REQUESTS FOR PROPOSALS FOR ASSESSMENT OF THE IMPACT OF MEASLES ERADICATION ACTIVITIES ON ROUTINE IMMUNIZATION AND ON HEALTH SYSTEMS
Background
Background
Measles eradication1 and control involve four major strategies:
- Provide the first dose of measles vaccine to successive groups of all children at the age of nine months or shortly after.
- Guarantee a ‘second opportunity’ for measles vaccination, either through campaigns or routine immunization2.
- Establish an effective system to monitor coverage, and conduct measles surveillance with integration of epidemiological and laboratory information.
- Improve clinical management of every measles case.
Although the same strategies are used for both eradication and control, the differences lie in the coverage that must be achieved and in the effectiveness and sensitivity of the surveillance system, with eradication requiring at 92-95% population immunity and a sensitive and specific case-based surveillance system. This means that countries aiming to eliminate measles must implement the strategies in a way that ensures 92-95% population immunity (for example, carry out more frequent follow up campaigns) compared to a country aiming for measles control.
Critics of a global eradication initiative argue that such an activity is diverting resources and commitment away from more pressing priorities in some countries and that it is not conducive to the development of a health infrastructure that can support routine immunization and primary health care.
A number of studies have been done to assess the impact of polio eradication on health systems(1-4). Although useful, these studies do not capture key differences between polio eradication activities and measles eradication activities. Operational differences include the frequency of the immunization campaigns, the use of health staff rather than volunteers for the implementation of the campaigns, the use of injectable rather than oral vaccine, the need for safe waste disposal, the adverse events associated with errors in reconstituting and injecting the vaccine, the integration of multiple additional health interventions with measles campaigns, etc.
The impact of measles eradication activities on health systems will differ according to the health system in a given country. Health systems differences include funding channels and predictability of external support, differing allocative decisions for investments in infrastructure and Human Resources Development; and differences in how policies for decentralization and more integrated services are adapted to achieve various immunization-specific targets. In addition, previous studies have not specifically focused on identifying strategies and steps that could be taken in order to minimize any negative impact on efforts to strengthen health systems and maximize synergies. Nor have these studies addressed how such strategies could be promoted and applied in countries.
In order to assess the feasibility and appropriateness of measles eradication, programmatic, biological, economic and health systems considerations must be taken into account. This analysis is concerned with the impact of eradication activities on health systems. Other aspects of the feasibility and appropriateness of measles eradication will be addressed in separate areas of work as part of the WHO feasibility of measles eradication project. These include the biological feasibility, the programmatic feasibility, the cost effectiveness analysis and expected impact on vaccine demand and supply.
Proposals will be reviewed by the WHO Quantitative Immunization and Vaccine related Research Advisory Committee (QUIVER) who will select the most qualified proposal. Throughout this analysis, the models and methodology will be reviewed by QUIVER and its working group on measles. In addition, the successful applicants will work closely with other groups working on the WHO project on assessing the feasibility of measles eradication (most notably, work with the group carrying out the economic analysis of measles eradication).
1 Eradication represents the sum of successful elimination efforts in all countries.
2 The majority of countries have used catch-up and follow-up campaigns. Some countries are implementing both campaigns and a routine second dose to ensure the provision of the second opportunity.