Since its inception in the 1970's, EPI in the Western Pacific has greatly evolved in many areas.
While EPI initially focused on building sustainable routine immunization systems to protect children against common childhood diseases through administration of vaccines during infancy, achieving by 1988 less than 80% coverage of children receiving the basic set of vaccines, in 1988, when the WHO World Health Assembly (WHA) and the Western Pacific RCM endorsed resolutions to eradicate poliomyelitis (WHA 41.28 and WPR/RC39.R15), WPR - EPI embraced a new era of eradication, elimination and accelerated control of specific diseases and as a result of those efforts, the last indigenous case of poliomyelitis occurred in 1997 and poliomyelitis eradication was certified on 29 October 2000. The poliomyelitis-free status has been maintained since although several episodes of imported wild poliovirus occurred and vaccine derived polioviruses (VDPV) emerged in areas of low coverage. None of these events though resulted in sustained poliovirus transmission.
Measles had declined substantially in the Region over the past 25 years and most countries had attained the 90% disease reduction goal set by the 1989 WHO World Health Assembly due to high routine coverage with measles vaccine. The introduction of hepatitis B vaccine into the routine immunization programmes of all countries was almost achieved, with Cambodia and Lao PDR scheduled for September 2001. Neonatal tetanus (NT) had been eliminated in all but five countries of the Region.
In this context regional measles elimination and hepatitis B control goals were established in 2003 by the Regional Committee Meeting (RCM), WHO's governing body in the Western Pacific, and a target year of 2012 was endorsed by the RCM in 2005.
Focusing on providing hepatitis B vaccine birth dose and a second dose measles vaccine was perceived as offering new opportunities to complete the whole schedule. In the broader context of generally strengthening routine immunization services and health systems additional vaccine preventable diseases could be averted, and by fostering collaboration with mother and child health services further contributions can be made to reducing childhood mortality as well as maternal mortality, the latter mainly through prevention of tetanus. Both will support achieving the important respective Millennium Development Goals (MDG).
Since the regional twin goals were established, efforts are also being made at regional and national levels to prepare countries to take informed decisions on introduction and expansion of new and underutilized vaccines against Haemophilus influenza type b (Hib), Streptococcus pneumoniae, Rotavirus, rubella, and Japanese encephalitis (JE). Introduction of new and expansion of underutilized vaccines will offer additional opportunities to reduce childhood deaths and progressively protected more people from vaccine preventable diseases.
These new initiatives, build on the established routine immunization systems and the specific regional goals of measles elimination and hepatitis B control by 2012.
Consultation on the Global Post Marketing Surveillance (PMS)
Network for Pre-qualified Vaccines
16-18 August 2011, Beijing, China
The Global Vaccine Safety Blueprint is a strategic plan led by WHO in broad consultation with regulatory agencies, vaccine manufacturers, technical agencies and vaccine safety experts. This strategic plan will be finalized in 2011 and is expected to achieve three goals with eight objectives aiming to build and support effective vaccine pharmaco-vigilance in all low- and middle-income countries and promote a systemic approach to doing so.
Among the eight objectives of the Global Vaccine Safety Blueprint, the first objective is to "strengthen vaccine safety monitoring in all countries". For this objective, WHO has been leading a pilot project, which is called "the Global Post Marketing Surveillance (PMS) Network for Pre-qualified Vaccines" to: (1) ensure standardized approach to monitoring Adverse Events Following Immunization (AEFIs); (2) identify/address safety signals (potential real safety issues) in a timely manner; and (3) ensure adequate safety information to support vaccination policy and recommendations.
Currently, 12 countries globally, among them, China and Viet Nam from the Western Pacific Region – are collaborating with the Network in trying to pool their vaccine safety data in a single global database. This effort will lead to a recommended standard format for exchanging AEFI information. It will serve as a demonstration of the value of global exchange of vaccine safety information for signal detection with an initial focus on WHO prequalified vaccines.
As a database repository, it is expected also to encourage important secondary analyses of AEFI successive to the collation of data over time. Subsequently, the models developed with those 12 countries may be adopted by others in their respective geographic areas, and local expertise may participate in the global collaboration, providing an additional decentralized resource for technical support.
For the participation of China to the Global PMS Network for Pre-qualified Vaccines, the staff from the Ministry of Health China, WHO Western Pacific Regional Office, WHO Headquarters and the Uppsala Monitoring Centre held a meeting in Beijing, China, from 16 to 18 August 2011.
Through the meeting, a baseline assessment of China relevant to the Network was completed using a standard data collection tool, and a one-year country-specific work plan in relation to the network activities was developed. The country-specific work plan will include a pilot project in selected provinces in China, a training workshop on causality assessment of AEFI, a workshop on safety data analysis and signal detection, and development of a data exchange platform.