A vaccination planning tool for avian influenza

Presented by DM Castellan FAO Emergency Centre for Transboundary Animal Diseases Regional Office for Asia and the Pacific, Bangkok, Thailand

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Acknowledgements • FAO country and regional staff and national government colleagues, OIE consultant D. Swayne contributed theoretical and empirical information • Animal health, public health, academia and poultry industry representatives from Bangladesh and Nepal who contributed to the development of the vaccination planning tool 2

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Outline Basis Process Structure Application

Lessons and Next Steps 3

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Basis Country Requests

International Guidelines

Country Experience

Peer-Reviewed Studies

In-country Pilot Testing

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Country Experience • Application of OIE and FAO Guidelines and Recommendations • FAO and OIE Program and Consultant Reports • Country-Based Studies • FAO Meetings ECTAD Meeting at RAP with D. Swayne

China-Vietnam Vaccination Meeting,

• January 2011

• March 2011

5th Annual ECTAD Meeting • February 2011 5

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Health Interventions Model vis a vis FAO/OIE Disease Control Strategies (FAO, 2006)

Exposure

Transmission

Host Immunity

• Humane culling • Quarantine • Biosecurity • Surveillance

• Movement control • Biosecurity • Surveillance

• Vaccination • Biosecurity • Surveillance • Sero-monitoring

Compensation, Communication, Public-Private Collaboration 6

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Process • Linear based (Kinman et al., 2006)

• Decision based

• Socratic method (http://www.thefreedictionary.com)

“…ask a series of questions, with the result that the respondent comes either to the desired knowledge by answering the questions or to a deeper awareness of the limits of knowledge” 7

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Key questions to address • Should vaccination be included as part of a national disease control strategy? • What should be expected from vaccination in terms of disease prevention and control? • Which factors are most important when deciding whether to conduct vaccination? • What are the requirements for developing realistic vaccination policies and practices? • What are the consequences (costs/benefits) and impacts associated with instituting a vaccination policy? 8

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Structure Vaccination Planning Tool (Mind Node Ver. 1.7.4, © 2008 – 2011) • National Priorities (Table 1) • International/Regional/National Contexts (Table 2) • National Planning Issues: – Financial Resources (Table 3) – Enabling Mechanisms (Table 4) – Vaccine Quality and Efficacy (Table 5) – Surveillance and Monitoring Program (Table 6) – Vaccination Objectives and Strategy (Table 7) – Vaccination Program (Table 8)

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Planning Criteria • Referenced planning criteria (n=225) • Reference table: NATIONAL PRIORITiES

PLANNING CRITERIA

RELATED VERONA CONSIDERATIONS AND RECOMMENDATIONS

REFERENCES

Increasing trend of human cases

C5; C16; C21; R25

FAO, 2011a; FAO, 2011b; FAO, 2011c; FAO 2011d; Sims and Dung, 2009; WHO, 2013

High human case-fatality rate

C5

FAO, 2011a; FAO, 2011b; Otte et al., 2008; WHO, 2012

National health policy requirement

C5; C16; C25; R7

FAO, 2011a; FAO, 2011b; WHO, 2012

Media influence

C13; C18; C21; R24

FAO, 2011a; FAO, 2011b; FAO 2100c

International influence

C3; R1; R2;

FAO, 2011d

Protect National Public Health

IMPLICATIONS

Associated with seasonal variation related to natural and anthropogenic factors; 2004-2005 increasing trend in Viet Nam Indonesia and China; Viet Nam reported no human cases in 2006 during second round of vaccination When combined with surveillance may constribute to lower human human exposure and fatalities; CFR in January 2012: Indonesia 82% ,China 62%, Viet Nam 50%; Consumers mitigate losses by eating infected poultry Public health and economic viability of poultry production are main drivers Effect on mobilizing public awareness and support nationally and internationally Donors from XX countries provided $XX in funding support

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Vaccination planning workshop • • • •

Two days duration; maximum of 30 participants Group allocation balanced by sector and discipline Semi-quantitative: ranking, scoring; un-weighted Justification and gaps to address

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Application: Based on government request Dhaka, Bangladesh • August 2012 • Decision: Prior

Kathmandu, Nepal • August 2013 • Decision: Pending

Multi-sectoral: Animal/public health, producers/industry, academia Multi-disciplinary: Laboratory diagnostics, epidemiology, poultry production, policy and socio-economic 12

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National Priorities: Bangladesh (Ranking Scale: None = 0; Minimal = 1; Moderate = 2; Serious = 3; Critical =4)

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National Priorities: Nepal (Ranking Scale: None = 0; Minimal = 1; Moderate = 2; Serious = 3; Critical =4)

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Comprehensive Vaccination Program: Bangladesh (% Attained)

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Comprehensive Vaccination Program: Nepal (% Attained)

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Top risks influencing vaccination strategy (Adapted from Swayne, Pavade, Hamilton, Vallat, Miyagishima, 2011)

• Bangladesh Proximity of poultry breeders to high risk poultry populations or high density zones Repeated or seasonal outbreaks in a zone or a largeholder compartment HPAI outbreaks occur rarely or sporadically in a zone or a largeholder compartment First incursion or seasonal large-scale outbreak in a zone or a largeholder compartment Presence of at-risk poultry populations in a zone or in a largeholder compartment

• Nepal Proximity of poultry breeders to high risk poultry populations or high density zones Repeated or seasonal outbreaks in a zone or a large holder compartment First incursion or seasonal large-scale outbreak in a zone or a large holder compartment Presence of at-risk poultry populations in a zone or in a large holder compartment Presence of high risk production systems (long-lived poultry) at zone or large holder compartment level 17

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Composite Score Both Countries

Planning Component

% Attained

Financial Resources

40

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Enabling Mechanisms

50

38

Vaccine Quality and Selection

72

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Surveillance and Monitoring

71

60

Vaccination Strategy

75

71

Comprehensive Vaccination Program

64

49

Aggregate Score

62

42

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Vaccination Planning Profiles: Self-Assessment of 36 Planning Elements Creating a relative baseline for follow up…

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Did the workshop achieve it’s objectives? 5%

YES NO

95%

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How did the workshop affect your understanding of the requirements for vaccination? 5% 21%

NO IMPROVEMENT IN UNDERSTANDING SOME IMPROVEMENT IN UNDERSTANDING

74%

SIGNIFICANT IMPROVEMENT IN UNDERSTANDING

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Lessons and Next Steps:

Lessons Self assessment => consensus Process and product are both useful

Next steps

Technical and non-technical issues

Systematically addressing gaps based on priorities

Group facilitation/dynamics

Refinement and update of tool

Foundation for detailed in-country consultation

Additional tools to assist countries already vaccinating

Challenges in follow up action

Iterative approach to further optimize use of vaccination 22

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Building evidence through field research (Source: Do Ho Dung) Viet Nam

2003

2004

2005

2006

Objective

2007

YEAR 2008

2009

2010

2012

2013

Gradual Reduction in North, Central and South Epidemiological Zones

Control

Strategy

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Emergency and Routine Targeted Vaccination by Province/Zone/Species (ducks)

Mass Vaccination Tactical Approach

Estimated Millions of Doses Imported or Produced/Year with 2-Year Moving Average 1000

Operational Research: GETS Project

900 800 700 600 500 400 300 200 100

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0 2005

2006

2007

2008

2009

2010

2011

2012

2013

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The journey continues… Thank you for your attention

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