GAVI/Vaccine Fund Supportto Improve Injection Safety

On behalf of the Injection Safety sub-group

GAVI is an Alliance

The Bill The Bill & Melinda & Melinda

Gates Gates FoundationFoundation

The The World World BankBank

UNICEFUNICEF

WHOWHO

TechnicalTechnicalhealth health

instituteinstituteCDC, USACDC, USA

ResearchResearchinstituteinstituteNIH, USANIH, USA

Health Health MinistriesMinistries

Bhutan Bhutan MaliMali

Bilateral Bilateral agenciesagencies

CanadaCanadaThe NetherlandsThe Netherlands

NorwayNorway

FoundationFoundationRockefeller Rockefeller

Fdtn.Fdtn.

Industry-Industry-OECD countryOECD countryAventis Pasteur, Aventis Pasteur,

FranceFrance

Industry-Industry-DevelopingDeveloping

CountryCountryCIGB, CubaCIGB, Cuba

NGONGOGates Children’sGates Children’sVaccine Program Vaccine Program

at PATH,at PATH,USAUSA

GAVI Board

GAVI Secretariat W orking Group

Task Forceon Financing(W B/USAID lead)

Task Forceon Advocacy

(UNICEF lead)

Task Forceon Country Coordination

(W HO lead)

Task ForceR esearch & D evelopm ent

(Academ ia/Industry/W HO lead)

Board Vaccine Fund

GAVI Structure

Initial steps taken:

Injection Safety (IS) plan required as part of application Member of WHO SC on Immunization Safety participates on independent review teamEstablished IS established as a top priority of the Advocacy Task ForceConceptually “Bundling” each dose of vaccine supplied by Vaccine Fund with an AD syringe and means for disposal

Unmet need:Support countries in their transition to use of AD syringes for all vaccinesNational and local ownership of problem and means for addressing it Support for governments and partners to develop implement long-term multifaceted plans to increase awareness and stimulate necessary behavior changeGuidance and options for disposal of health care wastes (HCW) resulting from immunization efforts

GAVI commitmentsBased on the principle of “first do no harm” commit to focusing special attention on Injection Safety Commit to “The Joint WHO/UNICEF/UNFPA/IFRC Joint Statement on the Use of AD syringes in Immunization Services”Request WHO finalize a statement on medical waste disposalCommit to using the Aide Memoires on Injection Safety and Healthcare Waste Management to guide investments and actions

Vaccine Fund support for transition to ADs

Support for three years, all countries that receive awards from the Vaccine FundCountries currently without means for obtaining ADs and means for disposal for all traditional routine EPI vaccines will be provided these supplies.

Vaccine Fund support

Countries with means to obtain safety supplies will be provided the equivalent amount of grant funds for use on injection safety and waste disposal related activities. Proposal has to indicate: source and amount of funding for the AD

syringes and safety boxes, areas to be financed by the Vaccine Fund

Vaccine Fund Support

Support can be applied for either as part of a proposal for immunization services or new vaccine support. Countries that have previously been approved for immunisation services or new vaccine support must resubmit injections safety portion of application.

Vaccine Fund support

Syringes/funds awarded based on review of IS plan component of country application. Plans must include process for establishing national

policies documentation of national

commitment plans of actions

Plans of actionAssure compliance with the WHO/UNICEF/UNFPA statement of 1999 both now and after the resources provided by the Vaccine Fund are no longer available;

provide training and support the necessary behavior change among health care providers;

provide, appropriate information, education and communication to clients on the risks resulting from unsafe injections and poor sharps waste management;

Plans of actionplan for monitoring programme progress (including specific indicators that will be used, and annual targets for these indicators);

steps that will be taken to improve safety of the disposal of medical waste (especially sharps) resulting from immunization activities.

formulation of policy, assessment of the waste management system, and, selection of appropriate waste disposal systems for all levels

of health care facilities.

Additional ActionsSupport implementation of Vaccine Fund assistance (i.e., number of safety boxes, source of safety boxes)Monitor improvement in the safety in a manner that encourages safety to serve as a “counterbalance” to coverage as GAVI priorities (TFCC)Commit to support long-term communication effort (Advocacy Task Force, WHO, UNICEF)

Additional ActionsBased on the principle of “polluter pays” support countries in immediate action to use best options available for safely disposing of HCW.Support R & D of environmentally sound and reasonably priced methods for HCW disposal

SummaryFocus special attention on IS and commit to follow existing policies and guidelinesThrough the Vaccine Fund provide temporary assistance to countries in their transition to full use of AD syringesSupport long-term efforts which are crucial to sustainability Commit to support efforts to improve the safety of HCW disposal

Problem/OpportunityAvailable data suggest that injection overuse and unsafe injection practices result in: 22.5 million Hep B virus infections 2.7 million Hep C virus infections 98,000 HIV infections

Injections provided by immunization programs represent roughly 5% of global injections widely considered the safest

Immunization programs can be the leaders in improving the safety/quality of health service delivery