1
|
Evans-Gilbert T, Lewis-Bell KN, Irons B, Duclos P, Gonzalez-Escobar G, Ferdinand E, Figueroa JP. A review of immunization legislation for children in English- and Dutch-speaking Caribbean countries. Rev Panam Salud Publica 2023; 47:e19. [PMID: 36686892 PMCID: PMC9847406 DOI: 10.26633/rpsp.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the legislative frameworks concerning childhood vaccination in the English- and Dutch-speaking Caribbean and propose a model legislative framework for Caribbean countries. Methods This study included a survey of 22 countries and territories in the Caribbean regarding legal vaccination mandates for school entry, budget allocations, sanctions, or exemptions. A legal consultant conducted a comprehensive search and analysis of legislation regarding vaccination among 13 Caribbean countries/territories. A comparative analysis of the legislation under five themes-legislative structure, mandatory vaccination, national immunization schedule, sanctions, and exemptions-formed the basis for the proposed model legislation. Results Among the 22 Caribbean countries/territories, 17 (77%) had legislation mandating vaccination, 16 (94%) mandated vaccination for school entry, 8 (47%) had a dedicated budget for immunization programs, and 13 (76%) had no legislated national schedules. The source of legislation includes six (35%) using the Education Act, eight (47%) the Public Health Act, and five (29%) a free-standing Vaccination Act. Three countries/territories-Jamaica, Montserrat, and Saint Lucia-had immunization regulations. In 12 (71%) of the 17 countries with legislation, sanctions were included, and 10 (59%) permitted exemptions for medical or religious/philosophical beliefs. Conclusions Several countries in the Caribbean have made failure to vaccinate a child an offense. By summarizing the existing legislative frameworks and approaches to immunization in the Caribbean, the analysis guides policymakers in making effective changes to immunization legislation in their own countries.
Collapse
Affiliation(s)
- Tracy Evans-Gilbert
- University of the West IndiesKingstonJamaicaUniversity of the West Indies, Kingston, Jamaica,Tracy Evans-Gilbert,
| | - Karen N. Lewis-Bell
- Pan American Health OrganizationParamariboSurinamePan American Health Organization, Paramaribo, Suriname.
| | - Beryl Irons
- Pan American Health OrganizationRetired Immunization AdvisorBridgetownBarbadosPan American Health Organization, (Retired Immunization Advisor, Bridgetown, Barbados).
| | - Philippe Duclos
- University of GenevaGenevaSwitzerlandUniversity of Geneva, Geneva, Switzerland.
| | - Gabriel Gonzalez-Escobar
- Pan American Health OrganizationCaracasVenezuelaPan American Health Organization, Caracas, Venezuela.
| | - Elizabeth Ferdinand
- University of the West IndiesCave HillBarbadosUniversity of the West Indies, Cave Hill, Barbados.
| | - J. Peter Figueroa
- University of the West IndiesKingstonJamaicaUniversity of the West Indies, Kingston, Jamaica
| | | |
Collapse
|
2
|
Duclos P, MacDonald NE, Dochez C, Thacker N, Steffen CA, Nohynek H, Lambert PH, Wharton M. Report of the 2nd workshop of the International Collaboration on advanced vaccinology training. Vaccine 2022; 40:6689-6699. [PMID: 36273989 DOI: 10.1016/j.vaccine.2022.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values.
Collapse
Affiliation(s)
- Philippe Duclos
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | - Carine Dochez
- University of Antwerp, Network for Education and Support in Immunisation, Universiteitsplein 1, 2610 Antwerp, Belgium
| | | | | | - Hanna Nohynek
- National Institute for Health and Welfare Department of Vaccines and Immune Protection, 166 Mannerheimintie, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Paul-Henri Lambert
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
| | | | | |
Collapse
|
3
|
Dochez C, Duclos P, MacDonald N, Steffen C, Lambert PH. Advanced vaccinology training globally: Update and impact of the COVID-19 crisis. Vaccine 2022; 40:5683-5690. [PMID: 36030127 PMCID: PMC9393177 DOI: 10.1016/j.vaccine.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
A total of 33 advanced vaccinology courses were in existence in 2021. Some vaccinology courses were not sustained since 2018. The number of vaccinology courses has been increasing during the last few years, with courses offered in each WHO region. The COVID-19 pandemic resulted in the cancellation or postponement of some vaccinology courses. Due to the COVID-19 pandemic, an increased number of courses are using an online or hybrid format.
The rapid development of innovations and new technologies, the focus on the life-course approach to immunization and equity, and the prevalent hesitancy towards vaccines requires immunization staff to be well-trained and updated regularly in order to deliver quality immunization services to the public. The need for advanced vaccinology training is therefore paramount. In preparation for a second Global Workshop on Advanced Vaccinology Training that took place in March 2022, this paper presents the results of a survey aiming to provide a thorough update of a landscape analysis on advanced vaccinology courses conducted in 2018 and a look at the impact of the COVID-19 crisis. Thirty-three course organizers responded to a survey to provide information on their respective course. Of those, 17 courses are short courses, 11 post-graduate courses and 5 are Master level courses. Most courses are organized on an annual basis. Even though some courses were not sustained overtime, the number of courses has been increasing during the last few years, and at least one vaccinology course is now being offered in each WHO region. Although the training capacity has increased tremendously, the need still exceeds the capacity and many courses have way more applicants than they can select. The most frequent challenges reported included sustainable funding and identifying faculty. The COVID-19 pandemic impacted the delivery of several vaccinology courses, which have been postponed or reformatted to an online or hybrid training event. An e-portal of the global collaboration has been established to facilitate communication between the different courses and to assist future course participants to identify the most suitable course for their needs.
Collapse
Affiliation(s)
- Carine Dochez
- University of Antwerp, Network for Education and Support in Immunisation, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Philippe Duclos
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | | | - Paul-Henri Lambert
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
| | | |
Collapse
|
4
|
Baay M, Lina B, Fontanet A, Marchant A, Saville M, Sabot P, Duclos P, Vandeputte J, Neels P. SARS-CoV-2: Virology, epidemiology, immunology and vaccine development. Biologicals 2020; 66:35-40. [PMID: 32600951 PMCID: PMC7309765 DOI: 10.1016/j.biologicals.2020.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
This first International Alliance for Biological Standardization Covid-19 webinar brought together a broad range of international stakeholders, including academia, regulators, funders and industry, with a considerable delegation from low- and middle-income countries, to discuss the virology, epidemiology and immunology of, and the vaccine development for SARS-CoV-2.
Collapse
Affiliation(s)
- Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium.
| | - Bruno Lina
- University Claude Bernard Lyon, VirPath Research Laboratory, Lyon, France.
| | - Arnaud Fontanet
- Department of Global Health, Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Philippe Sabot
- International Alliance for Biological Standardization - IABS, Geneva, Switzerland.
| | | | - Joris Vandeputte
- International Alliance for Biological Standardization - IABS, Geneva, Switzerland.
| | - Pieter Neels
- International Alliance for Biological Standardization - IABS, Geneva, Switzerland.
| |
Collapse
|
5
|
Asturias EJ, Duclos P, MacDonald NE, Nohynek H, Lambert PH. Advanced vaccinology education: Landscaping its growth and global footprint. Vaccine 2020; 38:4664-4670. [PMID: 32475535 PMCID: PMC7294226 DOI: 10.1016/j.vaccine.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
In preparation for the first Global Vaccinology Training workshop in 2018, a survey of 27 advanced vaccinology courses was conducted to provide a landscape of the vaccinology education around the world. Advanced vaccinology courses have expanded dramatically over the last 20 years, with courses located in almost all regions, but with underrepresentation amongst the Eastern part of the European region, the Eastern Mediterranean and the Western Pacific regions. Most courses are of short duration (<2 weeks), have a global or regional reach, and attract a diverse range of participants from high, middle and low-income countries with representation from public health, academia, industry and less often regulators. Lack of sustainable funding and time commitments of faculty and coordinators is a constraint for most vaccinology courses and needs to be addressed. Continuation and extension of training in vaccinology worldwide will be necessary as increasing number of new and more complex vaccines are introduced, vaccine safety concerns and rumors continue their trend, and reemergence of some vaccine-preventable diseases will require a competent workforce to advance and deploy immunizations to larger populations.
Collapse
Affiliation(s)
- Edwin J Asturias
- University of Colorado School of Medicine, 13199 East Montview Blvd., S-310 Aurora, CO, USA; The Jules Amer Chair in Community Pediatrics, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA.
| | - Philippe Duclos
- University of Geneva, Centre for Vaccinologie, 1 rue Michel Servet, 1211 Geneve 4, Switzerland
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | - Hanna Nohynek
- National Institute for Health and Welfare, Department of Vaccines and Immune Protection, 166 Mannerheimintie, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Paul-Henri Lambert
- University of Geneva, Centre for Vaccinologie, 1 rue Michel Servet, 1211 Geneve 4, Switzerland
| | | |
Collapse
|
6
|
Duclos P, Martinez L, MacDonald N, Asturias E, Nohynek H, Lambert PH. Global vaccinology training: Report from an ADVAC workshop. Vaccine 2019; 37:2871-2881. [PMID: 30898392 DOI: 10.1016/j.vaccine.2019.02.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
At a workshop on 7-8 November 2018 the leaders of 26 advanced vaccinology courses met to carry out an extensive review of the existing courses worldwide, in order to identify education gaps and future needs and discuss potential collaboration. The main conclusions of the workshop concerned: opportunities for strengthening and expanding the global coverage of vaccinology training; evaluation of vaccinology courses; updating knowledge after the course; how to facilitate post-course 'cascade' training; developing and sharing best practices; the application of online and innovative approaches in adult education; and how to reduce costs and facilitate wider access to vaccinology training. The importance of collaboration and information exchange through networks of alumni and between courses was stressed. A web platform to provide information about existing courses for potential applicants is needed. Lack of sustainable funding is a constraint for vaccinology training and needs to be addressed.
Collapse
Affiliation(s)
- Philippe Duclos
- University of Geneva, Centre de Vaccinologie, 1 rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Lindsay Martinez
- Independent consultant, 13 Chemin Maurice Ravel, CH-1290 Versoix, Switzerland.
| | - Noni MacDonald
- Dalhousie University, Division Pediatric Infections, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Edwin Asturias
- University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 310, 80045 Aurora, United States.
| | - Hanna Nohynek
- National Institute for Health and Welfare Department of Vaccines and Immune Protection, 166 Mannerheimintie, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Paul-Henri Lambert
- University of Geneva, Centre de Vaccinologie, 1 rue Michel Servet, 1211 Geneva 4, Switzerland.
| | | |
Collapse
|
7
|
Sobanjo-Ter Meulen A, Duclos P, McIntyre P, Lewis KDC, Van Damme P, O'Brien KL, Klugman KP. Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries. Clin Infect Dis 2017; 63:S123-S133. [PMID: 27838664 PMCID: PMC5106619 DOI: 10.1093/cid/ciw530] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI.
Collapse
Affiliation(s)
| | | | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Westmead, New South Wales, Australia
| | | | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | |
Collapse
|
8
|
MacDonald NE, Duclos P, Wichmann O, Henaff L, Harnden A, Alshammary A, Tijerino RA, Hall M, Sacarlal J, Singh RR. Moving forward on strengthening and sustaining National Immunization Technical Advisory Groups (NITAGs) globally: Recommendations from the 2nd global NITAG network meeting. Vaccine 2017; 35:6925-6930. [PMID: 29103592 PMCID: PMC6278871 DOI: 10.1016/j.vaccine.2017.10.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 01/30/2023]
Abstract
NITAGs provide independent, evidence-informed
immunization advice to governments. Global NITAG Network (GNN) now formally
launched. GNN: country lead organization formed to strengthen
NITAGs, no participation fees. GNN: nurture development of inter-country NITAG
relationships. GNN: facilitate voluntary sharing information,
technical expertise. GNN: venue to discuss NITAG immunization
decision-making, implementation concerns.
National Immunization Technical Advisory Groups (NITAGs)
provide independent, evidence-informed advice to assist their governments in
immunization policy formation. This is complex work and many NITAGs face
challenges in fulfilling their roles. Inter-country NITAG collaboration
opportunities have the potential to enhance NITAG function and grow the quality
of recommendations. Hence the many requests for formation of a network linking
NITAGs together so they can learn from each other. The first Global NITAG
Network (GNN) meeting, held in 2016, led to a push to launch the GNN and grow
the network. At the second GNN meeting, held June 28–29, 2017 in Berlin, the GNN
was formally inaugurated. Participants discussed GNN governance, reflected on
the April 2017 Strategic Advisory Group of Experts (SAGE) on Immunization
conclusions concerning strengthening of NITAGs and also shared NITAG experiences
in evaluation and inter-country collaborations and independence. They also
discussed the role of Regional Technical Advisory Groups on Immunization (RTAGs)
and regional networks. A number of issues were raised including NITAGs and
communications, dissemination of recommendations and vaccine implementation as
well as implications of off-label recommendations. Participants were alerted to
immunization evidence assessment sites and value of sharing of resources. They
also discussed potential GNN funding opportunities, developed an action plan for
2017–18 and selected a Steering Committee to help move the GNN forward. All
participants agreed on the importance of the GNN and the value in attracting
more countries to join the GNN.
Collapse
Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Philippe Duclos
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Louise Henaff
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Aisha Alshammary
- Department of Pediatrics, Alyamamah Hospital, Riyadh, Saudi Arabia
| | - Roberto Arroba Tijerino
- National Commission on Vaccination and Epidemiology, Ministry of Health, San Jose, Costa Rica
| | - Madeline Hall
- Vaccine Preventable Diseases, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - Jahit Sacarlal
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | |
Collapse
|
9
|
Yeung KHT, Duclos P, Nelson EAS, Hutubessy RCW. An update of the global burden of pertussis in children younger than 5 years: a modelling study. The Lancet Infectious Diseases 2017. [DOI: 10.1016/s1473-3099(17)30390-0] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Adjagba A, MacDonald NE, Ortega-Pérez I, Duclos P. Strengthening and sustainability of national immunization technical advisory groups (NITAGs) globally: Lessons and recommendations from the founding meeting of the global NITAG network. Vaccine 2017; 35:3007-3011. [PMID: 28456526 PMCID: PMC5877398 DOI: 10.1016/j.vaccine.2017.04.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 11/06/2022]
Abstract
National Immunization Technical Advisory Groups (NITAGs)
provide independent, evidence-informed advice to assist their governments in
immunization policy formation. However, many NITAGs face challenges in
fulfilling their roles. Hence the many requests for formation of a network
linking NITAGs together so they can learn from each other. To address this
request, the Health Policy and Institutional Development (HPID) Center (a WHO
Collaborating Center at the Agence de Médecine Préventive - AMP), in
collaboration with WHO, organized a meeting in Veyrier-du-Lac, France, on 11 and
12 May 2016, to establish a Global NITAG Network (GNN). The meeting focused on
two areas: the requirements for (a) the establishment of a global NITAG
collaborative network; and (b) the global assessment/evaluation of the
performance of NITAGs. 35 participants from 26 countries reviewed the proposed
GNN framework documents and NITAG performance evaluation. Participants
recommended that a GNN should be established, agreed on its governance,
function, scope and a proposed work plan as well as setting a framework for
NITAG evaluation.
Collapse
Affiliation(s)
- Alex Adjagba
- Health Policy and Institutional Development (HPID) Center, Agence de Médecine Préventive, Paris, France
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Canada.
| | - Inmaculada Ortega-Pérez
- Health Policy and Institutional Development (HPID) Center, Agence de Médecine Préventive, Paris, France
| | - Philippe Duclos
- Department of Immunization, Vaccine and Biologicals (IVB) World Health, Geneva, Switzerland
| | | |
Collapse
|
11
|
Marti M, de Cola M, MacDonald NE, Dumolard L, Duclos P. Assessments of global drivers of vaccine hesitancy in 2014-Looking beyond safety concerns. PLoS One 2017; 12:e0172310. [PMID: 28249006 PMCID: PMC5332020 DOI: 10.1371/journal.pone.0172310] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/02/2017] [Indexed: 11/28/2022] Open
Abstract
Vaccine hesitancy has become the focus of growing attention and concern globally despite overwhelming evidence of the value of vaccines in preventing disease and saving the lives of millions of individuals every year. Measuring vaccine hesitancy and its determinants worldwide is important in order to understand the scope of the problem and for the development of evidence-based targeted strategies to reduce hesitancy. Two indicators to assess vaccine hesitancy were developed to capture its nature and scope at the national and subnational level to collect data in 2014: 1) The top 3 reasons for not accepting vaccines according to the national schedule in the past year and whether the response was opinion- or assessment-based and 2) Whether an assessment (or measurement) of the level of confidence in vaccination had taken place at national or subnational level in the previous 5 years. The most frequently cited reasons for vaccine hesitancy globally related to (1) the risk-benefit of vaccines, (2) knowledge and awareness issues, (3) religious, cultural, gender or socio-economic factors. Major issues were fear of side effects, distrust in vaccination and lack of information on immunization or immunization services. The analysis revealed that 29% of all countries had done an assessment of the level of confidence in their country, suggesting that vaccine confidence was an issue of importance. Monitoring vaccine hesitancy is critical because of its influence on the success of immunization programs. To our knowledge, the proposed indicators provide the first global snapshot of reasons driving vaccine hesitancy and depicting its widespread nature, as well as the extent of assessments conducted by countries.
Collapse
Affiliation(s)
- Melanie Marti
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Monica de Cola
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Noni E. MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, Canada
| | - Laure Dumolard
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Philippe Duclos
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
12
|
Perronne C, Adjagba A, Duclos P, Floret D, Houweling H, Le Goaster C, Lévy-Brühl D, Meyer F, Senouci K, Wichmann O. Implementing efficient and sustainable collaboration between National Immunization Technical Advisory Groups: Report on the 3rd International Technical Meeting, Paris, France, 8-9 December 2014. Vaccine 2016; 34:1325-30. [PMID: 26859237 DOI: 10.1016/j.vaccine.2016.01.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
Many experts on vaccination are convinced that efforts should be made to encourage increased collaboration between National Immunization Technical Advisory Groups on immunization (NITAGs) worldwide. International meetings were held in Berlin, Germany, in 2010 and 2011, to discuss improvement of the methodologies for the development of evidence-based vaccination recommendations, recognizing the need for collaboration and/or sharing of resources in this effort. A third meeting was held in Paris, France, in December 2014, to consider the design of specific practical activities and an organizational structure to enable effective and sustained collaboration. The following conclusions were reached: (i) The proposed collaboration needs a core functional structure and the establishment or strengthening of an international network of NITAGs. (ii) Priority subjects for collaborative work are background information for recommendations, systematic reviews, mathematical models, health economic evaluations and establishment of common frameworks and methodologies for reviewing and grading the evidence. (iii) The programme of collaborative work should begin with participation of a limited number of NITAGs which already have a high level of expertise. The amount of joint work could be increased progressively through practical activities and pragmatic examples. Due to similar priorities and already existing structures, this should be organized at regional or subregional level. For example, in the European Union a project is funded by the European Centre for Disease Prevention and Control (ECDC) with the aim to set up a network for improving data, methodology and resource sharing and thereby supporting NITAGs. Such regional networking activities should be carried out in collaboration with the World Health Organization (WHO). (iv) A global steering committee should be set up to promote international exchange between regional networks and to increase the involvement of less experienced NITAGs. NITAGs already collaborate at the global level via the NITAG Resource Centre, a web-based platform developed by the Health Policy and Institutional Development Unit (WHO Collaborating Centre) of the Agence de Médecine Préventive (AMP-HPID). It would be appropriate to continue facilitating the coordination of this global network through the AMP-HPID NITAG Resource Centre. (v) While sharing work products and experiences, each NITAG would retain responsibility for its own decision-making and country-specific recommendations.
Collapse
Affiliation(s)
- Christian Perronne
- Communicable Diseases Commission, Haut Conseil de la Santé Publique, University of Versailles Saint Quentin, Paris, France.
| | - Alex Adjagba
- Health Policy and Institutional Development Unit, WHO Collaborative Centre, at Agence de Médecine Préventive (AMP), Paris, France
| | - Philippe Duclos
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Daniel Floret
- Comité Technique des Vaccinations (CTV), Haut Conseil de la Santé Publique, University of Lyon 1, Paris, France
| | - Hans Houweling
- The Dutch NITAG, Health Council of the Netherlands, The Hague, The Netherlands
| | - Corinne Le Goaster
- Comité Technique des Vaccinations (CTV), Haut Conseil de la Santé Publique, Paris, France
| | - Daniel Lévy-Brühl
- Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
| | - François Meyer
- International Relations, Haute Autorité de Santé, Saint Denis, France
| | | | - Ole Wichmann
- The German NITAG, Immunization Unit, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
13
|
Pottie K, Siu W, Duclos P. New recommendations to prevent pain during immunizations: WHO position paper - September 2015. Vaccine 2016; 34:3627-8. [PMID: 26778423 DOI: 10.1016/j.vaccine.2015.11.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Kevin Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine, Ottawa Primary Care Research Group, Bruyere Research Institute, University of Ottawa, 75 Bruyere St, K1S0P6 Ottawa, Ontario, Canada
| | - Winnie Siu
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto M5T3M7, Ontario, Canada
| | - Philippe Duclos
- Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland
| | | |
Collapse
|
14
|
|
15
|
Adjagba A, Henaff L, Duclos P. The NITAG Resource Centre (NRC): One-stop shop towards a collaborative platform. Vaccine 2015; 33:4365-7. [DOI: 10.1016/j.vaccine.2015.06.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
|
16
|
Abstract
Based on the concerns about vaccine hesitancy and its impact on vaccine uptake rates and the performance of national immunization programmes, the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy [1], carried out a review, and proposed a set of recommendations directed to the public health community, to WHO and its partners, and to the World Health Organization (WHO) member states. The final recommendations issued by SAGE in October 2014 fall into three categories: (1) those focused on the need to increase the understanding of vaccine hesitancy, its determinants and the rapidly changing challenges it entails; (2) those focused on dealing with the structures and organizational capacity to decrease hesitancy and increase acceptance of vaccines at the global, national and local levels; (3) and those focused on the sharing of lessons learnt and effective practices from various countries and settings as well as the development, validation and implementation of new tools to address hesitancy.
Collapse
Affiliation(s)
| | | | | | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
| | | |
Collapse
|
17
|
Yen C, Hyde TB, Costa AJ, Fernandez K, Tam JS, Hugonnet S, Huvos AM, Duclos P, Dietz VJ, Burkholder BT. The development of global vaccine stockpiles. Lancet Infect Dis 2015; 15:340-7. [PMID: 25661473 DOI: 10.1016/s1473-3099(14)70999-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Global vaccine stockpiles, in which vaccines are reserved for use when needed for emergencies or supply shortages, have effectively provided countries with the capacity for rapid response to emergency situations, such as outbreaks of yellow fever and meningococcal meningitis. The high cost and insufficient supply of many vaccines, including oral cholera vaccine and pandemic influenza vaccine, have prompted discussion on expansion of the use of vaccine stockpiles to address a wider range of emerging and re-emerging diseases. However, the decision to establish and maintain a vaccine stockpile is complex and must take account of disease and vaccine characteristics, stockpile management, funding, and ethical concerns, such as equity. Past experience with global vaccine stockpiles provide valuable information about the processes for their establishment and maintenance. In this Review we explored existing literature and stockpile data to discuss the lessons learned and to inform the development of future vaccine stockpiles.
Collapse
Affiliation(s)
- Catherine Yen
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katya Fernandez
- Pandemic and Epidemic Diseases Department, WHO, Geneva, Switzerland
| | - John S Tam
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | | | - Anne M Huvos
- Pandemic and Epidemic Diseases Department, WHO, Geneva, Switzerland
| | - Philippe Duclos
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Vance J Dietz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
18
|
Abstract
Canada has been known to have one of the better vaccine safety surveillance capacities in the world, but in the early 2000s, it was noted there was still room for improvement. How has Canada done over the last decade and is there more to be done? Canada has done well. First, there has been significant progress made by the Vaccine Vigilance Working Group to enhance the passive vaccine safety monitoring system and address potential issues arising from the review of surveillance data and cases or clusters of concern. Second, there has been an increased investigative capacity for clusters of adverse events and other vaccine safety issues, including an assessment and referral system for individuals with adverse events following immunizations (AEFIs). Third, the use of the Brighton Collaboration definitions and other international standards has facilitated international collaboration and represents the best standard of practice. Despite all these improvements, however, there is more that could be done. The sensitivity of Canada's passive surveillance system still varies from one province and territory to another. The timeliness of the data exchange flow could improve. The AEFI Signal Response Protocol, which identifies the processes and required actions for timely management of any newly detected or emerging vaccine safety signals, is a critical piece of a robust vaccine safety system but it is still in the making. It is commendable that Canada has decided to expand its focus on evaluation research from influenza vaccines to vaccine-preventable diseases more broadly, with the establishment of the Canadian Immunization Research Network (CIRN). CIRN's newly developed Provincial Collaborative Network and the move toward record linkages is excellent. These new investments are welcome in light of the rich vaccine development pipeline, the increased pool of available vaccines, and the growing set of technologies for vaccines production, delivery, and safety monitoring. What would round this all out would be a stronger capacity to monitor the implementation of vaccination programs and vaccine coverage, and better documentation of the reduction of the disease burden attributable to vaccination programs. Canada's investment in vaccines for the health of all deserves no less.
Collapse
Affiliation(s)
- P Duclos
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
19
|
Harmanci H, Duclos P, Rodriguez Hernandez CA, Meek A, Balakrishnan MR, Kumar Arora N, Wiktor SZ. World health organization approaches to evaluating the potential use and quality of hepatitis e vaccine. Open Forum Infect Dis 2014; 1:ofu099. [PMID: 25734167 PMCID: PMC4324226 DOI: 10.1093/ofid/ofu099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Philippe Duclos
- SAGE Secretariat, Department of Vaccines, Immunization and Biologicals, World Health Organization
| | | | - Andrew Meek
- Prequalification Team, World Health Organization
| | | | | | | |
Collapse
|
20
|
Chocarro L, Duclos P, Senouci K, Southern J. Consultation on interactions between National Regulatory Authorities and National Immunization Technical Advisory Groups. Expert Rev Vaccines 2014; 10:1265-70. [DOI: 10.1586/erv.11.96] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Duclos P, Okwo-Bele JM, Salisbury D. Establishing global policy recommendations: the role of the Strategic Advisory Group of Experts on immunization. Expert Rev Vaccines 2014; 10:163-73. [DOI: 10.1586/erv.10.171] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Rafferty E, Duclos P, Yactayo S, Schuster M. Risk of yellow fever vaccine-associated viscerotropic disease among the elderly: A systematic review. Vaccine 2013; 31:5798-805. [DOI: 10.1016/j.vaccine.2013.09.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
|
23
|
Duclos P, Dumolard L, Abeysinghe N, Adjagba A, Janusz CB, Mihigo R, Mosina L, Takashima Y, Öztürk MH. Progress in the establishment and strengthening of national immunization technical advisory groups: Analysis from the 2013 WHO/UNICEF joint reporting form, data for 2012. Vaccine 2013; 31:5314-20. [DOI: 10.1016/j.vaccine.2013.08.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
|
24
|
Affiliation(s)
- V S Moorthy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | | | | | | | | |
Collapse
|
25
|
Blau J, Sadr-Azodi N, Clementz M, Abeysinghe N, Cakmak N, Duclos P, Janusz C, Jauregui B, Mihigo R, Mosina L, Takashima Y, Senouci K. Indicators to assess National Immunization Technical Advisory Groups (NITAGs). Vaccine 2013; 31:2653-7. [PMID: 23398930 DOI: 10.1016/j.vaccine.2013.01.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/09/2013] [Accepted: 01/25/2013] [Indexed: 11/25/2022]
Abstract
A National Immunization Technical Advisory Group (NITAG) is an expert advisory committee that provides evidence-based recommendations to the Ministry of Health (MoH) to guide immunization programs and policies. The World Health Organization (WHO), the Initiative for Supporting National Independent Immunization and Vaccine Advisory Committees (SIVAC) at Agence de Médecine Préventive (AMP) and the US Centers for Disease Control and Prevention (US CDC) engaged NITAG stakeholders and technical partners in the development of indicators to assess the effectiveness of NITAGs. A list of 17 process, output and outcome indicators was developed and tested in 14 countries to determine whether they were understandable, feasible to collect, and useful for the countries. Based on the findings, a revised version of the indicators is proposed for self-assessment in the countries, as well as for global monitoring of the NITAGs.
Collapse
Affiliation(s)
- Julia Blau
- Agence de Médecine Préventive (AMP), 164 rue de Vaugirard, Paris 75015, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Duclos P, Ortynsky S, Abeysinghe N, Cakmak N, Janusz CB, Jauregui B, Mihigo R, Mosina L, Sadr-Azodi N, Takashima Y, Dumolard L, Gacic-Dobo M. Monitoring of progress in the establishment and strengthening of national immunization technical advisory groups. Vaccine 2012; 30:7147-52. [DOI: 10.1016/j.vaccine.2012.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/28/2012] [Accepted: 04/04/2012] [Indexed: 11/15/2022]
|
27
|
Abstract
Vaccines have already saved many lives and they have the potential to save many more as increasingly elaborate technologies deliver new and effective vaccines against both infectious diseases--for which there are currently no effective licensed vaccines--such as malaria, tuberculosis, and HIV and non-infectious diseases such as hypertension and diabetes. However, these new vaccines are likely to be more complex and expensive than those that have been used so effectively in the past, and they could have a multifaceted effect on the disease that they are designed to prevent, as has already been seen with pneumococcal conjugate vaccines. Deciding which new vaccines a country should invest in requires not only sound advice from international organisations such as WHO but also a well informed national immunisation advisory committee with access to appropriate data for local disease burden. Introduction of vaccines might need modification of immunisation schedules and delivery procedures. Novel methods are needed to finance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to afford them. Here, we discuss some options.
Collapse
Affiliation(s)
- Orin S Levine
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Zuber PL, El-Ziq I, Kaddar M, Ottosen AE, Rosenbaum K, Shirey M, Kamara L, Duclos P. Sustaining GAVI-supported vaccine introductions in resource-poor countries. Vaccine 2011; 29:3149-54. [DOI: 10.1016/j.vaccine.2011.02.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 02/08/2011] [Accepted: 02/16/2011] [Indexed: 12/01/2022]
|
29
|
Abstract
This supplement of Vaccine contains detailed descriptions of the experiences and processes of 15 well-established National Immunization Technical Advisory Committees from all regions of the world. All of these committees provide information to national governments that is used to make evidence-based decisions regarding vaccine and immunization policy. Nevertheless, many differences between committees exist including their legal basis, size and scope of committee membership, scope of work, role of the Ministry of Health on the committee, existence of conflict of interest policies, and ultimate role in the decision-making process. Individual country authors identified numerous areas for improvement and these are summarized here.
Collapse
|
30
|
Bryson M, Duclos P, Jolly A, Cakmak N. A global look at national Immunization Technical Advisory Groups. Vaccine 2010; 28 Suppl 1:A13-7. [PMID: 20412990 DOI: 10.1016/j.vaccine.2009.07.089] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 07/23/2009] [Accepted: 07/24/2009] [Indexed: 11/27/2022]
Abstract
This paper presents the results of a global survey that aimed to collect information on country's immunization policy development processes, particularly on the presence and function of national Immunization Technical Advisory Groups (ITAGs). Characteristics of national ITAGs are described as well as attributes of these groups that appear to be imperative for an effective ITAG. ITAGs provide a valued service to over 89 countries that reported their establishment, some of which have been in existence for over 40 years. This paper provides basic information on the functioning of these groups and encourages future efforts to address gaps in knowledge and research in this area.
Collapse
|
31
|
Abstract
The majority of industrialized and some developing countries have formally established national technical advisory bodies to guide immunization policies; other countries are working towards or contemplating the establishment of such bodies. These advisory bodies are often referred to as National Immunization Technical Advisory Groups (NITAGs). A NITAG is a technical resource supplying guidance to national policy makers and programme managers to enable them to make evidence-based immunization related policy and program decisions. The focus of this paper is to: (1) review the value and functions of a NITAG; (2) provide directions and identify issues for countries to consider when establishing or improving the functioning of a NITAG; and (3) outline potential WHO and partners' roles and activities in support of the establishment and strengthening of NITAGs.
Collapse
Affiliation(s)
- Philippe Duclos
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland.
| |
Collapse
|
32
|
Bryson M, Duclos P, Jolly A. Global immunization policy making processes. Health Policy 2010; 96:154-9. [DOI: 10.1016/j.healthpol.2010.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/25/2022]
|
33
|
Letourneau M, Wells G, Walop W, Duclos P. Improving global monitoring of vaccine safety: a survey of national centres participating in the WHO Programme for International Drug Monitoring. Drug Saf 2008; 31:389-98. [PMID: 18422379 DOI: 10.2165/00002018-200831050-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The WHO Programme for International Drug Monitoring (PIDM) was established in 1968 following the thalidomide disaster. The PIDM has had considerable success in analyzing drug-related adverse event reports, but more limited progress has been made in analyzing vaccine-related reports. In June 2005, the Global Advisory Committee on Vaccine Safety, acknowledging these limitations, called for a global consultation to address the need for improved monitoring and analysis of vaccine-related adverse event reports on an international level. OBJECTIVE In preparation for this consultation and as part of a larger study designed to evaluate the PIDM, a survey of the National Pharmacovigilance Centres of all 76 countries participating in the PIDM at the time the survey was conducted. RESULTS Thirty-six countries (47%) responded. Of the 36 responding countries, 16 (44%) reported having a separate surveillance system for adverse events following immunizations (AEFIs) and 30 (83%) reported forwarding AEFI reports to the PIDM. Seven of the 36 countries (19%) indicated that one or more population subgroups are systematically excluded from their country's AEFI surveillance system. Five of the seven countries exclude reports concerning recipients of travellers' vaccines; three exclude recipients of vaccines administered by private physicians outside the national immunization programme and supply scheme; and five exclude reports from the military sector. Only half of the respondents knew of the Brighton Collaboration, a major international initiative aimed at the standardization of AEFI definitions. CONCLUSION The survey identified critical elements that should be addressed quickly to improve global vaccine safety monitoring. Communication between national adverse drug reaction and AEFI surveillance authorities, ability to pay for advancing technology in developing countries, and proper use of services and terminologies are issues of concern.
Collapse
Affiliation(s)
- Megan Letourneau
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | |
Collapse
|
34
|
Letourneau M, Wells G, Walop W, Duclos P. Erratum to “Improving global monitoring of vaccine safety: A quantitative analysis of adverse event reports in the WHO Adverse Reactions Database” [Vaccine 2008;26(9):1185–94]. Vaccine 2008. [DOI: 10.1016/j.vaccine.2008.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Letourneau M, Wells G, Walop W, Duclos P. Improving global monitoring of vaccine safety: a quantitative analysis of adverse event reports in the WHO Adverse Reactions Database. Vaccine 2008; 26:1185-94. [PMID: 18243428 DOI: 10.1016/j.vaccine.2007.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/11/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
The World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) was initially developed for chemical rather than biological products. The PIDM made considerable achievements in analysing drug-related adverse event reports, progress was more limited for vaccine-related reports. In 2005, the Global Advisory Committee on Vaccine Safety, called for a global consultation to address the need for improved monitoring and analysis of vaccine-related adverse event reports on an international level. In preparation for this consultation, the WHO Adverse Reactions Database was quantitatively assessed and results of this analysis are presented in this paper. Three countries contributed 82% of vaccine-related reports in the database. The mean difference between onset date and report date was 2.4 years. Several issues of concern were identified, such as the fact that many member countries do not forward any or all reports of adverse events following immunization to the PIDM, and the poor timeliness and regularity of reporting, which could prevent timely generation of safety signals.
Collapse
Affiliation(s)
- Megan Letourneau
- Department of Epidemiology and Community Medicine, University of Ottawa, 451Smyth Road, Ottawa, ON, Canada K1H 8M5.
| | | | | | | |
Collapse
|
36
|
Abstract
The World Health Organization (WHO) has a dual mandate of providing global policies, standards and norms as well as support for member countries in applying such policies and standards to national programmes with the aim to improve health. The vaccine world is changing and with it the demands and expectations of the global and national policy makers, donors, and other interested parties. Changes pertain to : new vaccines and technologies developments, vaccine safety issues, regulation and approval of vaccines, and increased funding flowing through new financing mechanisms. This places a special responsibility on WHO to respond effectively. WHO has recently reviewed and optimized its policy making structure for vaccines and immunization and adjusted it to the new Global Immunization Vision and Strategy, which broadens the scope of immunization efforts to all age groups and vaccines with emphasis on integration of immunization delivery with other health interventions. This includes an extended consultation process to promptly generate evidence base recommendations, ensuring transparency of the decision making process and added communication efforts. This article presents the objectives and impact of the process set to develop global immunization policies, norms, standards and recommendations. The key advisory committees landscape contributing to this process is described. This includes the Strategic Advisory Group of Experts, the Global Advisory Committee on Vaccine Safety and the Expert Committee on Biological Standardization. The elaboration of WHO vaccine position papers is also described.
Collapse
Affiliation(s)
- Philippe Duclos
- Immunization, Vaccines and Biologicals, World Health Organization, 20, avenue Appia, CH-1211 Geneva 27, Suisse.
| | | |
Collapse
|
37
|
Bentsi-Enchill AD, Zongo I, Khamassi S, Pless R, Thombiano R, Tiéndrebéogo S, Nelson CB, Duclos P. Monitoring of adverse events during the 2003 mass vaccination campaign with a trivalent meningococcal A/C/W135 polysaccharide vaccine in Burkina Faso. Vaccine 2007; 25 Suppl 1:A72-8. [PMID: 17544552 DOI: 10.1016/j.vaccine.2007.04.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During a mass campaign with a newly licensed meningococcal polysaccharide ACW135 vaccine in Burkina Faso, adverse events following immunization (AEFI) were monitored up to 4 weeks after the campaign. Eighty-six AEFI cases (5.9 cases per 100,000 vaccine doses distributed) were reported. Among 22 serious events, 4 severe local reactions were considered very likely and 4 severe allergic reactions were considered probably related to the vaccination. One fatal case in a child followed protracted seizures of undetermined cause. In a setting with no prior surveillance system, adverse events were reported at rates comparable to documented rates for meningococcal polysaccharide vaccines in other settings. The findings confirm the benefits of the vaccine in the control of meningococcal meningitis.
Collapse
|
38
|
Wilder-Smith A, Martinez L, Rietveld A, Duclos P, Hardiman M, Gollogly L. World Health Organization and International Travel and Health. Travel Med Infect Dis 2007; 5:147-9. [PMID: 17448940 DOI: 10.1016/j.tmaid.2007.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Abstract
OBJECTIVES Concerns about unsafe injection practices and possible infections with blood-borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the 'Focus Project', which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow-up survey was carried out in February 2004, 2 years after initiation of the project. METHODS Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004. RESULTS Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non-negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle-stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle-stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001). CONCLUSIONS The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well-structured immunization programme to the more diverse curative health services.
Collapse
Affiliation(s)
- Carsten Mantel
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Kohl KS, Gidudu J, Bonhoeffer J, Braun MM, Buettcher M, Chen RT, Drammeh B, Duclos P, Heijbel H, Heininger U, Hummelman E, Jefferson T, Keller-Stanislawski B, Loupi E, Marcy SM. The development of standardized case definitions and guidelines for adverse events following immunization. Vaccine 2007; 25:5671-4. [PMID: 17400339 DOI: 10.1016/j.vaccine.2007.02.063] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Mantel C, Khamassi S, Baradei K, Nasri H, Mohsni E, Duclos P. Improved injection safety after targeted interventions in the Syrian Arab Republic. Trop Med Int Health 2007. [DOI: 10.1111/j.1365-3156.2007.01802.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Al Awaidy S, Bawikar S, Duclos P. Safe injection practices in a primary health care setting in Oman. East Mediterr Health J 2006; 12 Suppl 2:S207-16. [PMID: 17361692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We conducted a national survey of injection practices in 78 government health facilities in Oman in 2001. Data were obtained by interview and observation. The overall standards were good and the stock of disposable equipment was adequate. Recapping of needles was only observed in 1 facility but in 28%, waste disposal boxes contained recapped needles and 17.9% reported needle-stick injuries in the past year. In 9% of the institutions, sharps were observed around the facility, in 12.8% unsupervised disposal containers were seen and in 11.5% unsafe storage of full boxes was observed. While disposal of the used waste was done away from the health facility, only 33.3% disposed of it by correct incineration.
Collapse
Affiliation(s)
- S Al Awaidy
- Department of Communicable Disease Surveillance & Control, Ministry of Health, Muscat, Oman.
| | | | | |
Collapse
|
43
|
François G, Duclos P, Margolis H, Lavanchy D, Siegrist CA, Meheus A, Lambert PH, Emiroğlu N, Badur S, Van Damme P. Vaccine safety controversies and the future of vaccination programs. Pediatr Infect Dis J 2005; 24:953-61. [PMID: 16282928 DOI: 10.1097/01.inf.0000183853.16113.a6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the years following the hepatitis B vaccination/multiple sclerosis controversy, a number of new issues regarding vaccine safety have been raised, in some cases leading to more debate and confusion. Against this background, an international group of experts was convened to review the current points of view concerning the use of thimerosal as a preservative and its potential risks; the suggested link between thimerosal-containing vaccines and acute lymphoblastic leukemia; the alleged association between aluminum-containing vaccines/macrophagic myofasciitis and general systemic complaints; a possible link between vaccination and autoimmune pathology; and a hypothetical link between measles-mumps-rubella vaccination and autism. At present, there are no data to conclude that childhood vaccines, and in particular hepatitis B vaccine, pose a serious health risk or justify a change in current immunization practice. However, vaccine "scares" continue to have an international impact on immunization coverage. Creating a positive environment for immunization can be achieved by repositioning the value of vaccines and vaccination, supported by evidence-based information. The role of international organizations, the media, and the industry in the implementation of communication strategies was discussed and the impact of litigation issues on vaccination was evaluated. The Viral Hepatitis Prevention Board confirms its commitment to current recommendations for universal and risk group hepatitis B vaccination and further encourages the conduct of vaccine safety studies and the dissemination of their results.
Collapse
Affiliation(s)
- Guido François
- Viral Hepatitis Prevention Board, WHO Collaborating Centre for Prevention and Control of Viral Hepatitis, Department of Epidemiology and Social Medicine, University of Antwerpen, Antwerp, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
BACKGROUND Unsafe delivery and overuse of injections can result in the spread of hepatitis B virus, hepatitis C virus, and HIV. The aim of the present survey was to estimate the frequency of safe injection practices in Burkina Faso. METHOD Using the new standardized World Health Organization tool to assess injection practices, we selected 80 primary health facilities with a two-stage cluster sampling method, collected information using structured observations and provider interviews, and analyzed the data using Epi-Info software. RESULTS We observed 116 injections in 52 facilities. In 50 facilities [96%; 95% confidence interval (CI) 85-99%] injections were given with a new, single-use syringe and needle. In 29 facilities (56%; 95% CI 36-74%), staff recapped needles using two hands. All 80 facilities visited had a stock in the community to provide new, single-use syringes and needles. In 61% (95% CI 54-79%) of facilities, staff reported needlestick injuries in the last 12 months. Used needles were discarded in open containers in 66 facilities (83%; 95% CI 55-96%) and observed in the surroundings of 46 facilities (57%; 95% CI 32-80%). CONCLUSIONS In 2000, most of the health facilities in Burkina Faso were using sterile injection equipment. However, practices were still observed that could expose patients, health care workers, and communities to risks, and that required specific interventions.
Collapse
Affiliation(s)
- J Fitzner
- World Health Organization Headquarters, Geneva, Switzerland.
| | | | | | | | | |
Collapse
|
45
|
Abstract
"Immunization Safety" (i.e., ensuring and monitoring the safety of all aspects of immunization, including vaccine quality, storage and handling, vaccine administration and the disposal of sharps) remains a major challenge. Any vaccine safety issue, real or perceived, may lead to rumors and undermine confidence in vaccination and, ultimately, have dramatic consequences for immunization coverage and disease incidence. In 1999, WHO's Department of Vaccines and Biologicals launched the Immunization Safety Priority Project to establish a comprehensive system to ensure the safety of all immunizations given in national immunization programmes. The project aims at strengthening each country's capacity. The principal areas of activity of the project include: research and development of safer vaccines and safer and simpler vaccine delivery technologies; assurance of vaccine safety through quality control procedures and quality specifications; implementation of tools to ensure vaccine quality up to vaccine administration; access to safe and efficient vaccine administration technologies and their disposal; and identification and management of risks related to immunization. This report focuses on the latter area and highlights challenges and critical factors in establishing a safety profile for a vaccine and the importance and limits of post market surveillance. It presents some of WHO's supporting activities among which the establishment of a Global Advisory Committee on Vaccine Safety to provide an independent scientific assessment of vaccine safety issues. WHO has a role to play not only because of its technical and normative role but also because of its privileged relation with country authorities and its global vision and mandate and being perceived as neutral and free of conflicts of interest.
Collapse
Affiliation(s)
- Philippe Duclos
- Immunization Safety Priority Project, Department of Vaccines and Biologicals, Health Technology and Pharmaceuticals, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| |
Collapse
|
46
|
Affiliation(s)
- Jan Bonhoeffer
- Division of Pediatrics Infectious Diseases and Vaccines, University Children's Hospital, P.O. Box 8, 4005 Basel, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Bonhoeffer J, Heininger U, Kohl K, Chen RT, Duclos P, Heijbel H, Jefferson T, Loupi E. Standardized case definitions of adverse events following immunization (AEFI). Vaccine 2004; 22:547-50. [PMID: 14741142 DOI: 10.1016/s0264-410x(03)00511-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
48
|
Affiliation(s)
- Philippe Duclos
- Immunization Safety Priority Project, Department of Vaccines and Biologicals, Health Technology and Pharmaceuticals, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| |
Collapse
|
49
|
Duclos P, Delo A, Aguado T, Bilous J, Birmingham M, Kieny MP, Milstien J, Wood D, Tarantola D. Immunization safety priority project at the World Health Organization. Semin Pediatr Infect Dis 2003; 14:233-9. [PMID: 12913836 DOI: 10.1016/s1045-1870(03)00038-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 1999, the World Health Organization's (WHO) Department of Vaccines and Biologicals launched the Immunization Safety Priority Project with the aim of establishing a comprehensive system to ensure the safety of all immunizations given in national immunization programs. Countries are the primary focus of the project. WHO has a role, not only because of its technical and normative role, but also because of its privileged relationship with country authorities and other partners, and its global vision and mandate. The four major areas of focus in the project are to (1) promote and coordinate research and development of safer and simpler delivery systems; (2) ensure vaccine safety, from vaccine development all the way through clinical trials and vaccine distribution until use; (3) broaden access to safer and more efficient systems for vaccine delivery and management of sharps waste; and (4) establish efficient mechanisms to detect serious or potentially serious adverse events following immunization, and enable prompt and effective response. The project emphasizes the importance of advocating safety and building capacity at national levels.
Collapse
Affiliation(s)
- Philippe Duclos
- Department of Vaccines and Biologicals, Health Technology and Pharmaceuticals, World Health Organization-Geneva, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kohl KS, Bonhoeffer J, Chen R, Duclos P, Heijbel H, Heininger U, Loupi E. The Brighton Collaboration: enhancing comparability of vaccine safety data. Pharmacoepidemiol Drug Saf 2003; 12:335-40. [PMID: 12812014 DOI: 10.1002/pds.851] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Katrin S Kohl
- Centers for Disease Control and Prevention, National Immunization Program, 1600 Clifton Rd, Mailstop E-61, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | |
Collapse
|