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