Pablo Kuri Morales, México

Undersecretary ofPreventionand HealthPromotion
Advantages ofVaccination inthe Americas
“Mexican Vaccination Model”
PabloKuriMoralesM.D.
February,2016
Vaccination history
PresidentialDecree
forvaccination
againstsmallpox
Dr.Francisco
Balmis Mexico
introduces
smallpox
vaccination
1804
1908
Combined
Diphtheria
andPertussis
Vaccine
1926
1948
Creationofthe
NationalInstitute
ofBacteriologyin
infectiousdiseases
andvaccines
1951
Last case
ofPolio
OralPolio
vaccination
begins
1962
BCG
vaccination
begins
Lastcaseof
smallpoxin
Mexico
1970
CONAVA and
Universal
Vaccination
Program
creation
National Immunization
Program:5vaccines
7diseases
1973
Measles
vaccination
begins
National
Immunization
Record(Cartilla
devacunación)
1979
1980
1986
Intensive
Workshops,
NationalDays
andNational
Immunization
Week
1990
1991
Last caseof
Diphtheria
Universal
Vaccination
Vaccination history
Congenital
Rubella
Syndrome
Elimination
NeonatalTetanus
Elimination
VPH
vaccination
begins
Evolution of
scheme
2new
Immunogens
1991
1993
National
Health
Weeks
Pneumococcal
Vaccine
Introduction
1996
1997
2003
2006
2008
VPHVaccine
Universalization
2009
Evolution of
scheme
5new
Immunogens
2010
AH1N1
Influenza
Vaccine
Rubella
Elimination
Pneumococcal
Vaccine
Universalization
2012
2016
Possible
introduction of
DengueVaccine
Milestones
VaccinationUniversalProgram
TheUniversalVaccinationProgramisapublicpolicytoreducepreventable
vaccinediseases,thegoalistoaimspecificprotectiontothepopulation.
Thiswillallowsustocontrol,eliminatedoreradicateddiseasesthroughthe
universalandfreevaccinationschedule.
Thebeneficiariesofthispolicyarechildren,adolescents,elderlyand
vulnerablegroupsofallthecountry.
MexicanGovernmentthroughallit’shealthinstitutionsinvestsmorethan
6mmdp(328millionofdollars*)inthisprogram.
Characteristics
Public Good
*1dollar=18.20 Mexicanpeso
Universal
Free
Goals
The national and international commitments of the
Universal Vaccinate Program are:
Achieveandmaintainthevaccinationcoverageon90%withthebasic
VaccinateScheduleonchildrenunderoneyear,fourandsixyears.
Achieveandmaintainthecoveragevaccinationon95%foreachbiologic.
MaintainthePoliomyelitiseradicationandMeasles,Rubella,Congenital
RubellaSyndromeandneonataltetanuselimination.
KeepepidemiologicalcontrolofDiphtheria,whoopingcough,meningeal
andmiliaryTuberculosis,Rotavirusdiarrhea,invasivepneumococcal
infection,influenzaandhumanpapillomavirus.
Detection,reportingandtimelystudyofeventssupposedlyassociatedto
vaccinateimmunization(ESAVI).
National immunization
schedule
2012-2016
- 14vaccines /14diseases
2004 -- 6diseases
1999
10diseases
2007
11diseases
1973
1998
8diseases
2011
13diseases
BCG (Tuberculosis)
BCG(Tuberculosis)
(Tuberculosis)
BCG
HepatitisB
Polio(Sabin)
Polio(Sabin)
DPT+Hib
+Polio(Diphtheria, Pertussis yTetanus,
DPT (Diphtheria,
(Diphtheria,Pertussis
Pertussis yTetanus)
yTetanus)
DPT
Haemophilus influenzae bandPolio)
SRP (Measles,
(Measles, Rubella
Rubella andMumps)
andMumps)
Measles
SRP
Rotavirus
DPT+Hib +Polio
+HepB
whole cell vaccine
(Diphtheria,
+Polio(Diphtheria,
(Diphtheria,
Pertussis
yTetanus,
DPT+Hib
Pertussis
yTetanus,
Pneumococcal
Pertussis yTetanus,Haemophilus
Haemophilus
influenzae bandPolio)
bandPolio) influenzae band
Haemophilus
influenzae
MRM
(Measles,Rubella andMumps)
HepatitisB)
Influenza
Influenza
DPT
(Diphtheria, Pertussis yTetanus)
Influenza
HepatitisB
HepatitisB
Influenza
HepatitisB
Rotavirus
Polio(Sabin)
Pneumococcal
VPH
(Human papillomavirus)
MR (MeaslesandRubella)
Pneumococcal Adult
Td (Tetanus andDiphtheria)
Tdpa acelular (Tetanus andDiphtheria)
Vaccination Coverage
Mexico
Vaccines
BCG
Hepatitis B
DPT + HiB + Polio
Rotavirus
Pneumococcal
Complete Schedule < 1 year
Measles/mumps/rubella 1 year
DPT + HiB + Polio (18 months)
Pneumococcal
Complete Schedule 1 year
Diphtheria, tetanus, & pertussis DPT 4 years
Measles/mumps/rubella 6 years
Human Papilloma virus vaccine
Seasonal Influenza
InformationSource:Subsystem ofservices benefit(SIS)
Coverage
2013
91.3
79.1
82.6
81.4
84.5
Coverage
2014
95.6
84.6
89.9
84.6
89.8
88.7
62.5
84
97.8
89.4
93.6
83.8
88.9
85.3
91.8
99
79
90
98.7
97.9
96.4
91
99
Vaccine Program Impact
Thanks tocoverages ofthe Universal
National Vaccination Program andthe
National Health Weeks:
Eradicated
Smallpox - 1951
Poliomyelitis - 1990
Eliminate
Measles- 1996
Rubella - 2008
CongenitalRubellaSyndrome- 2010
NeonatalTetanus - 1994 minus one
casefor each 1000 live births for
municipality
Under Control:
Tetanus
Meningeal tuberculosis
Pertussis
Invading diseases for Haemophilus
influenzae b(Meningitis,pneumonia
andseptic arthritis)
Rotavirusdiarrhea andmumps
Diphtheria (last casein1991)
Protection against:
Influenza
HumanPapilloma virus
HepatitisB
Impactonreducingthemortality
rateofchildrenunder1year
PVU
Campaign against
measles Clean Water
Program
National
Vaccination Days
Oral
Hydration
60
51.0
45
48.5
45.9
44.3
National
Vaccination
Week
42.0 41.2
39.7
15
0
38.5 38.5
(SeguroMedicoNueva
Generación)
DPT+Hib +
Hep B
Rotavirus
Universalization
Even Start
inlife
National
Vaccination
Week
MRM
36.3
30
MedicalInsurance for
aNewGeneration
Introduction
ofRotavirus
And 7Pneumococcal
Influenza
Vaccine
PCV-7
Universalization
32.5 31.1
29.7 28.4
27.2 26.0
Every Children,
24.9 23.8
Seguro
22.8 21.8
Every Cancer
Popular
20.8 20.0
19.1 18.3
17.6 16.9 16.3
15.7 15.1 14.6
14.1 13.7 13.2 12.9
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Mortality rate:GeneralDirection ofInformation System inHealth “Methodology for adjust newborn andchild mortality in<5years for indicators use.
Immunization Record
(cartilladevacunación)
By Presidential Decree since 1979, it is mandatory that children under 6
years old have this immunization record were basic vaccines included in
the Vaccination National Program were registred.
This immunization record was issue by the Civil Registry.
From 1979 to 1990, the National System for the Integral Development
of the Family (DIF) was in charged for the administration operation of
this vaccine record.
Immunization Record
(cartilladevacunación)
38years ofsuccessful experienced
Mandatory official document since 1979 by Presidential Decree.
Applied vaccines, and other health actions like length and weight
in children and adolescents.
This record is for free in all the National Health System facilities.
Allows the following of the vaccination schedule in all age groups.
Official document for national and international process.
This document has allow to validate the inmmunization coverage
by rapid surveys and validate the records by the information
system.
FromImmunizationrecordto
NationalHealthCard2008
Immunization record
(Cartilladevacunación)
Population <5years old
Policy continuity of a social right.
It’s used in all the healthcare facilities
of the National Health System.
National Health Card
All ages
National Councilof
Vaccination (CONAVA)
In 1991 the National Health Council was created, this
council is responsible for the public policy in vaccination
and publish to all the National Health System.
Members:
National Health System leaders
Academy and collegiate member National Health
Institutes
States Health departments
Civil Society
National Health Weeks
Since 1980 Mexico has been delivering health promotion and
prevention actions to the population like:
Intensive Workshops
National Health Days
National Immunization Week
National Health Weeks (1993)
These weeks aims to bring health actions to the population
Vaccine Preventable Diseases
Distribution oforalhydration
Diarrheas andacute respiratory infections preventionand
Nutritional supplements
Vaccineintroductionand
ImplementationPolicy
Criteria for
deciding on the
introduction of
newvaccines
PLANFORINTRODUCINGTHEVACCINE
Vaccine program development
Goals andtechnical justification
Technical and
politics aspects
Programmatic
andfeasibility
aspects
Impact
Assessment
Scope andbeneficiares
Introduction strategy
Plancosts andactivities schedule
Evaluation
Coverages
Epidemiologic
surveillance
Reduction
burden of
disease
VaccineIntroduction Phases
1.Review oftechnical andpolitics aspects for priority definitions
a) Burden of diseases, incidence, prevalence, disability, hospitalizations,
mortality
b) Efficacy, quality and safety vaccines
c) Other interventions
d) Financial and economics criteria's
i. Budget analysis impact
ii.Budgetanalysis cost benefit andcost effectiveness
2. Programmatic aspects
a) Vaccine formulation
b) Cold chain capacity
c) Vaccination, supervision, training and follow up inputs
Interinstitutional work group
Inclusion Groups ofexpertsfromtheNationalCouncilofImmunization
National CouncilofImmunization
UniversalVaccination
Program Process
CONAVA
Operational
Research
COEVAs
Interinstitution
alWork Group
Group of
experts
Surveillance
ofESAVIand
EPV
Universal
Vaccination
Program
National
Health Weeks
Population
Distribution
Supervision
Permanent
Program
Training
Cold
Chain
Information
System
Denguevaccine,
implementationprocess
Vaccine
Sanitary
Registration
Security
COFEPRIS
Efficacy
Quality
Twoclearly
differentiated
processes
Vaccine
Public
Policy
Whereare
wenow?
NHS
CONAVA
DengueExpert
Group
Cost/
Benefit
Cost/
Effectiveness
Denguevaccine,
implementationprocess
On December 9th, 2015, Mexico was the first country of the
world to obtained the sanitary registration to the dengue
vaccine.
World Health Organization (WHO) recognized the Federal
Commission for Protection against Health Risks (COFEPRIS) as
Functional Regulatory Agency for the 2014-2017 period.
Mexico is for the first time part of a select group of 28
countries
with
an
agency
capable
of
manufacturing, distributing, reviewing and commercializing
vaccines worldwide.
Challenges
Keep high vaccination coverage in all
municipalities.
Fortify the cold chain net.
Implement of the Electronic Immunization
Record.
Implement of the Web Vaccination Supplies
Stock Management Sistem (wVSSM)
Conclusions
Mexico has one of the most complete vaccination schedule of the
world, this schedule is free and universal.
Mexico has been working since 1804 in vaccination and has a
strong commitment with the population health, vaccination is a
priority on the National Health Agenda.
Although we don’t have a strong anti vaccination movement we
are always expectant.
Vaccination is an essential component of every health system, and
is responsibility of people, community and governments.
Vaccines and immunization are essential investment for the future
of the country and even the world.
Mexico is one of the countries to promote the global initiative in
favor of vaccines.
One timeevent
PopeFrancisvaccinated against polioinhis
recent visit toMexico
Undersecretary ofPreventionand HealthPromotion
Advantages ofVaccination inthe Americas
“Mexican Vaccination Model”
PabloKuriMoralesM.D.
February,2016