The ProVac International Working Group (ProVac IWG) and the TRIVAC model

1. The ProVac International Working Group (ProVac IWG) and the TRIVAC model Alex Adjagba Acting Director, SIVAC Initiative

2. Outline • Origins of the ProVac IWG • PAHO’s ProVac Initiative • TRIVAC model: tool and experiences • Benefits of the ProVac experiences to the countries • Objectives of the ProVac IWG • ProVac IWG in practice • Partners • Activities • Timelines and next steps

3. PAHO’s ProVac Initiative • Established as a response to PAHO Directing Council Resolution 2006 (CD47.R10) • Goal: strengthen the technical capacity in countries (of the Americas Region – PAHO) for evidence-based decisions on new vaccine introduction. • Objectives: • Strengthen process for decision making • Develop tools and training to national teams • Perform analysis and gather evidence base • Advocate for evidence-based decisions • Plan an effective introduction (when evidence supports the introduction)

4. The ProVac Method for Strengthening the Decision-making Process for New Vaccine Introduction EPI Manager Surv. Officers ProVac Country Focal Point Health Economist ProVac Country Team Ministry of Health WHO Regional Office Nat’l Consultant Clinician ProVac Central Team (PAHO HQ) National Committee ProVac International Working Group Partner International level National level

5. The TRIVAC Model

6. Input parameters

7. Model structure A Outpatient visits Outpatient visits B Admissions Deaths Life-years in cohort between 1m and 5yrs Outpatient visits Admissions C Deaths Sequelae (Grp A) Sequelae (Grp B) Between 1 and 20 stacked cohorts Outpatient visits D Admissions Deaths

8. Pneumococcal Pneumococcal otitis media Outpatient visits Outpatient visits Pneumococcal pneumonia Admissions Deaths Life-years in cohort between 1m and 5yrs Outpatient visits Admissions Pneumococcal meningitis Deaths Sequelae (Grp A) Sequelae (Grp B) Outpatient visits Pneumococcal NPNM Admissions Deaths

9. Hib Outpatient visits Hib pneumonia Admissions Deaths Life-years in cohort between 1m and 5yrs Outpatient visits Admissions Hib meningitis Deaths Sequelae (Grp A) Sequelae (Grp B) Outpatient visits Hib NPNM Admissions Deaths

10. Rotavirus Rotavirus Non-sev diarrhoea Outpatient visits Outpatient visits Rotavirus Severe diarrhoea Admissions Deaths Life-years in cohort between 1m and 5yrs

11. Vaccine impact Number of life-years 1-59 months per cohort x Incidence of cases 1-59 months per 100,000 per year x % of cases in age group (<3m, 3-5m, 6-8m, 9-11m, 12-23m, 24-35m, 36-47m, 48-59m) x Efficacy by dose (1, 2, 3, booster) x Vaccine Type Coverage (SP and Rota) x Coverage by dose (1, 2, 3, booster) x Timeliness by dose (1, 2, 3, booster) x Relative coverage (% of coverage reaching high risk children) x Decrease in protection due to Waning x (1 - % of total observed impact <5yrs due to Herd Effect)

12. What-if scenario analysis

13. Results

14. Use of TRIVAC in the Americas

15. Benefits of performing a nationally-owned cost-effectiveness analysis The process is more important than the result: • Formation of a national multidisciplinary team • Visibility of existing data, gaps in information, and problems with quality of data • Justification for the continuation/improvement of data collection at the national level • Components of a CEA are a large part of the necessary evidence

16. Sharing ProVac experience: The ProVac International Working Group (IWG) • Transfer ProVac tools and methods to other WHO Regions: • AFRO • EMRO • EURO • Partners • PAHO’s ProVac Initiative • WHO-HQ and WHO Regional & Country Offices • AMP • PATH • Sabin Vaccine Institute • CDC • Pilot Phase: 2012 – 2013, financed by BMGF

17. Reasons for establishing the ProVac International Working Group (IWG) • Promote country-led analyses (instead of rapid desk-based analyses with default data) as a capacity building process • Establish coordinated way to share ProVac models, methodologies and lessons learned in the Americas • Provide a platform through which all requests and questions about the models and methodologies can be channeled • Enable ProVac to improve its tools and methodologies by exposing them to a broader scientific community and different Regional and national contexts

18. ProVac IWG Partner’s Activities AMP • Implement ProVac tools and methodologies to support three countries’ decision making processes in EURO and EMRO CDC • Provide expert consultation on data quality and data availability Sabine Vaccine Institute • Develop a strategy and guide to effectively communicate evidence generated to decision-makers WHO HQ • Provide direct technical assistance to 2 countries with the comprehensive WHO cervical cancer prevention and control costing tool (C4P), at least 1 in AFRO

19. ProVac IWG activities in the African region As ProVac IWG in the AFRO region, PATH will : • Implement ProVac tools and methodologies to support three countries in their decision making processes in the AFRO Region • Host a Regional workshop • Work in collaboration with the WHO Regional Office

20. Planned use of TRIVAC under the ProVac IWG(2012 – 2013)

21. Conclusions • The aim of this project is to support an evidence-based decision making process in immunization • The TRIVAC decision support model was designed for for use at country level by teams led by the Ministry of Health • The TRIVAC model is a user-friendly, didactic tool, ideal for building national capacity • The process of carrying out a nationally-led CEA is more important than the result • PATH, in collaboration with WHO, will provide assistance to countries in the AFRO Region for the carrying out of a CEA using ProVac tools

22. Contacts • For ProVac IWG: felixg@who.int • For PATH: datherly@path.org • For WHO HQ: hutubessyr@who.int