Seasonal influenza vaccine dose distribution in 157 countries (2004–2011)

Abstract

Globally there are an estimated 3-5 million cases of severe influenza illness every year, resulting in 250,000-500,000 deaths. At the World Health Assembly in 2003, World Health Organization (WHO) resolved to increase influenza vaccine coverage rates (VCR) for high-risk groups, particularly focusing on at least 75% of the elderly by 2010. But systematic worldwide data have not been available to assist public health authorities to monitor vaccine uptake and review progress toward vaccination coverage targets. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations Influenza Vaccine Supply task force (IFPMA IVS) developed a survey methodology to assess global influenza vaccine dose distribution. The current survey results represent 2011 data and demonstrate the evolution of the absolute number distributed between 2004 and 2011 inclusive, and the evolution in the per capita doses distributed in 2008-2011. Global distribution of IFPMA IVS member doses increased approximately 86.9% between 2004 and 2011, but only approximately 12.1% between 2008 and 2011. The WHO's regions in Eastern Mediterranean (EMRO), Southeast Asian (SEARO) and Africa (AFRO) together account for about 47% of the global population, but only 3.7% of all IFPMA IVS doses distributed. While distributed doses have globally increased, they have decreased in EURO and EMRO since 2009. Dose distribution can provide a reasonable proxy of vaccine utilization. Based on the dose distribution, we conclude that seasonal influenza VCR in many countries remains well below the WHA's VCR targets and below the recommendations of the Council of the European Union in EURO. Inter- and intra-regional disparities in dose distribution trends call into question the impact of current vaccine recommendations at achieving coverage targets. Additional policy measures, particularly those that influence patients adherence to vaccination programs, such as reimbursement, healthcare provider knowledge, attitudes, practices, and communications, are required for VCR targets to be met and benefit public health.

Seasonal influenza vaccine policy, use and effectiveness in the tropics and subtropics – a systematic literature review

“…Seasonal influenza vaccine supply increased from 350 million doses in 2006 to around 900 million in 2009 29. It increased by 87% between 2004 and 2011 but by only 3% per annum in the last 3 years 30. Less than 20% of the global seasonal influenza vaccine was produced by regional manufacturers in tropical and subtropical countries 31.…”

“…The coverage was 7–12 per 1000 in Singapore despite influenza vaccines being offered at a cost in public hospitals 41. In contrast, countries in Central and South America (except Guatemala, Guyana, Haiti and Jamaica), Mauritius and China, Hong Kong SAR reported a coverage of more than one dose per 1000 population 30. Seasonal influenza vaccination coverage varied widely across different targeted population groups (Table 1) in the tropics.…”

“…Vaccine coverage estimated by national immunization programmes is less meaningful as they are based on the number of vaccine doses distributed or administered expressed as a fraction of number of doses procured. Global distribution of vaccines by the major manufacturers has been used as a proxy for vaccine coverage 30. However, these coverage estimates do not account for 21% of the global vaccine supply by developing country manufacturers that do not contribute to this database.…”

The beneficial effects of vaccination on the evolution of seasonal influenza

“…Yet this is where most studies estimating the value of vaccination take place [21,22]. By contrast, source populations that contribute more to influenza's evolution (e.g., China and India) have almost zero vaccination [32][33][34], and few studies of vaccination occur there [35].…”

“…Vaccination mostly occurs in temperate populations such as North America, Europe, and Oceania, which do not consistently contribute to the long-term evolution of influenza viruses [32][33][34]. Yet this is where most studies estimating the value of vaccination take place [21,22].…”