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GAVI Update

Fifth GAVI Board Meeting, 21-22 June 2001, London, England

June 2001


GAVI and the Vaccine Fund Support to Improve the Safety of Immunization Programs

Worldwide, each year, the overuse of injections and unsafe injection practices combine to cause an estimated 22.5 million hepatitis B virus infections, 2.7 million hepatitis C virus infections and 98,000 HIV infections. Although injections given as a part of immunization programs account for a very limited proportion (approximately 5%) of the injections delivered and are widely considered the safest of all delivered, there is a growing body of data demonstrating the safety of immunization programs throughout the world need to be improved. Among unsafe practices, the re-use of syringes and/or needles without sterilization is of particular concern.

Based on the principle of "do no harm" we, the GAVI partners, acknowledge the importance of improving the safety of immunization programs and have focused special attention on safety in relation to the other elements of immunization programs.

We commit to "The Joint WHO/UNICEF/UNFPA/IFRC Joint Statement on the Use of Auto-disable Syringes in Immunization Services" (PDF document – approx. 42kb) which calls for the exclusive use of Auto Disable (AD) syringes for all immunizations by the end of 2003 and request WHO to finalize a statement on medical waste disposal with a focus on immunization programs for our approval.

In recognizing the above joint statement we acknowledge our roles and responsibilities with regard to improving the safety of immunization programs. For instance national partners that support the purchase of vaccines will also finance an appropriate number of AD syringes and provide for the safe management of wastes for those vaccines.

We also commit to use the "Aide Mémoire" on injection safety (PDF document – approx. 65kb) and the "Aide Mémoire" on healthcare waste (PDF document – approx. 74kb) to guide investments and efforts to improve the safety of injections provided in immunization programs, serving as a model for other sectors of health programs.

To assist countries in their efforts to improve the safety of immunization programs and to transition to full use of AD syringes we request that the Vaccine Fund, in addition to supplying AD syringes and safety boxes for Fund supplied vaccines, also provide ADs for all traditional routine EPI vaccines or the equivalent amount of money for three years to all countries that received approval for applications submitted for either sub-account of the Vaccine Fund. These ADs/ funds will provide countries and their partners the opportunity to begin to improve the safety of their programs immediately while they are identifying other sources of funds to support a national plan to improve safety and medical waste disposal. Funds will be awarded based on a review of the injection safety plan component of the country application to GAVI. These plans must describe a process for developing national policies and plans of action and document national/partners' commitment to improve the safety of the immunization program. Countries that have already received awards will be asked to ensure that their injection safety plan is complete as described in the revised application guidelines and submit it to the GAVI Secretariat. (India, Indonesia and China will also be eligible, but as these negotiations are be done on a country-by-country basis they will be handled individually).

Recognizing that safety will not be improved solely by the provision of technology, We also commit to a long-term communication effort to increase awareness of the severity of the problem of unsafe practices and advocate for behavior change both among health providers and recipients. This effort will be lead by the WHO, UNICEF and the GAVI Advocacy Task Force.

As a centerpiece of these efforts GAVI partners will monitor improvement in the safety of national immunization programs in a fashion that will encourage national governments and their partners to afford safety similar attention to that given to expanding DTP3 coverage. In this context (monitoring progress) safety will be recognized as a sentinel of overall program quality. We request that the Task Force for Country Coordination develop means for monitoring safety and highlight safety with special emphasis while developing guidelines for the preparation of annual reports and midterm reviews.

Finally, we acknowledge that appropriate disposal of medical waste is an important element of efforts to improve the safety of national immunization programs and should be based on the principle that the "polluter pays". Although we realize that there are very limited environmentally sound options for safely eliminating waste we commit to supporting countries in their immediate action, using the best practices available to minimize the risk of exposure to medical wastes for staff and the community. We encourage fellow GAVI partners to invest in the development of environmentally sound, reasonably priced methods for disposing of medical wastes.


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