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This paper reviews the key design features, accomplishments of and lessons learned from two regional group procurement mechanisms dealing with vaccines that have been in operation for more than 25 years. The Pan American Health Organization (PAHO) EPI Revolving Fund purchases vaccines and immunization supplies on behalf of more than 35 countries in the Latin American and Caribbean region. Based on a 'central contracting' model, the program handles most aspects of procurement-from tendering to contracting with and paying producers--using a common fund to pay producers before being reimbursed by countries once goods are received in-country. The Gulf Cooperation Council (GCC) Group Purchasing Program among seven Persian Gulf States issues joint tenders for vaccines, as well as drugs and other medical goods. Through this 'group contracting' program, countries are responsible for contracting with and paying producers on their own, once the group has selected winning bids. Both programs have experienced substantial growth in the past two decades and are considered to have contributed to or accelerated achievements of immunization programs in both regions, including the introduction of new vaccines. The paper identifies several features of both programs--both those designed to attract country participation and those designed to ensure the programs' financial viability--which help explain their success and longevity.

Since 1994, when the goal of interrupting indigenous measles transmission was adopted, important progress has been made toward the control of measles in the Americas. Thirty-nine (95%) of 41 countries reporting to the Pan American Health Organization (PAHO) conducted catch-up vaccination campaigns during 1989-1995 and follow-up measles campaigns every 4 years. Routine (keep-up) vaccination coverage in the Region increased from 80% in 1994 to 94% in 2000. Measles vaccination coverage ranged between 75% and 99% in 2000 and between 53% and 99% in 2001. As a result, in 2001, the total number of confirmed measles cases reached a record low of 537, 99% lower than the number reported in 1990. In 2002, only Venezuela and Colombia had known indigenous transmission. As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002. This is due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.

The region of the Americas has shown extraordinary progress in its fight to interrupt measles transmission. The Pan American Health Organization's recommended strategy includes the following: a 1-time nationwide campaign targeting 1- to 14-year-old children; routine vaccination among 1-year-olds; and nationwide campaigns conducted every 4 years, targeting all 1- to 4-year-olds. Rapid house-to-house monitoring of vaccination and measles surveillance are other essential components of the strategy. During 2001, only 541 cases were confirmed in the region. In 2002, only Venezuela and Colombia had indigenous transmission. After important vaccination efforts in both countries, the last reported case occurred on 20 September 2002, in Venezuela. Since then, no confirmation exists of indigenous measles circulation anywhere else in the region. Nonetheless, important challenges remain, including insufficient coverage during routine and campaign vaccination and inadequate investigation of some cases.