On December 6, 2012, Dr. Gina Tambini, Manager of the Family and Community Health Area, presented PAHO´s best practices in immunization as part of the GAVI Alliance Partners´Forum, which took place in Tanzania. 

Dr. Tambini highlighted the following from lessons learned in immunization:

"Having joined PAHO more than 22 years ago and having participated in the Eradication of Polio in the Americas and the elimination of measles and rubella, I was reflecting on the topic that I received for this panel: The role regional communities can play in enhancing health and immunization results.

A regional technical body with excellent expertise in the field, supported by motivated and committed staff, with accurate knowledge of the health situation has proven to play a critical role in enhancing health and immunization results.

When DA Henderson - the leader of the Global Effort to eradicate smallpox - was the Dean in the School of Public Health in JHU, he was asked the question: What do you consider a critical element of success of the Eradication of Smallpox?  He replied:  A motivated and committed team of epidemiologists. For him, the element of success of the eradication of smallpox was the people that he chose to work with him. One of them was Dr. Ciro de Quadros, who built up the regional immunization team at PAHO.

The aim of the regional secretariat is to strengthen national capabilities at country and sub-national levels, as they are the single most important factors that contribute to strengthening the leadership role of the government.

From the experience of PAHO´s Regional Immunization Program, the features of a regional response are:

• Motivated and committed staff
• Regional Strategy and Plan of action
• Country specific Strategies and five-year national plans with:
• clear objectives,
• realistic targets, and
• measurable indicators
• Inter-country Surveillance and laboratory network and cross learning through multiple instances
• Capacity building at the national and sub-national levels
• Permanent technical cooperation at the regional and national levels, and among countries (horizontal)
• Standardized multidisciplinary evaluation of national immunization programs
• TAG that revise jointly with the countries the advancements and the challenges, and provide concrete recommendations
• National Immunization Technical Advisory Groups (NITAGs) in place to review available evidence and provide technical recommendations on immunization to the MoH
• PAHO Revolving Fund for the procurement of vaccines, as mechanism of solidarity among countries, that started in 1979 with a working capital of US$ 1 million which has increased to US$ 100 million
• Political support at both regional and country levels
• Presidents, First Ladies, Ministers of Health, Ministers of Education, Ministers of Finance, Religious leaders, Community leaders, Majors, Local authorities
• Partnerships
• Rotary International Polio Plus, IDB, UNICEF, CDC, CIDA Canada, Spain, and many others
• Use of regional and sub-regional bodies for resources mobilization
• UN Agencies
• NGOs
• Banks (Caribbean Development bank, IDB, WB, etc)
• Integration Systems at the subregional level: CARICOM, MERCOSUR, SISCA (CA region), Convenio Hipolito Unanue (Andean Region)
• Legislation and policies (24 countries and 3 territories with existing legislation on immunization)
• Civil society involvement (the countries in the region have created a culture of prevention)
• Record tracking of best practices and lessons learned
• Information and Communication Strategy
• Social Media
• Print Media – periodical bulletins, press releases, pamphlets, posters
• TV – advertisements, interviews

Thanks to the contribution of all these regional features, vaccination remains a priority in the PAHO Region. Countries are implementing legislation and policies to ensure an early, equitable and sustained adoption of the most valuable vaccines available.

This model to support immunization programs advocates for strong immunization policies grounded on evidence, which has allowed for an increase in the regional spending on EPIs from US$750 million (with 90% government funding) to over US$1600 million (with 99% government funding) over the last decade.   

In addition, this approach supported with efforts to enhance national capacity to make evidence-based policy decisions on the introduction of new vaccines has resulted in the rapid introduction of rotavirus vaccine (16 countries), pneumococcal conjugate vaccine (26 countries) and HPV vaccine (7 countries). This has occurred on top of the eradication of polio, measles and rubella from the Region.

The Role of the Caribbean Community

The Caribbean Community (CARICOM) has played a major role in the successful implementation of the EPI in the Caribbean countries.  

CARICOM, whose headquarters are in Georgetown, Guyana,  is an organization of 15 Caribbean nations and dependencies, whose main purposes are to promote economic integration and cooperation among its members, ensure that the benefits of integration are equitably shared, and coordinate foreign policy. Its major activities involve coordinating economic policies and development planning; devising and instituting special projects for the less-developed countries within its jurisdiction; operating as a regional single market for many of its members (Caricom Single Market); and handling regional trade disputes.

There is also a health arm of CARICOM, which has been instrumental in policy decision making for countries as a whole. The eradication/elimination initiatives of poliomyelitis, measles and rubella were in response to the resolutions passed by the Ministers Responsible for Health in the Caribbean Community; in 1988, the Ministers Responsible for Health made a resolution for the elimination of measles, and in 1998 for rubella. With the support, technical advice and direction from PAHO/WHO and other agencies, they implemented the activities toward elimination: the Caribbean region has had no indigenous case of measles since 1991, rubella since 2001, and CRS since 1999.

Maintenance/sustainability of surveillance and high vaccination coverage has been achieved through advocacy, evaluation/validation and the commitment of staff. Strategies for success include the Annual EPI Managers’ Meeting of the Caribbean, the sharing of information among countries, country attachments, and annual plans of action."

Relevant links

GAVI Alliance 

GAVI honors four PAHO member countries for their immunization achievements

Immunizations - PAHO