine on preventing chronic infection. The results of the serosurvey showed that coverage with timely hepatitis B birth dose was 95%, and with three doses of hepatitis B vaccine, no child had hepatitis B surface antigen. Because there was no case of hepatitis B in this study, vaccine effectiveness could not be calculated. Cook Islands had a 0% seroprevalence of hepatitis B surface antigen among second graders in 2012. A verification package that was recently submitted verified that Cook Islands achieved the 2017 regional goal of less than 1% prevalence. Despite geographic challenges, Cook Islands has maintained high timely birth dose coverage and three-dose coverage. The level of coverage is consistent among all islands, even remote ones. She also mentioned that being a small population makes it easier to ensure high vaccination rates. 2.2.11 New vaccines in the Pacific: progress and the way forward
Dr Diorditsa, discussed GVAP and the five goals of the Decade of Vaccines. One of the goals is to develop and introduce new and improved vaccines and technologies. Ways to achieve this goal include introducing appropriate new vaccines, generating surveillance and cost evidence for decision-making, and ensuring that comprehensive approaches are used to control disease.
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WHO recommendations for some commonly considered new and underused vaccines include: inclusion of Hib vaccine, PCV and rotavirus vaccine in all national infant immunization schedules; introduction of HPV vaccine where cervical cancer is a priority and introduction is feasible and sustainable. Typhoid vaccine should be considered for outbreak control and where endemic disease is a significant public health problem. Introduction of new vaccines must be evaluated, considering disease burden and cost issues, and reviewing available surveillance, hospitalization and reported cases data for pneumonia and diarrhoea among children under-5 years old and data on cervical cancer. He encouraged Pacific island countries to ensure that vaccine introduction is accompanied by comprehensive plans to control targeted diseases. He recommended: 1) review the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) and develop a national plan to implement it, identifying priority steps that can be done in the short term and steps that will require more time and/or resources to carry out; 2) strengthen disease surveillance to generate information for decision-making and to monitor impact of immunization; and 3) after reviewing available data (first bullet), assess the quality of the data and the systems to collect data, and identify areas for improvement. 2.2.12 New vaccine introduction in Fiji
Sister Litiana Volavola presented Fiji’s experience with new vaccine introduction, specifically PCV, rotavirus vaccine and HPV vaccine). Before the introduction of the three new vaccines, Fiji studied the burden of disease of pneumonia, rotavirus infection and cervical cancer. With strong evidence of high burden of disease, in 2011, the Cabinet endorsed the introduction of the three vaccines. The Ministry of Health also added an indicator for new vaccine introduction in its five-year strategic plan. Challenges include, as a lower- middle-income country, new vaccine introduction can utilize a sizable portion of total health expenditure. Also, a shortage of secure, predictable funding can be a barrier for developing countries planning long-term health programmes for their children. However, with support from Australia's bilateral health programme, a unique partnership was formed and significant technical support was provided at all stages of new vaccine introduction through the Fiji Health Sector Support Program. A new immunization schedule was developed to incorporate these three new vaccines. Cold chain capacity increased dramatically. At the storage level, it increased 4.6 times, while at the service level, the capacity increased 3.6 times. New vaccines were incorporated into the Public Health Information System (PHIS), which moved from paper-based to computerized system. The child health card, which had been used for 25 years, was revised to reflect the new vaccines and other health interventions. Around 1000 nurses were trained in the new vaccine introduction, new child health record, and updated PHIS. A four-phase communication strategy was developed to create public awareness. Fiji launched the new vaccines during Child Health Week in September 2012. Currently, coverage is 98% for the first dose of PCV and rotavirus vaccine, 80% for the third dose of PCV and rotavirus vaccine, and 92% for the first dose of HPV vaccine. In conclusion, new and underutilized vaccines can be introduced into lower-middle-income countries, and innovative financing solutions and significant technical support are required to achieve high coverage.
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2.2.13
New vaccine introduction in Kiribati
Ms Tikua Tekitanga presented Kiribati’s introduction PCV. In 2013, with support from the GAVI Alliance, Kiribati received PCV13 vaccines and launched a campaign from 6 to 10 May. The campaign targeted children using fixed sites and mobile teams to cover all villages and maneabas. Around 92% of children were vaccinated with the first dose of PCV. Preparations for the introduction of PCV began in 2012, with the revision of EPI policy, handbook, immunization card, register and monthly reporting form. To increase public awareness, posters, pamphlets and CDs were developed, and media communication also was used (newspaper, radio, TV). Guidelines, micro-planning and training package for nurses and supervisors were also developed. The cost of PCV introduction (not including the vaccine costs) was around US$ 100 000. Additional benefits of PCV13 introduction have been strengthened routine immunization (capacity-building in micro-planning, data management, injection safety, waste management), improved surveillance and enhanced cold chain system. Areas for improvement include monitoring and supervision, documentation (including reporting and recording), and communication with nurses in outer islands. Kiribati plans to conduct EPI coverage surveys, hepatitis serosurveys and introduce rotavirus and HPV vaccines. The success of PCV introduction was the result of excellent coordination between the Ministry of Health and Medical Services and the Interagency Coordinating Committee (ICC), a sound deployment plan, public/community awareness and commitment from nurses. 2.3 2.3.1 Improve vaccine procurement and supply chain management Vaccine Independence Initiative beyond 2015
Mr Nahad, Sadr Azodi presented the Vaccine Independence Initiative (VII) touching upon the performance review of the 13 Pacific countries participating in VII, and explaining how Pacific island countries would procure vaccines in future. Since 1995, the 13 countries have benefited from VII, a transactional financing pooled procurement system for routine vaccines. Through this mechanism, countries can access 10 types of vaccines through a revolving fund. The benefits of VII include competitive pricing, quality assurance, solidarity in vaccine security and transparency. VII has been extended until 2015 when the UNICEF Executive Board will discuss the possibility of a five-year extension. Regardless of the pending decision, VII should continue to improve its management and administrative processes to improve forecasting, stock management and payment timeliness. 2.3.2 Vaccine procurement system in the United States of America
Dr Minal Patel explained that the immunization programme in the United States of America is funded by taxpayers. Funds are provided to US CDC through two appropriations from the United States Congress. Funding is then distributed to 50 states, six urban centres, six United States Affiliated Pacific Islands (USAPIs), and two Caribbean islands to support immunization programmes. In exchange, these programmes must meet requirements, such as assessing and maintaining high coverage. The Vaccines for Children (VFC) programme, which covers 50% of children in the United States of America and territories, eliminates or reduces vaccine cost as a barrier to vaccinating eligible children. The VFC covers all vaccines recommended by the United States Advisory Committee on Immunization Practices, as well as operational costs. The programme covers some children in Guam, American Samoa and the Commonwealth of the Northern Mariana Islands. A second funding stream, "317", covers children missed by VFC; all six USAPIs qualify for this funding source. There are four American manufacturers of vaccines; US CDC maintains around 20 contracts that are bid on by these four manufacturers. Multiple manufacturers supply
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the same antigen, enabling awardees to choose a source based on their needs and prevent shortages. US CDC gives money to the manufacturer based on projections. US CDC maintains an online ordering system that allows providers/awardees to order directly from a distributor. US CDC monitors the distributor's stock and places weekly orders with the manufacturer to ensure supply. The distributor sends the completed order directly to the doctor's office. In USAPIs, however, vaccine is sent to central level, as it is hard to send to lower levels. 2.3.3 Procurement of vaccines outside of VII
Ms Kylie Jenkins presented the procuring vaccines in the open market. In 2011, the Ministry of Health Fiji committed to the introduction of HPV, PCV and rotavirus vaccine. They elected to tender out vaccine supply following regular procurement procedures. The Ministry of Health negotiated a suitable price for the vaccines and awarded a tender. AusAID agreed to assist with a co-financing agreement, whereby the Ministry of Health would fully fund these vaccines in four years. 2.3.4 Effective Vaccine Management (EVM)
Mr Raymond Mauriasi presented the results of an EVM assessment that was conducted in Solomon Islands in 2013. The EVM initiative provides materials and tools to monitor and assess vaccine supply chains and help countries improve their supply chain performance. The EVM assessment in Solomon Islands identified the strengths and weaknesses in nine areas of vaccine management at each of the four levels of the vaccine supply chain. Nine criteria were assessed, with results ranging from 20% to 69% (failing to reach the standard of 80%). Storage capacity and buildings received the highest scores. Solomon Islands’ strengths include adequate staffing, availability of guidelines and standard operating procedures, operation of cold chain in many places, sufficient storage capacity, good buildings, autonomy in planning at provincial level, computerized vaccine stock management and involvement of all nurses in immunization. Weaknesses included information systems and supportive management functions, stock management, vaccine management, maintenance, and temperature monitoring. The post-EVM improvement plan and the status of its implementation, covering capacitybuilding, equipment, human resources, roles and delineation plan, and vaccine and cold chain policy revision. All recommendations would be followed up and implemented. 2.3.5 International EPI review
Ms Jenny Gaiofa presented an international review conducted in Solomon Islands in 2012. A team of 12 international staff (GAVI Alliance, JICA, Ministry of Health Mongolia, UNICEF and WHO) and 18 staff from the Ministry of Health and Medical Services Solomon Islands conducted the review from 29 October to 15 November 2012. Activities included a desk review, training, field visits, consolidating findings, and reporting to the Government of Solomon Islands and international partners. The objectives of the review were to assess the national immunization programme with regard to national, regional and global immunization goals and targets, to suggest policy options, and to provide technical recommendations for the Government of Solomon Islands to address strategic issues. Five provinces, one city council, 12 area health centres and 13 rural area health centres were selected as part of the review. The findings of the review included: (1) EPI has been strengthened at national and provincial levels; (2) vaccination coverage has improved over the year; (3) EPI and the MCH programme have been well integrated at all levels; (4) community awareness on and demand for immunization has increased; and (5) incidence of polio, measles and maternal and neonatal tetanus sustained at zero level.
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Challenges included the denominator for vaccination coverage, cold chain, vaccine management, and funding data management. 2.4 2.4.1 AEFI surveillance system Country mapping of AEFI surveillance system in the Pacific
Dr Valiakolleri presented a brief overview of the AEFI surveillance system in the Pacific. In many countries, the AEFI surveillance system is relatively weak, functional NRAs are nonexistent or limited, and human resources are limited for vaccine and drug regulation and AEFI surveillance. The AEFI surveillance system is administered at the national level in the Commonwealth of the Northern Marianas, Cook Islands, French Polynesia, Guam, Kiribati, Marshall Islands, New Caledonia, Niue, Palau, Samoa, Tonga and Tuvalu (health authorities). In American Samoa, the system is at the second administrative level, while in the Federated States of Micronesia the system is operated at national and state levels, and in Fiji and Tokelau, the system is available at all levels. While AEFI reporting forms are available in many countries, the investigation form and guidelines are available in limited countries. The countries supported by US CDC follow the Vaccine Adverse Events Reporting System (VAERS). There is a need to strengthen the AEFI surveillance system in the Pacific. 2.4.2 AEFI system in New Caledonia
Dr Anne Pfanstiel presented an overview of the robust immunization and AEFI system in New Caledonia. New Caledonia has a population of 265 000 and an infant mortality rate of 3.8 per 1000 live births. New Caledonia procures vaccines and medicines only from French and Europe, a process that is monitored by the French National Agency for Medicine and Health Products Safety (ANSM) in Paris. New Caledonia has a functioning NRA/Pharmaceutical Department with guidelines and standard operating procedures in place and an advisory committee to review AEFI reports. AEFI reporting is an obligation under the legislation for all health professionals. Legal provisions for the NRA stipulated that manufacturers should perform a specific study of safety in the post-marketing period to assure the safety of authorized products. Training is also provided regularly to doctors, pharmacists and laboratory staff on how to fill out the forms, interest and consequences of declaration. The AEFI system is working well with timely and complete reporting. 2.4.3 Causality assessment scheme and establishment of subregional causality committee for the Pacific Dr Md. Shafiqul Hossain presented on the formulation of a Subregional Causality Assessment Committee (SRCAC) for AEFI in the Pacific. Strong AEFI surveillance systems are needed to monitor existing and new vaccines in order to sustain confidence in national immunization programmes. The quality of AEFI surveillance systems and their functionality vary widely in the Pacific. There have been discussions in different meetings including PIPS to strengthen AEFI surveillance systems in Pacific island countries. An AEFI system relies on having an expert committee for determination of causal association, but most countries and areas in Pacific do not have adequate experts to form a causality committee. WHO organized a training workshop on basic AEFI surveillance in Pacific island countries in January 2012. One recommendation from the AEFI workshop was to formulate a subregional committee to support countries in determining the causal relationship of reported serious AEFI cases and to solve any vaccine-related concerns. WHO has started the process of formulating the SRCAC as per the demand of countries and areas. Dr Hossain described the importance of having a causality assessment committee in the Pacific comprised of experts in different areas, the newly revised AEFI definition, classification
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and causality assessment scheme, and the four steps of causality assessment. He described the draft objectives, terms of references membership eligibility and next steps of the SRCAC. Detailed discussions on the SRCAC followed, along with group work to obtain further inputs. 2.4.4 Regional surveillance
Dr Josaia Samuela presented the Pacific Public Health Surveillance Network (PPHSN) and strengthening immunization programmes. PPHSN is a voluntary network of countries, areas, institutions and organizations that was established in 1996 under the auspices of SPC and WHO. He noted that a critical goal of surveillance is to control and/or prevent diseases. Therefore, any data collected must be organized and carefully examined, and any results need to be communicated to the public health and medical communities. The most relevant services for immunization strengthening are: 1) PacNet, which facilitates the rapid spread of information on outbreaks of vaccine-preventable diseases in the region (e.g. influenza outbreaks, rubella outbreaks, typhoid outbreaks) – previously monthly reports of hospital-based active surveillance (HBAS); 2) LabNet, which works broadly with laboratory strengthening, and specifically strengthening the abilities of laboratories to diagnose vaccine-preventable diseases: measles, tuberculosis, typhoid and influenza; and 3) syndromic surveillance, a weekly report of four syndromes, for early detection of outbreaks. To strengthen capacity, PPHSN is introducing a course on data for decision-making (first module delivered in USAPIs and Kiribati) and is planning to start a broader field epidemiology training programme for the Pacific. On HBAS, SPC has single and multiple sites of the surveillance to detect all AFP cases, to detect and alert measles and rubella outbreaks and to detect neonatal tetanus cases. In conclusion, surveillance is a valuable epidemiologic tool that can serve many purposes. When surveillance data are collected, analysed, interpreted and reported appropriately, these data can provide important information about disease patterns to inform public health practice and policy. 2.5 2.5.1 Systems strengthening WHO/UNICEF Joint Reporting Form and data quality issues
Dr Valiakolleri went through the WHO/UNICEF Joint Reporting Form on immunization and the importance of submitting high-quality data. While the quality of data from all countries has improved, there are still some gaps that need to be addressed. It was felt that countryspecific guidelines based on immunization schedules would assist in submitting quality coverage data and immunization indicators. 2.5.2 Immunization coverage survey in Fiji
Dr Rachel Devi presented a summary of an immunization coverage survey conducted in 2013 with technical support from Burnet Institute and financial support from AusAID. The design followed the 2008 survey, using samples of 30 clusters in each division and samples of 10 children and 10 mothers in each cluster. The survey covered 1200 children and 1200 mothers. The step-by-step survey process took around 20 weeks from preparation to data analysis (using Strata 12). Data on differences in coverage in relation to sex, geography or ethnicity, completeness of vaccination schedule for children and mothers, timeliness of doses and reasons why children and mothers weren’t fully immunized were analysed.
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For the 2013 immunization coverage survey, information was collected from child health cards, an indication that the recording immunization system is improving. Immunization coverage by card was around 88%, while by card and parental report was 95%. Around 92% (by card) and 98% (by card and parental report) of children were immunized on time, meaning, at 6, 10 and 14 weeks and 1 year for MR vaccine. While for tetanus toxoid, coverage was also reported to be high (94%). The 2013 coverage survey is important for Fiji's budgeting and planning, to develop and demonstrate good practices and lessons learnt for other countries in the region, to engage people who may not access facilities (health promotion and education), and to inform child health enumerators of health system issues and barriers to service utilization. 2.5.3 Immunization coverage survey in French Polynesia
Dr Jean Marc Segalin explained the history of EPI in French Polynesia. Immunization is free of charge and compulsory for school enrolment. A nationwide survey is implemented every five years. In the 2012 coverage survey, medical files of schoolchildren were analysed at 3 years, 7 years and 11 years of age using standardized forms. The participation rate of this study was very high, with 13 787 out of 14 024 children (98.7%) analysed. Results were compared with a 2007 study; both studies have shown high coverage of immunization. The study also took into account side effects of immunization that were reported directly online on the ANSM website. The immunization schedule in 2006 was revised in 2010 and will be revised again in 2014. Challenges in French Polynesia include: data management, transition period of the immunization schedules and the introduction of new vaccines. 2.5.4 Health information system in Fiji
Mr Amini Mucunabitu presented Fiji’s public health information system (PHIS) for immunization data management. This PHIS was introduced in the Ministry of Health in 2009 and reviewed in 2011 with support from AusAID and FHSSP in collaboration with the Global Fund through the Grant Management Unit (GMU). The objectives of PHIS are to provide timely, complete and accurate information that is being used to measure public health outcomes and to plan future activities. This monthly reporting system is maintained by community health nurses, area medical officers and nurse practitioners, subdivisional health sisters who enter the data online and send it to the divisional and national levels. She said many nurses are motivated to provide good data because they have seen the results. Challenges include data quality, connectivity and obtaining private sector data on immunization. The success of PHIS would depend on the development of a user-friendly guide, implementation of a data verification tool and timely provision of feedback. 2.5.5 J-PIPS2 terminal evaluation
Mr Hisakazu Hiraoka presented an outline of J-PIPS2 and the evaluation of J-PIPS2. JICA has been involved in EPI since 1997 (collaboration with UNICEF in cold chain provision). JPIPS has assisted Pacific countries in two phases, namely, Phase 1 (2005–2010) and Phase 2 (2011–2014), the latter covering Fiji, five focus countries and seven target countries in the Pacific. The aim of the J-PIPS2 project is to improve vaccine management and cold chain maintenance in a self-reliant manner in the countries under the PIPS mechanism, focusing on the five countries. A total of 462 participants were trained in vaccine management and cold chain maintenance at regional and in-country level. A terminal evaluation was conducted through interviews and field visits using the Development Assistance Committee's (DAC) five criteria: relevance, effectiveness, efficiency, impact and sustainability. The terminal evaluation found JPIPS2 to be “highly relevant”. This project is consistent with regional EPI efforts and policies of PIPS member countries. It is also in line with Japan’s assistance policy to promote “human security, with a particular focus on capacity building to ensure greater access to health”. The
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terminal evaluation also found J-PIPS2 to be “effective” (improved accuracy in reporting vaccine wastage, reduction in vaccine stock-outs and improvements in cold chain) and “moderately efficient”. It was too early to evaluate the impact; however, sufficient operational cost and reliable data systems should be secured for favourable impacts. Regarding sustainability, the terminal evaluation found J-PIPS2 to be “moderately sustainable”. The EPI policy will remain consistent in the Pacific, funding has been mostly secured, and knowledge and skills have improved to some extent, but the threat of emigration and retirement of nurses is a serious issue. Improvement in partnership was also noted under the PIPS framework. 2.6 Country consultations
Prior to the eighth PIPS workshop on 18 November 2013, PIPS partners (AusAID, JICA, UNICEF and WHO) conducted country consultations to hear about progress and challenges since the seventh PIPS meeting in 2011 . Country needs were captured in Annex 4. 3. RECOMMENDATIONS AND WAY FORWARD
Two parallel sessions were conducted before the closing ceremony for national EPI managers and PIPS partners to discuss recommendations and ways forward. 3.1 National EPI managers The national EPI managers discussed and agreed on the following: 3.1.1 Vaccine Independence Initiative (VII)
Heads of health of Pacific island countries should be kept informed by PIPS partners of VII status (and GAVI Alliance), and should make decisions for their countries. National EPI managers were supportive of VII as the best mechanism presently, but recognized that improvements are needed to enhance sustainability. 3.1.2 Donor/PIPS partner harmonization and country visits
There was some confusion as to the division of labour among partners and donors. This needs further clarification. A feedback mechanism should be put in place for partners and donors to follow up with Pacific island countries and areas after each in-country visit. 3.1.3 PIPS meeting reports and past PIPS meeting recommendations
National EPI managers recognized that some recommendations keep coming up since they were not fully implemented. Sometimes, when reports come out late, there is not enough time to revisit the recommendations for implementation and monitoring progress towards fulfilling them. 3.1.4 J-PIPS and continuing support
National EPI managers were in favour of J-PIPS continuing. J-PIPS support to national EPI programmes has been invaluable in community case management and capacity-building. If J-PIPS is extended for a third phase, it is recommended that Pacific island countries and areas be informed of this decision.
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3.1.5
PIPS workshop participation, logistics, agenda and presentations
For future PIPS meetings, Pacific island countries request support for the participation of at least two participants from each country. Since there were so many presentations, retaining information was a challenge. 3.1.6 Joint Reporting Form
The Joint Reporting Form is complicated and needs to be simplified. Countries should be given clear instructions or offered training on how to complete it. 3.1.7 Disease surveillance
There was some confusion between the PPHSN and HBAS surveillance systems. National EPI managers acknowledged the importance of disease surveillance and the need to continue zero reporting under HBAS. 3.1.8 Regional EPI network
There is a need to set up a regional online forum for communicating among regional EPI managers on topics of common interest to all (note: EPINet is being taken up by PPHSN for investigation and response). 3.1.9 Accounts payments to VII
There is a need to improve communication between UNICEF offices (Suva and Copenhagen) and countries because of delays, lack of clarification and confusing invoices that Pacific island countries and areas receive. 3.1.10 Marketplace concept
This agenda item needs clarification in future meetings since the concept was not clear to everyone. It is suggested to have alternate activities, such as a field visit to Yee Cold Storage, for managers to see the facility and its operations. 3.1.11 Hexavalent vaccine
National EPI managers requested further clarification on the delay of WHO prequalification of the hexavalent vaccine. 3.2 3.2.1 PIPS partners GVAP
1) Pacific island countries should update their national immunization plans using GVAP as a framework and should ensure that GVAP is on the agenda of their health strategic plan. 2) PIPS partners will assist Pacific island countries in revising the Joint Reporting Form in order to incorporate GVAP reporting. 3) PIPS partners will ensure that immunization issues in the Pacific are on the agenda of ministerial meetings as part of high-level advocacy.
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3.2.2
World Immunization Week
1) Pacific island countries are encouraged to observe World Immunization Week in 2014, with the theme of hepatitis B control, and to consider adding a Child Health Week according to the country’s needs. 2) PIPS partners will support Pacific island countries in carrying out World Immunization Week by providing technical support, advocacy materials and financial support, where applicable. 3.2.3 Verification of measles elimination
1) Pacific island countries should monitor measles elimination and prepare an annual progress report on the measles elimination goal based on the lines of evidence. 2) PIPS partners will assist Pacific island countries in preparing annual progress reports on the measles elimination goal. 3) PIPS partners will simplify reporting on the measles elimination goal using existing mechanisms (Joint Reporting Form and surveillance). 3.2.4 Strengthening routine immunization
1) Pacific island countries are encouraged to systematically map the underserved communities with missing children and prioritize them for micro-planning and supervision. 2) PIPS partners will support Pacific island countries with their specific needs in terms of mid-level managers training and development of EPI policy, cold chain policy and comprehensive multi-year plans (cMYP). 3.2.5 Polio endgame strategy
1) Pacific island countries should maintain high population immunity. Countries that are still using OPV should consider introducing at least one dose of IPV as part of the polio endgame strategy, without disrupting the country plan for introduction of new vaccines. 2) Pacific island countries should take urgent actions to bring AFP surveillance indicators to the level of certification standards. 3) WHO should develop guidelines on IPV introduction. 4) PIPS partners should ensure that Pacific island countries get support for the introduction of at least one dose of IPV, vaccine procurement and cold chain, where applicable. 3.2.6 Certification process for hepatitis B control
1) Pacific countries should consider conducting a hepatitis B serosurvey if the coverage targets have been met (followed by verification process) and if prevalence data indicate less than 1% hepatitis B infection among children. 2) Countries should analyse bottlenecks in improving birth-dose coverage of hepatitis B vaccine. 3) WHO and US CDC should support countries in the verification process.
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4) PIPS partners should analyse how to increase coverage with the timely hepatitis B birth dose and consider the possibility of implementing hepatitis B outside the cold chain or using the hepatitis B Uniject. 3.2.7 New vaccines
1) Pacific island countries' National EPI managers should discuss with senior management the priority of introduction of new vaccines. 2) PIPS partners should work with countries exploring options and developing concept notes for rational introduction of new vaccines, taking into account disease burden, cost issues and cold chain implications. 3.2.8 VII
1) Pacific island countries should ensure timely submission of agreement letters, accurate forecast charts, vaccine orders/acceptance forms, vaccine arrival report and payments. 2) Pacific island countries should send responses/input regarding the transition of VII via email or mail to UNICEF Pacific. 3) National EPI managers should discuss procurement options with senior management at the Ministry of Health. 4) UNICEF should improve timeliness of invoicing and communication with countries regarding their payment. 5) UNICEF should provide updates on the transition of VII if it ends in 2015. 3.2.9 Cold chain strengthening
1) Pacific countries that have carried out an EVM assessment should implement the EVM Improvement Plan and regularly monitor progress against the plan (activity and timeline). 2) Pacific countries should take responsibility for maintaining the cold chain. 3) Pacific countries should consider EVM if relevant. 4) PIPS partners should support countries in calculating the cold chain implication in the introduction of new vaccines. 5) PIPS partners should provide support, where applicable, to countries that need cold chain support and EVM. 3.2.10 AEFI 1) Participants from Pacific island countries should brief senior officials in the Ministry of Health on SRCAC and strengthening AEFI. 2) Pacific island countries are encouraged to liaise with WHO and SPC Pacific in strengthening AEFI. 3) Pacific island countries should explore options to integrate AEFI surveillance with the existing surveillance system.
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4) Pacific partners will assist Pacific island countries in strengthening AEFI (training and monitoring). 3.2.11 Vaccine-preventable diseases surveillance 1) Pacific countries that are introducing new vaccines need to consider extending vaccinepreventable disease surveillance to incorporate these new diseases. 2) Countries that are not introducing new vaccines should strengthen current vaccinepreventable disease surveillance. 3) WHO Pacific will discuss with SPC on the combining form for surveillance. 4) PIPS partners will assist Pacific countries in the surveillance system (technical support). 3.2.12 Country needs
1) Pacific countries should discuss country needs with their senior management at the Ministry of Health and inform PIPS partners within seven days. 2) PIPS partners should map existing resources (funding and technical) and provide feedback to Pacific countries. 3) The country needs will be reviewed by PIPS partners. 4) PIPS partners should monitor the progress by conducting a joint mission to selected Pacific countries.
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ANNEX 1
EIGHTH PACIFIC IMMUNIZATION PROGRAMME STRENGTHENING (PIPS) WORKSHOP 19-22 November 2013, Nadi, Fiji ANNOTATED AGENDA Chair-person for Opening Session: Dr. Sergey Diorditsa Tuesday, 19 November Time Topic 07:30- 08:00 Registration 08:00-08:10 Devotion 1. Opening Session 08:10-09:00 Opening Remarks 09:00- 09:10 09:10-09:35 09:35-09:40 09:40- 09:55 09:55- 10:15 Objectives of the workshop Self- Introductions Administrative Announcements Group Photograph Coffee Break Dr Jayaprakash Valiakolleri, WHO SP
Presenter/ Facilitator(s) All Participants Participant WHO, UNICEF, CDC, JICA, SPC, AusAid, NZAID Minitsry of Health, Fiji Dr Sergey Diorditsa, Team Leader, WPRO, WHO
Chairperson: Ms. Tikua Tekitanga Time Topic 2. Global and regional overview on 10:15-10:35 Immunization Programme 10:35-10:45 Discussion 3. Strengthening Routine Immunization 10:45-11:00 Development of Regional Framework for GVAP implementation in the Western Pacific 11:00-11:10 Status towards implementation of GVAP 11:10- 11:20 Status towards implementation of GVAP 11:20-11:35 Discussion Improving immunization service delivery in the 11:35- 11:45 Pacific 11:45-12:00 12:00-13:00 13:00-13:15 13:15-13:30 13:30-13:45 Discussion Lunch Break Country Experience on Maintaining High Immunization Coverage Country experience on Mid-level Managers (MLM) training on Immunization Discussion
Presenter/facilitator (s) Dr Sergey Diorditsa
Dr Takashima Yoshi, WHO, WPRO & Dr J Valiakolleri Ms Mine Pulu, Niue Ms Fuapepe Iese, Samoa Dr Wang Xiajoun, Immunization Specialist, EAPRO, UNICEF
Sr Sela Paasi, Kingdom of Tonga Dr J Valiakolleri / Ms Merlyn Basilius, Palau
Annex 1 13:45-14:00 14:00-14:10 14:10-14:30 14:30-14:45 Global Immunization Week and Child Health Week Discussion Country experience on Measles Supplementary Immunization Activities Verification of measles elimination- Lines of Evidence Dr Md. Shafiqul Hossain, WHO, WPRO Mr Morris Amos, Vanuatu
Dr J Valiakolleri / Dr Adi Lisi Tikoduadua, Chair, Sub-Regional Certification Committee (SRCC) for Poliomyelitis Eradication & Sub-Regional Verification Committee (SRVC) for Measles Elimination
14:45- 15:00 15:00-15:15 15:15- 15:30 15:30- 16:30
Discussion Coffee Break Polio End Game Strategy
Group work on Injectable Polio Vaccine (IPV) Introduction 18:30-20:30 Regional Director’s Reception Wednesday, 20 November Chairperson: Ms Mine Pulu Time Topic 08:00- 08:05 Devotion 08:05- 08:10 Programme for the day 08:10- 08:25 08:25- 08:35 08:35- 08:50 08:50- 09:05 09:05- 09:20 09:20- 09:35 09:35- 09:50 09:50- 10:10
Dr. J Valiakolleri /Dr Lisi Tikoduadua WHO/UNICEF/ Dr Lisi Tikoduadua
Presenter/facilitator (s)
10:10-10:25 10:25-10:40 10:40- 10:55
Mr Nahad Sadr-Azodi, UNICEF Pacific Country experience on certification process for Ms Rangi Tairi, Cook Islands Hepatitis B control Discussion New vaccines in the Pacific- Progress and way Dr Sergey Diorditsa forward Country Experience on New Vaccine Sr Litiana Volavola, Fiji Introduction Country Presentation on New Vaccine Ms. Tikua Tekitanga, Introduction Kiribati Discussion Coffee Break 4. Improved vaccine procurement and supply chain management Vaccine Independence Initiative options for Dr Wang Xiajoun, UNICEF pacific Regional Office, Bangkok US vaccine procurement system Dr Minal Patel, CDC, Atlanta Vaccine procurement system in Guam Ms Rita Olivia, Guam Procurement of vaccines outside of VII Ms Kylie Jenkins, FHSSP, Fiji
2
Annex 1 10:55- 11:10 11:10-12:30 12:30-13:30 13:30- 14:30 14:30- 14:45 14:45-15:00 15:00-15:15 15:15- 18:00 Discussion Group Work Lunch Break Group work cont’d Effective Vaccine Management (EVM) Assessment International EPI Review Coffee Break 4. Market place
Mr Raymond Mauriasi, Solomon Islands Dr J Valiakolleri / Mr Raymond Mauriasi All countries Partners Presenter/facilitator(s) Mr Nahad
Thursday, 21 November Chairperson: Dr Santus Wari Time Topic 08:15-08:25 Devotion 08:25-08:30 Programme for the day 08:30-08:45 5. Adverse Events Following Immunization (AEFI) Surveillance System Country Mapping of AEFI Surveillance System in the Pacific 08:45-09:00 AEFI system in New Caledonia 09:00- 09:15 Discussion 09:15- 09:35 Causality assessment scheme and establishment of sub-regional causality committee for the Pacific (national expert committee for vaccine safety) 09:35- 09:45 Discussion 09:45- 10:00 Coffee Break 10:00- 12:30 Group work 12:30-13:30 Lunch Break 6. Systems Strengthening 13:30: 13:50 Regional Surveillance 13:50- 14:45 WHO/UNICEF Joint reporting Form data quality issues 14:45-15:00 Coffee Break 15:00-15:15 Immunization coverage survey in Fiji 15:15- 15:30 Immunization coverage survey in French Polynesia 15:30- 15:45 Discussion 15:45-16:00 Health Information System in Fiji 16:00- 16:15 Discussion Friday, 22 November Chairperson: Ms Louisa Helgenberger Time Topic 08:15-08:25 Devotion
Dr J Valiakolleri Ms Anne Pfanistel, NEC Dr Md. Shafiqul Hossain
Facilitators and participants
Dr Josaia Samuela, SPC Dr J Valiakolleri
Fiji Dr Segalin Jean-Marc, French Polynesia Fiji
Presenter
3
Annex 1 08:25-08:30 08:30- 08:45 08:45- 08:55 08:55- 10:15 10:15- 10:30 10:30- 11:00 11:00:11:15 11:15- 12:00 12:00- 12:30 12:30- 13:30 Programme of the day JPIPS Evaluation Discussion 07. Parallel Sessions EPI Managers PIPS Partners Coffee Break 08. Recommendations and way forward 09. Joint Calendar on Technical Assistance Package Closing Ceremony Joint Press Release Lunch Break Mr Nahad
Facilitators and participants
Ms Louisa Helgenberger, FSM WHO/UNICEF
4
EIGHTH PACIFIC IMMUNIZATION PROGRAMME STRENGTHENING (PIPS) WORKSHOP 19-22 November 2013, Nadi, Fiji TIMETABLE Time 07:30-08:00 08:00-08:10 08:10-09:55 Tuesday, 19 November 2013 Registration Devotion 1. Opening Session Opening Remarks Objectives of the workshop Self-introductions Administrative announcement Group Photo Time 08:00- 08:05 08:05-08:10 08: 10- 08:35 08:35- 09:35 Wednesday 20 November 2013 Devotion Programme of the day 3.8 Country experience on certification process of Hepatitis B control 3.9 New vaccines Introduction- Progress and way forward - Presentations and discussion Time 08:15-0:825 08:25-08:30 08: 30-09:15 Thursday 21 November 2013 Devotion Programme of the day 6. Adverse Events Following Immunization (AEFI) System 6.1 AEFI surveillance system in Pacific -Presentations and discussion 6.2 Establishment of sub-regional causality committee for the Pacific - Presentation and discussion Time 08:15-0:825 08:25-08:30 08:30- 08:55 08: 55-10:15 Friday 22 November 2013 Devotion Programme of the day JPIPS Evaluation 8. Parallel sessions - EPI Managers & Partners
09:15-09:45
09:55-10:15 10:15- 10:45 10:30-12:00
COFFEE BREAK 2. Global and regional overview of EPI 3. Strengthening Routine Immunization 3.1 Implementation of Global Vaccine Action Plan - Presentations & discussion 3.2 Improving immunization service delivery in the Pacific
09:35-09:50 09:50- 12:30
COFFEE BREAK 4. Vaccine independence initiative (VII) 4.1 VII options in Pacific and vaccine procurement system - Presentations and Group Work
09:45-10:00 10:00-12:30
COFFEE BREAK 6.3 Group work on establishment of subregional causality committee for the Pacific
10:15-10:30 10:30-11:15 11:15-12:00 12:00-12:30
COFFEE BREAK 9. Recommendations and technical assistance package 10. Closing Remarks 11. Joint Press Release
12:00-13.00 13:00- 13:45
LUNCH BREAK 3.3 Maintaining high routine immunization coverage 3.4 Mid-level Managers training on EPI - Presentations and discussion 3.5 Global Immunization Week and Child Health Week - Presentation and discussion 3.6 Measles elimination and Supplementary Immunization Activities (SIAs) -presentations and Discussion COFFEE BREAK 3.7 Polio End Game Strategy - Presentation and Group Work Regional Director's reception
12:30-13:30 13:30-14:30 14:30-14:45 14:45-15:00
LUNCH BREAK Group Work presentations 4.2 Effective Management Assessment -Presentation 4.3 International EPI Review - Presentation
12:30-13:30 13:30-13:50
LUNCH BREAK 7. Systems Strengthening 7.1 Regional Vaccine Preventable Diseases (VPDs) Surveillance - Presentation and discussion 7.2 WHO/UNICEF Joint Reporting Form - Review and Discussion
12:30-13:30
LUNCH BREAK
13:45- 14:10 14:10-15:00
13:50- 14:45
15:00-15:15 15:15 -16:30
1500-15:15 15:15-18:00
COFFEE BREAK 5. Market Place
14:45-15:00 15:00-15:45 15:45-16:30
COFFEE BREAK 7.3 EPI Coverage Survey - Presentation and discussion
ANNEX 2
7.4 Fiji Health Information System
18:30-20:30
ANNEX 3 Summary of participants’ evaluation of the eighth PIPS workshop 1. • • • • • • • • • • • • • • Most relevant aspects: The agenda was better than the previous meeting. Updates and progress from PIPS participants and donors Fruitful discussions and very informative Appropriate forum to discuss challenges Country sharing on best practices Consistency of follow-up from previous years All presentations and discussions were very interesting especially the VII processes. Opportunity to share country’s experiences Global strategy GVAP World Immunization Week VII AEFI EPI coverage
2. Least relevant: • Most participants found all topics were relevant. • A few mentioned that marketplace was not impressive. • One participant mentioned that recommendations were repetitive from previous meeting. • Not respecting the agenda – presentation time • Less communications with donors 3. Country consultations: • For countries that participated in the country consultations, most of them expressed that this was necessary and a good effort. However, they need to be informed of this agenda item earlier. • Able to share progress, concerns and feedback and negotiate more for partnership and support. 4. Suggestions for administration, logistics and accommodation: • Many countries said this PIPS meeting was well organized. • Tentative agenda should be sent three weeks prior to the meeting. • Some countries were late in their nominations. • Some asked for more information in advance for group discussions. 5. Suggestions for future PIPS meetings: • Technical agencies to visit individual countries after PIPS meetings • More participants for bigger countries, at least two participants from each country • Field trip to health facilities, regional cold storage (UNICEF) • More time control on each presentations • Create network for exchange of information among countries and technical agencies. • Keep presentations brief and according to template prepared and provided. • Fewer PowerPoints presentations and more discussions • Technical agencies (WHO and UNICEF) to co-chair with country representative to prompt more discussions.
Summary of country requests for further follow up action by technical agencies/donors No. Country Disease burden study New Vaccines introduction Financial support Procurement of Technical vaccines guidelines HPV and other vaccines 2015 PCV, rota and HPV Yes SIA Hepatitis B Surveillance seo-survey AEFI and certification process Yes Yes Yes Pohnpei Yes state Yes Rota (cofinancing) Yes Yes Yes Yes Yes Yes Refrigerator, cold storage, cold room Yes 2014 Yes Yes Yes Yes Yes Yes (cold chain, vehicle) Trainings Cold chain EVM Development/ Others revision cMYP EPI Cold Policy chain Policy YesYes review
Vaccine Routine/ Immunization Procurement Management MLM in practice Yes Yes
1 COK 2 FJI 3 PYF 4 FSM
5 GUM 6 KIR
7 NRU 8 NEC 9 NIU 10 PLW 11 SMA 12 SLB Rota/ HPV/PCV GAVI Yes Yes Yes
Yes Yes Yes Rota
Yes
Yes
Yes
Incinerator
Yes Yes
Yes
Yes Yes 2015 MR (up to 15 years) Yes Yes Yes Yes
Yes Yes 2015
TA for 3 years Continue TA
13 TOK 14 TON Pneumo coccus infection HPV
Yes
Yes
Yes Yes
Yes Yes Yes
Incinerator
15 TUV 16 VUT
HPV
Yes Yes Yes Yes
Yes
Yes
ANNEX 4
ANNEX 5 LIST OF PARTICIPANTS, TEMPORARY ADVISER, REPRESENTATIVES/OBSERVERS AND SECRETARIAT
1. PARTICIPANTS AMERICAN SAMOA Ms Sharmain Mageo, Programme Manager, Epidemiological Laboratory Capacity, EPI POC/INF Disease Surveillance Nurse, American Samoa Health Department, P.O. Box 96799, Pago Pago. Tel no.: (684) 699 8680. Fax no.: (684) 699 6385. E-mail: sharmain.mageo@doh.as; sharmainmageo@gmail.com Mrs Rangi Tairi, Manager Public Health Nurse and EPI Manager Ministryo f Health, P.O. Box 109, Tupapa, Rarotonga Tel no.: (682) 29110 ext. 728 Fax no.: (682) 29100. E-mail: r.tairi@health.gov.ck Ms Litiana Volavola, National EPI Coordinator, Fiji Pharmaceutical and Biomedical Services Centre, Lot 1, Jerusalem Road, Vatuwaqa, Suva. Tel no.: (679) 3388000 ext. 109. Fax no.: (679) 3388012. E-mail: Litiana.volavola@govnet.gov.fj; lvolavola@yahoo.com Dr Rachel Devi, Acting National Advisor, Family Health, Ministry of Health, Dinem House, Amy Street, Suva. Tel no.: (684) 731 4779. E-mail: rachelrama07@gmail.com FRENCH POLYNESIA Dr Jean-Marc Segalin, Medicin responsable du, Bureau des Programmes de Pathologies Infectieuses, Direction de la Sante, (Medical Officer, Bureau of Infectious Diseases Programme Health Bureau), 98713 Papeete BP 611. Tel no.: (689) 0 488 215. Fax no.: (689) 488 224. E-mail: jean-marc.segalin@sante.gov.pf; jmsegalin@yahoo.fr. Ms Rita Q. Oliva, CDC Coordinator II, Immunization Program Department of Public Health and Social Services, 123 Chalan Kareta Mangilao 96913-6304. Tel no.: (671) 735 7143. Fax no.: (671) 734 1475. E-mail: rita.oliva@dphss.guam.gov. Ms Tikua Tekitanga, Principal Nursing Officer – EPI Coordinator, Ministry of Health and Medical Services, P.O. Box 268, Tarawa Tel no.: (686) 90841. Fax no.: (686) 28152. E-mail: tikutanga@gmail.com Ms Teanibuaka Tabunga, Senior Health Information Officer, Health Statistics and Information Unit, Ministry of Health and Medical Services, Nawerewere, Bikenibeu, Tarawa. Tel no.: (686) 28100. Fax no.: (686) 28152. E-mail: teanibuakatabunga@gmail.com
COOK ISLANDS
FIJI
GUAM
KIRIBATI
Annex 5 COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS
Mr Jeffrey T. Sablan, Community Outreach Worker, Immunization Program, Division of Public Health, Commonwealth Healthcare Corporation, Hinemlo Drive Garapan, P.O. Box 500409 Saipan MP 96950. Tel no.: (670) 483 2375; 236 8734. Fax no.: (670) 233 0030. E-mail: jsablan74@gmail.com Ms Daisy Pedro, Immunization Programme Manager, Ministry of Health P.O. Box 16, Majuro, MH 96960, Tel no.: (692) 625 3399. Fax no.: (692) 625 3432/4543. E-mail: tasse23@gmail.com. Ms Herokko Neamon, Chief Nurse for Public Health Clinic, Ministry of Health, P.O. Box 16, Majuro, MH 96960. Tel no.: (692) 455 5346. Fax no.: (692) 625 3432/4543. E-mail: shots4kids@yahoo.com. Ms Mailynn Konelios-Langinlur, Assistant Secretary of Health, Bureau of Primary Health Care Services, Ministry of Health, P.O. Box 16 Majuro, MH 96960. Tel no.: (692) 455 0263. Fax no.: (690) 625 3432/4543. E-mail: mailynnlang@gmail.com Ms Bremity Lakjohn, Chief Nurse for Public Health – Outeach Program Ministry of Health, P.O. Box 16, Majuro, MH 96960. Tel no.: (692) 456 5135. Fax no.: (690) 625 3432/4543. E-mail: shots4kids@gmail.com; bremo73@yahoo.com
REPUBLIC OF MARSHALL ISLANDS
MICRONESIA, FEDERATED STATES OF
Mr Richard Moufa, Coordinator, NCD through Primary Health Care WHO Country Liaison Office for Northern Micronesia, Department of Health and Social Affairs, Mogethin Building, 1st Floor, National Capital Complex, P.O. Box PS 70, Palikir, FM 96941. Tel no.: (691) 320 2619. Fax no.: (001) 866 868 3940. E-mail: moufar@wpro.who.int. Ms Louisa Helgenberger, National Immunization Programme Manager Department of Health and Social Affairs, P.O. Box 554, Kolonia Pohnpei 96941. Tel no.: (691) 320 2619/2643 2872. Fax no.: (691) 320 8632. E-mail: lhelgenberger@fsmhealth.fm. Mr Wincener J. David, FSM Health Planner, National Health Administration, P.O. Box 1152, Kolonia, Pohnpei 96941. Tel no.: (691) 320 2619/2643. Fax no.: (691) 320 8632. E-mail: wdavid@fsmhealth.fm. Mr Dominic Taruwemai, Department of Health Services, P.O. Box 148 Kolonia, Yap 96943, Tel no.: (691) 350 2115. Fax no.: (691) 350 3444. E-mail: dtaruwemai@fsmhealth.fm.
NAURU
Ms Rosella Egingotera Raidi, Primary Health Care Staff Nurse, Naoero Public Health Centre, Ministry of Health and Medical Services Republic of Nauru. Tel no.: (674) 5582762. E-mail: silinavm@gmail.com.
Annex 5 NEW CALEDONIA Dr Anne Pfannstiel, Medecin de programme de sante publique National Health Administration, Direction des Affaires Sanitaires et Sociales de Nouvelle, Caledonia-Service des Actions Sanitaires BPN4 38851 Noumèa Cedex. Tel no.: (687) 24 37 85. Fax no.: (687) 24 37 14. E-mail: anne.pfannstiel@gouv.nc. Ms Minemaligi Pulu, Maternal and Child Health Nurse and EPI Coordinator, Niue Health Department, P.O. Box 179, Alofi. Tel no.: (683) 4100. Fax no.: (683) 4265. E-mail: Mine.Pulu@mail.gov.nu. Ms Salustia Mira, Perinatal Hepatitis B Coordinator, Ministry of Health P.O. Box 6027, Koror 96940. Tel no.: (680) 488 2552 ext. 185 Fax no.: (680) 488 1211. E-mail: mirasalustia@gmail.com. Ms Merlyn Basilius, Immunization Programme Manager, Ministry of Health, P.O. Box 6027, Koror 96940. Tel no.: (680) 488 2212 ext. 300. Fax no.: (680) 488 4800. E-mail: mbasilius@gmail.com. SAMOA Dr Loloma Toelupe-Fonoti, Manager, Primary Health Care, National Health Services, Private Mail Bag, Apia. Tel no.: (685) 66600. Fax no.: (685) 32856. E-mail: LolomaT@nhs.gov. Ms Fuapepe Manuleleua, National EPI Coordinator, National Health Services, Private Mail Bag, Apia. Tel no.: (685) 66693. Fax no.: (685) 32856. E-mail: Fuapepel@nhs.gov.ws. Ms Maatasesa Samuelu-Matthes, Manager, Nursing and Midwifery National Health Services, Private Mail Bag, Motootua, Apia. Tel no.: (685) 66693. Fax no.: (685) 22905. E-mail: maatasesas@nhs.gov.ws. SOLOMON ISLANDS Ms Cynthia Angela Joshua, Surveillance Coordinator, World Health Organization, Office of the WHO Representative in Solomon Islands P.O. Box 22, Honiara. Tel no.: (677) 23406. Fax no.: (677) 21344. E-mail: joshuac@wpro.who.int. Ms Jenny Gaiofa, Child Health Information Officer, Reproductive and Child Health Division, Ministry of Health and Medical Services, P.O. Box 349, Honiara. Tel no.: (677) 21202. Fax no.: (677) 20085. E-mail: jgaiofa@moh.gov.sb. Mr Raymond Mauriasi, National EPI Coordinator, Reproductive and Child Health Division, Ministry of Health and Medical Services P.O. Box 349, Honiara. Tel no.: (677) 21202. Fax no.: (677) 20085. E-mail: rmauriasi@moh.gov.sb.
NIUE
PALAU
Annex 5 TOKELAU Ms Malae Fepuleai-Etuale, Integrated Sexual Reproductive Health, Coordinator, Tokelau Health Department, Nokunonu. Tel no.: (690) 4212. E-mail: mfepuleai.etuale@gmail.com. Ms Sela Paasi, Chief Nursing Officer and National Coordinator, Immunization Services, Ministry of Health, P.O. Box 59, Nuku'alofa. Tel no.: (676) 23200 ext. 1419. Fax no.: (676) 24291 E-mail: spaasi@health.gov.to. Ms Alaita Taulima, Public Health Sister/Assistant EPI Coordinator, Princess Margaret Hospital, Ministry of Health, Funafuti. Tel no.: (688) 20506. E-mail: alaitataulima@yahoo.com. Dr Santus Wari, Acting Director General of Health, Ministry of Health, Private Mail Bag 042, Port Vila. Tel no. : (678) 7109018 E-mail: swari@vanuatu.gov.vu. Mr Morris Willie Amos, Head of Family Health, Ministry of Health, Private Mail Bag 9009, Port Vila. Tel no.: (678) 774 3519. E-mail: mamos@vanuatu.gov.vu. 2. TEMPORARY ADVISERS
TONGA
TUVALU
VANUATU
Dr Adi Lisikoveni Vesikula Tikoduadua, (Polio SRCC Chair), Consultant Paediatrician, Department of Paediatrics, Colonial War Memorial Hospital, Box 115, Suva, Fiji. Tel no.: (679) 9925082. Fax no.: (679) 3303232. E-mail: ltikoduadua@health.gov.fj; liztiko@gmail.com 3. REPRESENTATIVES/OBSERVERS
FIJI SCHOOL OF MEDICINE
Mrs Paulini Dilagi Qica, Registered Nurse Practitioner, Fiji School of Nursing, College of Medicine, Nursing and Health Science, Tamavua, Suva, Fiji. Tel no.: (679) 3321 499 ext. 3605. E-mail: Paulini.qica@fnu.ac.fj. Mr Kylie Jenkins, Technical Facilitator, Infant and Child Health Fiji Health Sector Support Programme, P.O. Box 14986, Suva, Fiji. Tel no.: (679) 3215 803 / 3215 804. Fax no.: (679) 3301 536 E-mail: kylie.jenkins@fhssp.org.fj. Sr Seru Koroituki, Technical Support Officer, Infant and Child Health Fiji Health Sector Support Programme, P.O. Box 14986, Suva, Fiji. Tel no.: (679) 3215 806. Fax no.: (679) 3301 536 E-mail: seruwaiakoroituku@gmail.com.
FIJI HEALTH SECTOR SUPPORT PROGRAM
Annex 5 Mr Amini Mucunabitu, Assistant Technical Facilitator, Health System Strengthening, Fiji Health Sector Support Programme, P.O. Box 14986, Suva, Fiji. Tel no.: (679) 3215 806. Fax no.: (679) 3301 536. E-mail: amini.mucunabitu@fhssp.org.fj.
4. SECRETARIAT
Dr Sergey Diorditsa, Team Leader, Expanded Programme on Immunization and Acting Director, Combating Communicable Diseases, World Health Organization, Western Pacific Regional Office, U. N. Avenue, 1000 Manila, Philippines. Tel. No.: 632 528 9045 Fax No.: 632 521 1036. E-mail: diorditsas@wpro.who.int Dr Md. Shafiqul Hossain, Technical Officer, Expanded Programme on Immunization, World Health Organization, Western Pacific Regional Office, U. N. Avenue, 1000 Manila, Philippines. Tel. No.: 632 528 9033. Fax No.: 632 521 1036. E-mail: hossains@wpro.who.int Dr Yoshihiro Takashima, Technical Officer (Vaccine Safety and Management), Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel no.: (632) 5289746. Fax no.: (632) 526 0279. E-mail: takashimay@wpro.who.int. Dr Jayaprakash Valiakolleri, Technical Officer, Expanded Programme on Immunization, Office of the WHO Representative in South Pacific, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Tel no.: (679) 3304600. Fax no.: (679) 3234166 and 3234177. E-mail: valiakollerij@wpro.who.int. Ms Lynette Irene Evans, Secretary, Division of Combating Communicable Diseases, Office of the WHO Representative in South Pacific, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Tel no.: (679) 3304600. Fax no.: (679) 3234166 and 3234177. E-mail: evansl@wpro.who.int. Dr Asaua Faasino, National Professional Officer, Non-Communicable Diseases and Tobacco-Free Initiative, Office of the WHO Representative in Samoa, P.O. Box 77, Apia, Western Samoa. Tel no.: (685) 24976. Fax no.: (685) 23938. E-mail: faasinoa@wpro.who.int. Ms Siutaisa Toumoua, Secretary, World Health Organization, Country Liaison Office, P.O. Box 70, Naku'alofa, Tonga. Tel no.: (676) 23217. Fax no.: (679) 23938. E-mail: toumouas@wpro.who.int. Dr Rufina Latu, Medical Officer, Health Services Development, WHO Country Liaison Office, P.O. Box 177, Port Villa, Vanuatu. Tel no.: (678) 27 683. Fax no.: (679) 22 691. E-mail: latur@wpro.who.int. Dr Karen Allen, Representative, UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679) 323 6133. Fax no.: (679) 330 1667. E-mail: kallen@unicef.org.
Annex 5 Mr Nahad Sadr-Azodi, Maternal Nutrition Child Health Specialist, UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building, 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679)3236118. Fax no.: (679) 3301667. E-mail: nsadraz@hotmail.com. Dr Wang Xiaojun, Regional EPI Specialist, UNICEF, Regional Office for East Asia and the Pacific, 19 Phra Atit Road, Chanasongkram, Phra Nakorn, Bangkok 10200, Thailand. Tel. no.: (66 2) 3569499. E-mail: xiawang@unicef.org. Dr Ingrid Hilman, UNICEF, EPI Consultant, Jalan Dago Pakar Permai II/54, Bandung, Indonesia. Tel. no.: +62811195767. Mobile: +62811195767. E-mail :ingridhilman@yahoo.com. Ms Tinai Iuta, Health and Nutrition Officer, UNICEF Kiribati Field Office, Teaorareke, Tarawa, P.O. Box 466, Bairiki, Tarawa, Republic of Kiribati. Tel no.: (686) 29267/68/69. Fax no.: (686) 22879. E-mail: tiuta.unicef@gmail.com. Mr Solomon Tesema Schumi, UNICEF EPI Officer (UNV Samoa), UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building, 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679)3236100. Fax no.: (679) 3301667. E-mail: stesema@unicef.org. Mr Robert Ninson, UNICEF EPI Officer (UNV Solomon Islands), UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building, 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679)3236100. Fax no.: (679) 3301667. rninson@unicef.org. Ms Christine Calo-oy, Senior Supply Assistant, UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building, 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679)3236142. Fax no.: (679) 3301667. E-mail: ccalo-oy@unicef.org. Ms Julie-Anne Buwawa, Interim Programme Assistant, UNICEF, Level 3 & 5 Floors, Fiji Development Bank Building, 360 Victoria Parade, Private Mail Bag, Suva, Fiji. Tel no.: (679)3236131. Fax no.: (679) 3301667. E-mail: jbuwawa@unicef.org. Dr Minal Patel, Medical Epidemiologist, Western Pacific Region Team, Disease Eradication and Elimination Branch, Global Immunization Division, Centers for Disease Control and Prevention 1600 Clifton Road MS A04, Atlanta, Georgia 30333, United States of America. Tel no.: (404) 639 8907. Fax no.: (404) 315 2497. E-mail: hgo9@cdc.gov. Ms Paulini Sesevu, Senior Program Manager Regional Health, Department of Foreign Affairs and Trade, Australian Aid Program, Australian High Commission, 37 Princes Road, Suva, Fiji. Tel no.: (679) 338 8276. Fax no.: (679) 338 2695. E-mail: Paulini.Sesevu@dfat.gov.au Dr Frances Bingwor, Program Manager Regional Health, Department of Foreign Affairs and Trade, Australian Aid Program, Australian High Commission, 37 Princes Road, Suva, Fiji Tel no.: (679) 338 8283. Fax no.: (679) 338 2695. E-mail: Frances.Bingwor@dfat.gov.au. Mr Hisakazu Hiraoka, Cooperation Planning, Associate Expert, Health Division 3, Health Group 2, Human Development Department, JICA Headquarters, Tokyo, Japan. Tel no.: (813) 5226 8374. Fax no.: (813) 5226 6341. E-mail: Hiraoka.Hisakazu@jica.go.jp. Dr Yoshikuni Sato, Technical Advisor (EPI), President and CEO, Headquarters of Medical Corporation, Seiwakai, Japan. Tel no.: (813) 5226 8374. Fax no.: 813) 5226 6341. E-mail: y-sato@hospital-ohshu.or.jp.; satoyoshikuni@hotmail.com.
Annex 5 Mr Keisuke Nishikawa, Consultant for the Evaluation, (Japan Economic Research Institute, Inc.) Tokyo, Japan. Tel no.: (813) 5226 8374. Fax no.: 813) 5226 6341. E-mail: nishikawa@jeri.co.jp Mr Matsuura Shinya, Project Formulation Advisor (Health), JICA FIJI Office, Level 8, Suva Central Building, Suva, Fiji. Tel no.: (679) 330 2522. Fax no.: (679) 330 2452. E-mail: Matsuura.Shinya@jica.go.jp. Ms Nila Prasad, Program Officer, JICA Fiji Office, Level 8, Suva Central Building, Suva, Fiji. Tel no.: (679) 330 2522. Fax no.: (679) 330 2452. E-mail: nilaprasad.fj@jica.go.jp. Mr Akio Kaneko, J-PIPS Expert for cold chain, JICA Fiji Office, Level 8, Suva Central Building Suva, Fiji. Tel no.: (679) 330 2522. Fax no.: (679) 330 2452. E-mail: Akio.Kaneko@jica.go.jp. Mr Masato Yamauchi, J-PIPS Expert for vaccine management, JICA Fiji Office, Level 8, Suva Central Building, Suva, Fiji. Tel no.: (679) 330 2522. Fax no.: (679) 330 2452. E-mail: Masato.Yamauchi@jica.go.jp. Dr Josaia Samuela, Health Manager, Health Advancement Unit, Public Health Division Suva Office, Secretariat of the Pacific Community, Suva, Fiji. Tel no.: (679) 3379 429. Fax no.: (679) 3385 480. E-mail: JosaiaS@spc.int.