IAIM Inaugural Conference by Sabin Vaccine Institute

Proceedings from the Inaugural Conference of the International Association of Immunization Managers (IAIM)

A program of the

TABLE OF CONTENTS

Acknowledgements ………………………………………………………………………………………………………………….3 Foreword ………………………………………………………………………………………………………………………………….5 Day 1 Sessions and Activities ………………...………………………………………………………….………………………7 Day 2 Sessions and Activities…………………………………………………………………………….……………………..22 Closing Remarks …………………………………………….……………………….……..……………………………………….33 Appendices………………………………………………………………………………………………………………………………34

ACKNOWLEDGEMENTS The International Association of Immunization Managers (IAIM) is an initiative of the Sabin Vaccine Institute and is funded by the Bill and Melinda Gates Foundation (BMGF). The IAIM Secretariat and the IAIM Governing Council would like to acknowledge the Bill and Melinda Gates Foundation for their support of IAIM. Additionally, the Secretariat extends gratitude to Gavi, the Vaccine Alliance for generously supporting the membership fees of immunization managers from countries receiving Gavi support.

participation during the Conference. We would like to acknowledge and express our deepest appreciation to all GC candidates and to those who were elected by the membership to serve on the associationâ&#x20AC;&#x2122;s first elected GC during this meeting. We would like to acknowledge the InterContinental Istanbul Hotel, where the event was hosted, which provided an excellent environment for the conference. Additionally, we would like to thank K2 Conference and Event Management, the event company that supported the operations of the conference in collaboration with the IAIM Secretariat. Finally, we thank and acknowledge the important contributions of all members who travelled to Istanbul for the Inaugural Conference, without whom this meeting could not have been a success.

We extend our deepest appreciation to all our distinguished speakers, and to our session moderators. We would also like to acknowledge the key roles played by the ad hoc Governing Council (GC) members, both in the planning of this Conference and for their active

LIST OF MEETING ORGANIZERS

Name Jon Andrus Peter Carrasco Katie Waller Alison Maassen

IAIM Secretariat - Sabin Vaccine Institute - Washington D.C. Title Country Executive Vice President, Sabin United States Vaccine Institute IAIM Secretariat Director, Sabin United States Vaccine Institute IAIM Secretariat Senior Program United States Officer IAIM Secretariat Program Officer United States

Emi Symenouh

United States

Gabrielle Hafalia

IAIM Secretariat Program Assistant IAIM Secretariat Research Intern

Carlos Franco-Paredes

Rapporteur, Consultant

United States

Members of the IAIM ad hoc Governing Council IAIM Member/Region Country Americas Region Karen Lewis-Bell (Secretary) Jamaica Claire Hannan (Treasurer) United States Carla Vizzotti Argentina Europe and Central Asia Region Silvia Bino Albania Gayane Sahakyan Armenia David Salisbury (President) United Kingdom Middle East and North Africa Region Jalila Sayed Jawad (Vice President) Bahrain Salah Al Awaidy Oman Sub-Saharan Africa Region Kwadwo Odei Antwi-Agyei Ghana Johann van den Heever South Africa South and Southeast Asia Region Paba Palihawadana Sri Lanka Western Asia and Pacific Region Chong Chee Kheong Malaysia Li Li* China * Absent at Governing Council Meetings and Inaugural Conference

FOREWORD From 3-4 March 2015, over 130 members from 70 countries â&#x20AC;&#x201C; representing all six regions of the world1 â&#x20AC;&#x201C; gathered in Istanbul, Turkey for the Inaugural Conference of the International Association of Immunization Managers (IAIM). IAIM is the first international professional association established for immunization managers and all other health professionals working or having interest in the field of vaccines and immunization. The success of IAIM stands on the shoulders of many health workers and stakeholders who laid the foundation for todayâ&#x20AC;&#x2122;s national immunization programs.

coverage of basic vaccines, and to accelerate and scale up the introduction of new and underutilized vaccines in low-income and middle-income countries. Yet, much remains to be achieved under the guidance of the Global Action Vaccine Plan (GVAP) of the WHO. In this global immunization policy environment, most national programs have established programmatic structures and processes for delivering vaccination services to their populations. National and subnational immunization managers play a major role in planning, organizing, and implementing their immunization program activities. Just as the smallpox eradication campaign, the forerunner of EPI, relied heavily on sound managerial strategies, the EPI program must also employ management strategies to be successful. The four basic core functions of effective management (planning, organizing, leading, and evaluating) are fundamental for achieving the highest public health impact of immunization systems. These days, however, immunization managers are facing an increasing number of challenges due to the introduction of new vaccines, shifting demographic patterns, complex networks of service providers, and maintaining the gains achieved with previous vaccination efforts. Over the last four decades, EPI has saved millions of lives and prevented incalculable suffering. Yet sustaining the gains achieved with routinely administered vaccines for each new annual birth cohort, while concomitantly introducing new vaccines poses a formidable challenge for program managers. In this complex environment, program managers must be equipped to design innovative solutions, re-engineer or abolish old processes and structures, and re-tool human resources for achieving the successful implementation of immunization programs. Simply put, establishing effective management practices allows immunization mangers to effectively

Vaccine delivery is an essential element of health systems worldwide. With the smallpox eradication as its legacy, the Expanded Program on Immunization (EPI) was established by the World Health Organization (WHO) in 1974 with the purpose to develop and expand immunization programmes throughout the world. By 1977, a global goal for universal child immunization against the six basic antigens (measles, poliomyelitis, diphtheria, pertussis, tetanus, and tuberculosis) was articulated at the World Health Assembly. From 1984 to 1990, UNICEF in partnership with countries and stakeholders launched the Universal Childhood Immunization (UCI), which defined a goal of 80% immunization coverage2 However, in the 1990s, estimates of immunization coverage suggested that immunization coverage instead was stagnating or failing. In response, Gavi, the Vaccine Alliance (formerly known as the Global Alliance on Vaccines and Immunizations) was launched in 1999 as a public-private partnership. Since then, substantial efforts and resources on the part of both countries and stakeholders have been invested into increasing 1

The Americas, Europe and Central Asia, the Middle East and North Africa, South and Southeast Asia, sub-Saharan Africa, and West Asia and the Pacific. 2 80 per cent BCG, OPV 3 and measles coverage for children under one year in 1990. African countries were considered to have achieved UCI if they reached 75 per cent BCG, OPV 3 and measles coverage for children under one year in 1990.

fulfill their roles in reducing the burden of vaccine-preventable diseases.

the decades. Dr. David Heymann, Head of the Centre on Global Health Security, Chatham House, United Kingdom, presented on public health emergencies, and recommended an innovative approach that shifts from the rapid response of controlling an outbreak to an approach requiring understanding the animal and human risk factors at the source of the epidemic, with a particular focus on the recent Ebola epidemic in West Africa. Dr. Tom Cherian, Coordinator, Program and Impact Monitoring of WHO Department of Immunization, Vaccines, and Biologicals, provided an up-date on country progress toward meeting GVAP goals and objectives. Unfortunately, progress is lagging in five of the six GVAP objectives, poignantly emphasizing the importance of strong immunization program management. IAIM members from around the world also offered presentations on such varied topics as managing the delivery of immunization in the private and public sectors; developing a management information system (MIS) for immunization programs; and ensuring success in immunization programs. Members who had received IAIM Peer-to-Peer Exchange awards, which provide current immunization managers the opportunity to learn from another immunization manager, also presented on lessons learned from their exchanges.

In response to the increasing challenges facing immunization program managers, the International Association of Immunization Managers (IAIM) was founded. IAIM is the first international professional association established to strengthen the managerial capabilities of immunization managers in order to improve program performance and attain national, regional and global immunization goals. Launched in June 2013, IAIM’s objectives are:  to establish a forum from which immunization managers can discuss and exchange best practices;  to build and support international and regional networks of immunization managers  to strengthen and/or develop managerial and leadership skills within the immunization program manager community in order to achieve better performing programs that achieve their objectives  to promote the benefits of immunization with governments and other stakeholders. During the IAIM Inaugural two-day conference, members elected 13 of their peers to the Governing Council, IAIM’s governing body. Members also voted to ratify the IAIM Bylaws. The conference presentations allowed members to hear success stories from their peers, and the networking and breakout sessions provided members in attendance opportunities to share best practices.

The Association’s Inaugural Conference provided IAIM members, particularly immunization managers, a house of their own. The presentations delivered provided members the opportunity to acquire new capabilities, learn about new technologies and approaches to lead their programs to meet future challenges and support strong immunization program management fundamentals.

The conference keynote speaker was Dr. William Foege, Professor Emeritus, Emory University, U.S.A. Dr. Foege discussed the history of vaccination and emphasized the key role that countless health workers have in managing and delivering immunization services which has contributed to the remarkable success of immunization to the program over

Peter Carrasco, Director International Association of Immunization Managers

DAY 1 Opening Remarks by Mr. Peter Carrasco, Director of the Secretariat of the International Association of Immunization Managers (IAIM) Mr. Peter Carrasco, Director of the IAIM Secretariat, welcomed everyone to Istanbul, Turkey and to the Inaugural Conference. He invited participants to reflect on the historic moment represented by this gathering. He also expressed his enthusiasm and gratitude for the growth of the association. Mr. Carrasco acknowledged immunization managers and their efforts toward preventing needless suffering, morbidity, and mortality caused by vaccine-preventable diseases. He Peter Carrasco, Director of the IAIM Secretariat, addresses Conference highlighted significant global participants during the opening remarks. immunization achievements: poliomyelitis eradication is in sight, and progress is being made in measles control. Next to speak was Dr. David Salisbury, President Global immunization coverage for basic of the ad hoc Governing Council. Dr. Salisbury vaccines is at its highest, and new vaccines are described IAIMâ&#x20AC;&#x2122;s goal of providing a forum for being added to immunization systems. Yet, to immunization managers to share best practices face the growing number of challenges and and experiences. Many of the challenges faced opportunities that immunization programs by immunization programs are rooted in currently face there is a need for innovative management, and can be addressed with good managerial approaches. management practices. This is a conference for immunization managers so that we can all learn The ad hoc Governing Council and the IAIM from each other, in particular through sharing Secretariat spent over two years planning for best practices. Dr. Salisbury expressed his this event. The presence of so many IAIM gratitude for being able to serve as the chair of members together in Istanbul marks a new the ad hoc GC since the inception of IAIM, and beginning for IAIM and for professionals who explained that during this inaugural conference work or are interested in the field of IAIM members will elect new members of the immunization. IAIM is the first professional GC through a democratic process for casting association dedicated to you, said Mr. Carrasco. votes. Ms. Katie Waller, the Secretariatâ&#x20AC;&#x2122;s Senior Finally, participants were reminded that at this Program Officer, also welcomed members and conference they are representing themselves as proceeded to offer some instructions to the individual members of IAIM and not as audience regarding the channels for languages representatives of their governments or their during the conference and provided other immunization programs and that the housekeeping information for members. discussions by members would be conducted under the Chatham House rules.

Keynote Opening Speech by William Foege, M.D., M.P.H, Professor Emeritus, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA Dr. Foege’s presentation was preceded by a brief outline by Mr. Carrasco of Dr. Foege’s life, and of his remarkable achievements in public health, including his central role played during the smallpox eradication campaign. Through a previously recorded video presentation, Dr. Foege addressed the conference on the history of vaccines and on how today’s current immunization programs make history each day. He provided an overview of the 219-year journey since Edward Jenner discovered that smallpox could be prevented through the inoculation of material obtained from cowpox lesions into human skin. He recounted the contributions of such important immunization figures as Charles Merieux, Jonas Salk and Albert Sabin. He also recognized individuals whose names are less well-known, such as Frederick Robbins, John Enders, Tom Weller, Thomas Francis, and Maurice Hilleman. He tied their accomplishments to recent achievements in immunization, including the rollout of an Indian-made rotavirus in the Indian Universal Immunization Programme and the replenishment of Gavi funding in early 2015. While noting the impressive scientific achievements gained to date, he quoted the famous physicist Richard Feynman: “science alone is nothing, its power relies on its application.”

Dr. Foege highlighted the central role of management in achieving immunization goals. Management is the catalyzer as to whether a body of science changes the world or not. Management principles assist us in producing vaccine, storing vaccine, getting the vaccine through customs, developing immunization schedules, training vaccinators, evaluating the vaccination program, carrying out surveillance, and so on. Solving day-to-day problems relies on application of management principles by immunization managers. Dr. Foege used a personal example to illustrate the power of good management and scientific breakthroughs: he was born almost 80 years ago and through reviewing his own vaccination record given to him by his mother, he learned that only 2 vaccines were routinely administered during his first year of life. Nowadays, we have gone from 2 to 18 vaccines used routinely and we will continue to see new vaccines for many other diseases coming down the line. Dr. Foege predicted vaccines for addiction, for preventing other cancers (beyond cervical cancer and liver cancer) and that in the near future, we may see vaccines developed to protect us against cardiovascular disease. He concluded his lecture by acknowledging that vaccines are the foundation of public health and reminding immunization managers that when they wake up every morning, they should realize that they are making history.

ITEM 1: Call to order and vote on the meeting agenda by Dr. Prof. David Salisbury, President of the ad hoc Governing Council and former Director of Immunisation for the Department of Health, United Kingdom Dr. Salisbury requested the approval of the Conference agenda by participants. Members approved the agenda with no comment.

ITEM 2: Overview of the Sabin Vaccine Institute by Dr. Michael McQuestion, Director of the Sustainable Immunization Financing Program at the Sabin Vaccine Institute on behalf of Dr. Jon Andrus, Executive Vice President of the Sabin Vaccine Institute Dr. Michael McQuestion, Director of the Sustainable Immunization Finance (SIF) initiative of the Sabin Vaccine Institute (SVI), addressed the conference on Dr. Andrus’ behalf who could not attend the opening session. Dr. McQuestion shared personal stories of his experiences with the institute’s namesake, Dr. Albert B. Sabin, and with the former Executive Vice President Ciro de Quadros. He went on to outline the mission and activities of the Sabin Vaccine Institute (Sabin). He explained that Sabin is a non-profit organization founded in honor of Dr. Albert Sabin, who is best known for developing the oral polio virus vaccine (OPV). Dr. Sabin dedicated his professional career to the elimination of human suffering associated with vaccine preventable and neglected tropical diseases, and thus this is what the Sabin Vaccine Institute seeks to do. The three main components of work at the Sabin Vaccine Institute are: a) vaccine advocacy and education; b) vaccine development; and c) the Global Network for Neglected Tropical Diseases.

Secretariat, which executes IAIM’s day-to-day operations. Other programs within the VAE department include the Coalition against Typhoid (CaT), whose members advocate the use of typhoid vaccines worldwide use based on evidence-based decision making, and the Sustainable Immunization Financing (SIF) program, which encourages key stakeholders, including ministries of health and finance, parliamentarians, and others – including external partners – to work together to identify sustainable financing mechanisms for immunization. The Sabin Vaccine Development unit, known as the Sabin Vaccine Institute Product Development Partnership (Sabin PDP), is based at Texas Children’s Hospital/Baylor College of Medicine. The Sabin PDP consists of scientific researchers developing vaccine candidates for neglected tropical diseases, including human hookworm, Chagas disease, and leishmaniasis and others. The Sabin PDP collaborates with partners around the world to develop new, lowcost vaccines that have essentially no commercial market (as the vaccines target diseases that primarily impact the world’s poorest populations). The Global Network for Neglected Tropical Disease aims to raise awareness, political will, and funds to control and eliminate the seven most common neglected tropical diseases by the year 2020.

Within the Vaccine Advocacy and Education (VAE) department, the goal to bring together key stakeholders and leaders in government, private sector and civil society in order to foster cooperation, share information and best practices, and advocate for improved vaccine policy and access. Sabin’s Vaccine Advocacy and Education department hosts the IAIM

ITEM 3: Introduction to IAIM by Mr. Peter Carrasco Mr. Carrasco provided an overview of IAIM’s goals and objectives, membership benefits, and governance. IAIM is the first-ever international professional association for immunization managers. IAIM is a membership organization, and the target population includes immunization managers at the national and

sub-national level from both the public and private sectors. The association is also open to other health professionals working in immunization programs (nurses, cold chain technicians, laboratory technicians, etc.), as well as others who are interested in advancing global immunization efforts.

The main objectives of IAIM are: 

 

to establish a forum from which immunization managers can discuss and exchange best practices in immunization program management; to build and support international and regional networks of immunization managers; and to provide immunization managers with opportunities to improve their management and leadership capacity for achieving good performing immunization programs.

the profiles of their peers and connect one on one Latest news and information in immunization with updated information from leading public health agencies (GAVI, WHO) Access to member experts

Associate Membership (USD $50/year), which is open to other health professionals working in immunization programs, as well as others interested in immunization.

IAIM currently offers two types of membership:

Associate Members are entitled to the following benefits:

Immunization Manager Membership (USD $100/year), is open to current and former immunization managers at the national or subnational levels;

 

Immunization Manager Members are entitled to the following benefits:     

Eligibility to apply for IAIM’s 72 Peer-toPeer Exchange Program Eligibility to apply for IAIM’s 24 Training Scholarship Program Free registration for IAIM Conferences and Regional Meetings Voting rights Access to interactive IAIM website and its informational products: o Discussion Forums, where immunization managers can network with peers to solve problems and share solutions o Membership Directory, where immunization managers can view

Free registration for IAIM Conferences and Regional Meetings Access to interactive IAIM website and its informational products: o Discussion Forums, where immunization managers can network with peers to solve problems and share solutions o Membership Directory, where immunization managers can view the profiles of their peers and connect one on one o Latest news and information in immunization with updated information from leading public health agencies (GAVI, WHO) o Access to member experts

Mr. Carrasco presented updated membership information. As of February 2015, IAIM had a total of 234 members from around the world, as shown in the Table 1, below:

Table 1. IAIM membership by type and region, February 2015 Americas Europe Middle South and SubWestern & East & Southeastern Saharan Asia & Central North Asia Africa The Asia Africa Pacific Immunization 29 14 35 10 62 13 Manager Members Trial 1 2 0 0 3 0 Members Associate 31 10 7 1 13 3 Members TOTAL PER 61 26 42 11 78 16 REGION

Mr. Carrasco reported a total of $16,658.14 of dues received by January 31, 2015.

TOTAL BY MEMBERSHIP TYPE 163

6 65 234

association: Mrs. Katie Waller, Ms. Alison Maassen, Ms. Emi Symenouh, and Ms. Gabrielle Hafalia. He also thanked representatives of the Bill and Melinda Gates Foundation for their attendance at the conference and for their support. Finally, he recognized Gavi, the Vaccine Alliance for their support of membership dues for national immunization managers in Gavi-supported countries.

Mr. Carrasco thanked the ad hoc Governing Council for their recruitment efforts. He asked each of them to make a brief presentation of themselves to the conference participants. He also acknowledged the members of the IAIM Secretariat joining him at the Conference, who manage the day-to-day affairs of the

ITEM 4: Presentation of Governing Council candidates by Mr. Peter Carrasco Mr. Carrasco introduced the twenty-one nominees for serving on the Governing Council, see below. After introducing each nominee and briefly discussing their vision for the future of IAIM, Mr. Carrasco proceeded to explain the process for casting votes. Only IAIM members

holding Immunization Manager Membership were eligible to cast a vote. From these 21 nominees, 13 would be elected to the Governing Council (GC). Table 2 below lists the 21 candidates for the first elected Governing Council.

Table 2. Candidates for the first elected Governing Council Americas Region United States Costa Rica Jamaica

Bruce Gellin Roberto Arroba Simone Spence

Europe and Central Asia Region Albania Armenia United Kingdom

Silvia Bino Gayane Sahakyan David Salisbury Jalila Sayed Jawad Salah Al Awaidy Dia Obeid Hassan Hjajia

Middle East and North Africa Region Bahrain Oman Palestine

Kwadwo Odei (‘K.O.’) Antwi-Agyei Johann van den Heever Sintayehu Abebe Woldie Hamadou Ousseini Adamou Sylvain Zeba Maurice Gatera

Sub-Saharan Africa Region Ghana South Africa Ethiopia Niger Burkina Faso Rwanda

Paba Palihawadana Shyam Raj Upreti Kyaw Kan Kaung Tshewang Dorji Tamang

South and Southeast Asia Region Sri Lanka Nepal Myanmar Bhutan

Chong Chee Kheong Li Li

Western Asia and Pacific Region Malaysia China

ITEM 5: Election of the Governing Council by Mr. Peter Carrasco The election was held in two rounds: first to elect twelve members who would represent the six world regions (two Governing Council members per region). Once those votes had been counted, a thirteenth ‘at-large’ member would be voted on from the remaining candidates not elected in the first round of voting. Voting members of the association (Immunization Manager Members) received

ballots which were then collected by Sabin staff. These ballots (and previously received absentee ballots) were taken to another location for counting by Sabin staff. While this counting was completed, Item 6 was presented. The following were the twelve nominees elected to the Governing Council during the first round of voting:

Table 3. Candidates elected to the first twelve seats on the Governing Council Americas Region United States Jamaica

Bruce Gellin Simone Spence

Europe and Central Asia Region Albania United Kingdom

Silvia Bino David Salisbury Jalila Sayed Jawad Salah Al Awaidy

Middle East and North Africa Region Bahrain Oman

Kwadwo Odei (‘K.O.’) Antwi-Agyei Johann van den Heever

Sub-Saharan Africa Region Ghana South Africa

Paba Palihawadana Shyam Raj Upreti

South and Southeast Asia Region Sri Lanka Nepal

Chong Chee Kheong Li Li

Western Asia and Pacific Region Malaysia China

Following announcement of the results, members were shown the remaining nominees eligible for election to the 13th ‘at large’ seat on the Governing Council. Voting members were asked to submit their votes for a single

candidate on a piece of paper, which were collected by Sabin staff and counted. Dr. Gayane Sahakyan, the national immunization program manager in Armenia, was elected as the IAIM ‘at-large’ Governing Council member.

The newly-elected members of the Governing Council gathered for an impromptu photo. From left to right: Silvia Bino, Salah Al Awaidy, Jalila Sayed Jawad, Johann van den Heever, Paba Palihawadana, David Salisbury, K.O. AntwiAgyei, Gayane Sahakyan, Chong Chee Kheong, Shyam Raj Upreti, and Simone Spence

ITEM 6: Summary of the Inaugural Regional Meeting of Middle East, North African, and sub-Saharan African members (Durban, South Africa, September 2014) by Dr. Jalila Jawad, Head of Immunization Group, Ministry of Health, Bahrain Dr. Jalila Jawad presented a summary of the first joint Regional Meeting for members from the Middle East and Africa. A total of 47 members attended the meeting from 20 countries. Dr. Jawad noted some of the highlights of the meeting, which included member presentations on their program management experiences, successes, and challenges; informational presentations featuring management best practices; and

networking sessions and break-out sessions for members to discuss the value of IAIM, as well as specific needs and challenges in their regions. This meeting provided the Secretariat and Governing Council with valuable member feedback – via survey and voting handsets – on how IAIM can best serve its members in these regions. It also assisted the Secretariat in preparing for the Inaugural Conference in Istanbul.

ITEM 7: Presentation of newly elected Governing Council and officers by Peter Carrasco The newly elected Governing Council convened their first meeting at lunch immediately following the election. They elected from amongst themselves the four officers of the

association: President, Vice-President, Treasurer and Secretary. Table 4 below displays the members of the newly elected Governing Council and the officers.

Table 4. The members of the first elected Governing Council Americas Region United States Jamaica

Bruce Gellin - Secretary Simone Spence

Europe and Central Asia Region Silvia Bino Albania David Salisbury - President United Kingdom Gayane Sahakyan - at large member Armenia Middle East and North Africa Region Jalila Sayed Jawad - Vice President Bahrain Salah Al Awaidy Oman Kwadwo Odei (‘K.O.’) Antwi-Agyei Johann van den Heever - Treasurer

Sub-Saharan Africa Region Ghana South Africa

Paba Palihawadana Shyam Raj Upreti

South and Southeast Asia Region Sri Lanka Nepal

Chong Chee Kheong Li Li

Western Asia and Pacific Region Malaysia China

ITEM 8: Ratification of the IAIM Bylaws conducted by Ms. Alison Maassen, Program Officer IAIM Secretariat, and by Mr. Peter Carrasco Ms. Maassen initiated this session by presenting a brief overview of the draft IAIM Bylaws. She reviewed the content of each of the 13 articles, highlighting particular passages that members may wish to discuss in more detail. Following this presentation, the Bylaws document was presented to the membership for ratification. Mr. Carrasco led the voting members through each article of the Bylaws, requesting their comments or proposed amendments on each article. All proposed amendments received during the absentee balloting process were presented in track change to the original document for the membership’s review. Once the membership was ready to vote on a particular passage or article, they used voting handsets to indicate their vote. The results of each vote were instantly available on the screen.

immunization program managers who can effectively shape their programs, introduce changes and innovations, and solve problems for improving program performance.” The members approved this amendment and voted on the amended text. It was approved. Article 2, Section 2.1 now reads “The International Association of Immunization Managers seeks to form a cadre of national and subnational immunization program managers who can effectively shape their programs, introduce changes and innovations, and solve problems for improving program performance.” There was also a proposed amendment to change Section 2.3’s title from “Objectives” and replace it with “Mission Statement.” This amendment was not seconded by the rest of the membership and thus not approved. Article 2 was ratified by a majority vote.

The following discussion highlights proposed amendments brought to the floor by members regarding the Association Bylaws and results of votes on each article:

Article 3. A number of absentee ballot amendments were received for this Article. The first stated “National programs also become members.” This amendment was not seconded by the membership, and thus not approved.

Article 1. Francophone members raised concern about the word gérant in the French-language Bylaws. They requested that this word be replaced with gestionnaire, which they indicated better captured the translation ‘manager’ in French. This amendment was accepted by the membership, and, in a subsequent vote, Article 1 was ratified by a majority vote. Article 2. Members proposed an amendment to add text to Article 2, Section 2.1. They proposed adding the text “and subnational” to the line “The International Association of Immunization Managers seeks to form a cadre of national

IAIM member Marie Kobela, Cameroon, proposes changing the Frenchlanguage translation of ‘manager’ from ‘gérant’ to ‘gestionnaire.’

Another proposed amendment to Article 3 suggested replacing and adding text to Section 3.4 revocation. The text original text read “If a member wishes to contest his/her membership termination, he/she may contact the Governing Council President in writing to express why he/she should not have membership revoked. Upon receipt of this written request, the Governing Council shall determine the status of the individual’s membership and inform the individual of their final decision.” The proposed amendment was seconded and modified, and resulted in the following final ratified text for Section 3.4 Revocation: “If a member wishes to contest his/her membership termination, he/she has 3 weeks to contact the Governing Council President in writing to express why he/she should not have membership revoked. The Governing Council must respond in writing with a decision within 3 weeks.”

who are currently or were previously responsible for managing the operation of all components of the immunization program at the national or subnational level.” Article 4 was ratified by a majority vote.

An additional proposed amendment was raised for Section 3.4 Appropriate use of IAIM Name and Logo. This amendment wished to replace and add text to the following line: “Failure to receive written consent for use of the Association name and logo may constitute sufficient cause for membership revocation.” This amendment was seconded, and the final ratified text for this section reads as follows: “The unauthorized use of the IAIM name and logo may constitute sufficient cause for membership revocation.” Article 3 was ratified by a majority vote.

Article 8. No amendments were received from absentee ballots. There were no amendments or modifications to Article 8. Article 8 was ratified by a majority vote.

Article 5. No amendments were received from absentee ballots. There were no amendments or modifications to Article 5. Article 5 was ratified by a majority vote. Article 6. No amendments were received from absentee ballots. There were no amendments or modifications to Article 6. Article 6 was ratified by a majority vote. Article 7. No amendments were received from absentee ballots. There were no amendments or modifications to Article 7. Article 7 was ratified by a majority vote.

Article 9. No amendments were received from absentee ballots. There were no amendments or modifications to Article 9. Article 9 was ratified by a majority vote. Article 10. No amendments were received from absentee ballots. There were no amendments or modifications to Article 10. Article 10 was ratified by a majority vote.

Article 4. A proposed amendment was received from the floor to Section 4.2 Composition. It was proposed to add text the text “or subnational” to the sentence: “Eligible Immunization Manager Members include those who are currently or were previously responsible for managing the operation of all components of the immunization program at the national level.” This amendment was seconded, and was followed by debate. The amended text was ratified by a narrow majority, and the text to Section 4.2 now reads “Eligible Immunization Manager Members include those

Article 11. A proposed amendment was received from the floor to Section 11.1 “Proposing Amendments.” The member wished to add and replace text to the following phrase: “An amendment proposed by an Immunization Manager Member shall be signed by the member and four other active Immunization Manager Members before being sent to Council.” The amendment was seconded and approved by the membership. The amended text to Section 11.1 now reads: “An amendment proposed by an Immunization Manager

Member shall be signed by the member and one other current Immunization Manager Member before being sent to Council.â&#x20AC;? Article 11 was ratified by a majority vote.

Article 12. No amendments were received from absentee ballots. There were no amendments or modifications to Article 12. Article 12 was ratified by a majority vote.

ITEM 9: Global Vaccine Action Pan (GVAP): Update on country progress; challenges in meeting GVAP goals and objectives. Dr. Thomas Cherian, Coordinator, Programme and Impact Monitoring, Department of Immunization, Vaccines, and Biologicals, WHO Geneva. Dr. Cherian provided an overall perspective of vaccine-preventable diseases and the impact of vaccines in reducing the burden of vaccinepreventable diseases. He argued that scaling up vaccination efforts to reach more children and introduce new vaccines remains as important and urgent as ever. He then proceeded to outline the major elements of the Global Vaccine Action Plan (GVAP) of the World Health Organization (WHO), and to discuss key issues regarding its implementation. According to Dr.

renewed optimism, untapped potential, and unprecedented opportunity by 2020. To achieve these ambitious goals, GVAP developed six key mid-point targets (see figure 1 below). Yet, unfortunately, just one of these six targets on track to be achieved on time, according to the 2014 Assessment Report of the Global Vaccine Action Plan (conducted by the Strategic Advisory Group of Experts, or SAGE, of the World Health Organization). Dr. Cherian noted that some of these targets have been missed multiple times before, such as the target to interrupt polio transmission by 2014. While each of these targets relates to different vaccines, they share some common reasons for their failure. These include failing to extend vaccination services to all people; and failing to strengthen the healthcare system so that all doses of vaccine are reliably provided.

Figure 1. GVAP mid-point targets. Cherian, GVAP has two great ambitions; first, to deliver vaccination to all (1.5 million children still die every year of diseases that can be prevented by vaccination); and secondly, to unleash vaccinesâ&#x20AC;&#x2122; vast future potential with

Three years after its start date, GVAP implementation is patchy and slow. Furthermore, poor quality and use of data is significantly impeding program management and improvement. Vaccine delivery is frequently disrupted by conflict, natural disasters, and major disease outbreaks, such as the current Ebola outbreak in West Africa. The key to achieving all targets of the GVAP lies in strengthening immunization systems, Dr.

Cherian said. In the 2014 Annual Report, there were 18 recommendations covering 5 key areas:     

above, introduction of new and under-utilized vaccines is on track. Some individual countries have also had better success in meeting the GVAP targets. He provided two illustrative examples for reducing mortality due to diarrhea in Mexico and Brazil. He also cited the impact of pneumococcal vaccine in many countries, which through direct protection and herd immunity, is reducing the burden of pneumococcal disease. He summarized his presentation by discussing the key role played by immunization managers and suggesting the following activities to further immunization goals:

Weak GVAP implementation Poor data quality and use Vaccine affordability and supply Failures of basic integration Situations disrupting immunization

It is valuable to remember that these recommendations come in the context of a “changing paradigm” for EPI, in which programs are expected to deliver a greater volume of vaccines against a greater number of diseases at greater cost to a larger population. See Figure 2. This obliges the political authorities to acknowledge that immunization managers at all levels are strategic in protecting the public health of its citizens.

   

Despite the many challenges and missed target deadlines, there have been some recent successes in immunization. As noted in Figure 2

Using data for planning and decisionmaking Establishing accountability processes at all levels Paying close attention to human resources Improving cooperation with other programs

Figure 2. The Changing paradigm for the Expanded Program on Immunization (EPI)

ITEM 9 continued: A discussion on the major management challenges that require attention to assure GVAP goals and objectives are achieved, moderated by Prof. David Salisbury Prof. David Salisbury moderated the answer and question session following Dr. Cherian’s presentation. Prof. Salisbury began by expressing his concern that approximately 40% of countries have ongoing shortages of new vaccines and more recently, there have been shortages of older vaccines. These shortages risk paralyzing immunization programs. Countries need to have “the certainty of vaccine supply” in order to achieve GVAP goals. In response, Dr. Cherian explained that some countries had historically relied on one vaccine supplier, but due to these vaccine shortages, some have opted to begin to use different vaccine manufacturers.

communications, given the increasing antivaccine groups in many settings. An IAIM member from Kenya noted that with the introduction of new vaccines and new technologies into countries, the quality of staff and training of staff within immunization programs is often forgotten. He stated that the problem is often “not a matter of science or technology but improving the abilities of immunization managers and staff.” Regarding this last point, Dr. Cherian suggested that IAIM is one important channel to address some of these concerns. He commented that deepening and strengthening immunization managers’ competencies is a crucial step towards enabling program success to achieving immunization goals.

An IAIM member from Mexico, reminded the audience that immunization managers cannot become complacent and that further concerted efforts are needed in maintaining gains achieved by routine immunization programs. He cited as examples the recent measles outbreak in Brazil, the ongoing one in California, as well as the one in Germany and explained that many are concerned about the potential spread of measles into other European countries. Another member, from Argentina, requested further support from WHO regarding vaccine safety

Other concerns raised by members regarding GVAP included: concerns surrounding vaccination registry when procuring the same vaccine from different manufacturers (given the ongoing vaccine shortages) and the need for innovative approaches to deal with this particular issue. Another member suggested that vaccine-financing reports should be part of capacity-building efforts at a country level, so that resources are adequately allocated and procured. A final comment from the audience related to concerns that some countries are under pressure from international agencies to introduce new vaccines and that this imposes new challenges to programs at times when their resources are limited and when they may be more focused on achieving their own countries’ immunization activities and targets. IAIM member Shyam Bawikar, Oman, makes an intervention during a presentation

ITEM 10: Role of the immunization manager: What core competencies should immunization managers have for managing todayâ&#x20AC;&#x2122;s challenges? Conducted by Dr. Carlos Franco-Paredes, IAIM member The aim of this session was to introduce an overall perspective of management theory and to foster discussion among participants on the core roles and competencies that immunization managers need to have or strengthen to achieve their immunization program goals. Dr. Franco-Paredes began his presentation by stating that too little attention is paid to management theory in health sciences. To be competent in biomedical and public health arenas, learning and applying managerial principles and approaches is crucial. As touched on in other presentations, the greatest challenges facing current immunization program managers are mostly managerial in nature. Immunization program management is frequently complicated by factors such as the introduction of new vaccines and immunization technologies, a shifting landscape of immunization service providers (i.e. public vs. private) and shifting target populations (i.e., the demographic for the HPV vaccine is different than that for MMR).

Dr. Franco-Paredes stated that there is no existing literature in either scientific journals or textbooks regarding conceptual managerial principles in the field of immunizations, and that often, immunization managers are not provided with management training for their jobs. He stated that this often results in a lack of management orientation among immunization managers. He also spoke of the prevailing assumption among healthcare workers that management is for administrators, not for medical personnel, and argued against it by emphasizing that achieving high immunization coverage rates requires effective management of human resources, supplies (including vaccines), and information. Dr. Franco-Paredes emphasized that by combining their technical expertise with managerial principles and approaches, immunization managers may improve their skills to respond to challenges and increase immunization coverage.

In the second part of his presentation, Dr. Franco-Paredes described the four core functions of managers: assessing, planning, implementing, and evaluating See Figure 3. A large part of the role of immunization managers, as with managers in many other industries, involves supporting and overseeing the activities of others, and ensuring that these activities are completed in support of program goals. The concepts of efficiency and effectiveness, based in resource usage and goal attainment, respectively, were also Figure 3. Four Core Functions of Management

presented in terms of immunization managers’ work.

immunization managers’ capacities to perform in these various roles.

Dr. Franco-Paredes presented Mintzberg’s Management Roles, which identify the various roles that managers play. These include: figurehead, leader, liaison, evaluator, disseminator, spokesperson, entrepreneur, disturbance handler, resource allocator, and negotiator. There is a need to improve

According to Dr. Franco-Paredes, there should be a set of standard competencies required of immunization managers. He emphasized the need for immunization managers themselves to articulate this standard set of competencies. In today’s world, possessing management and leadership skills is crucial to successfully manage the immunization program.

ITEM 11: Networking Session: Which of the IAIM objectives is most important to you? During this networking session, members were asked to prioritize the following objectives of IAIM, according to which members felt was most important: a) Providing a forum for immunization managers to discuss their work and share best practices b) Building regional and international networks of immunization managers c) immunization managers to build managerial and leadership skills through training and peer-to-peer exchange d) Promoting the benefits of immunization with governments and other stakeholders

Members broke out into small groups and discussed this issue amongst themselves. Information was collected informally through interactions with different members during this session. Most members suggested prioritizing IAIM objectives in the following order: 1) providing opportunities for immunization managers to build managerial and leadership skills through training and peer-to-peer exchanges; 2) providing a forum for immunization managers to discuss their work and share best practices; 3) fostering the visibility of immunization managers with governments and other key stakeholders; and 4) building regional and international networks of immunization managers.

IAIM members discuss the objectives of the association during the networking session at the end of Day 1.

DAY 2 ITEM 12: Public health emergencies: from rapid response to understanding and prevention, conducted by Dr. David Heymann, Head of the Centre on Global Health Security, Chatham House Dr. Heymann presented on responding to public health emergencies, focusing on a number of high-profile outbreaks – such as SARS, H5N1, and Ebola – and discussed how the manner of responding to these outbreaks could change in the future. As noted in the paper referenced in this presentation: 



“Public health authorities traditionally respond by identifying risk factors relating to human and increasingly animal diseases, focusing on an ‘emergency response’ to contain and then eliminate the infections in human and animal populations once they had been detected in humans. The global community is now moving towards a ‘One Health’ approach that recognizes the interrelatedness of human, animal and environmental sectors and calls for coordinated prevention, detection and control strategies. See Figure 4.



However, a recent Chatham House meeting concluded that better prevention and control could be achieved by addressing the underlying factors which, although not traditionally seen as related to animal and human health, facilitate the emergence and spread of these diseases. These factors shape disease risks by changing the nature of interactions among and between wildlife, livestock and humans – through, for instance, land-use change, trade practices and climate change.



To prevent serious infectious disease outbreaks in the future, collaborative efforts will need to focus on identifying the most cost-effective and feasible intervention strategies and mobilize the necessary political and financial support to implement them.”

Additional points emphasized by Dr. Heymann included the increase in international air travel, facilitating the rapid spread of illnesses around the world, and the importance of country-led alert and response systems, under the framework of the International Health Regulations (IHR).

Figure 4. The shifting paradigm for public health emergencies, adapted from Dr. Heymann’s presentation

ITEM 12 continued: Question and answer session, moderated by Dr. Karen Lewis-Bell In response to Dr. Heymannâ&#x20AC;&#x2122;s presentation, an IAIM member from Sierra Leone, one of the countries most heavily impacted by the 2014 Ebola outbreak, commented that during the initial spread of Ebola cases, clinical diagnosis was difficult given its similar symptoms to other existing infections. He also expressed substantial concern about measles outbreaks in West African countries due to weakening of public health programs. Finally, he remarked on the international attention given to the Ebola outbreak and the rapid development and testing of vaccines as compared to the attention historically given to Lassa fever. An IAIM member from Nigeria seconded the comment about lack of attention to Lassa fever, noting that Lassa fever has affected some areas of

Nigeria for many decades without international attention and without initiatives to develop an effective Lassa fever vaccine. Dr. Heymann concurred with the above comments and also discussed the importance of targeting vaccination efforts during future outbreaks to reach the most vulnerable and affected populations. Additionally, close collaboration by affected countries and international agencies is critical to prevent further spread of an outbreak. Finally, he also spoke about the development of toolkits for emergency response which would include surveillance activities, contact tracing, isolation and quarantine as well as basic infection control guidelines.

ITEM 13: Ensuring success in national immunization programs, conducted by Ms. Joanne Yarwood, National Immunisation Programme Manager, Department of Health, United Kingdom The aim of this presentation was to provide an overview of the managerial practices of the National Immunization Program (NIP) in the United Kingdom. As shown in Figure 5, skillful management is required to simultaneously oversee the many interdependent components of the national program. Timing is also of the essence in management, as the immunization manager must prepare for each phase of introducing a new vaccine or planning for any new vaccines that may be licensed. During the preintroduction phase, for instance, disease burden

Figure 5. The interdependent components of immunization programs

studies and strategic planning are crucial.

Communication Strategy for HPV Vaccination in the UK. She summarized the importance of precampaign research to develop a strategy for vaccinations to develop the right message, to deliver it to the right people, using the right method. She used the development of informational pamphlets for both daughters and mothers as an example.The United Kingdomâ&#x20AC;&#x2122;s NIP also plans for adverse event communication, which requires the program to prepare materials in the event of adverse events following immunization or any rise in vaccine hesitancy toward a certain vaccine. Ms. Yarwood mentioned that risk registration planning project for HPV took approximately 3 years in the UK. She emphasized that, for immunization managers, planning requires expecting the unexpected.

In the UK, general practitioners are an important component of the national immunization program, where they are required to use a web-based system for vaccine procurement. Vaccine stock management is critical to reduce vaccine wastage. The system they have introduced in the UK intends to help prevent vaccine wastage by including finance reports or invoices to make health practitioners aware that vaccines are not truly free. See Figure 6.

Communication competencies are important for managers at all levels within the immunization program. Regarding influenza vaccination coverage in the UK, for instance, she noted that even general practitioners demonstrated poor Figure 6. Vaccine stock management to reduce vaccine wastage perceptions and knowledge of influenza vaccination, which in turn served as a key driver Ms. Yarwood also spoke passionately about the of low immunization vaccination coverage in importance of communication with parents for the UK. Working to raise the vaccination rates childhood vaccines. The key message, according amongst healthcare workers would influence to Ms. Yarwood, is to always explain the these workers to recommend influenza important long-term benefits of immunizations vaccination to their patients. and to remind parents that immunization is a lifelong

process.

She

outlined

the

ITEM 14: Presentation of the first round of Peer-to-Peer exchanges followed by question and answer session moderated by Dr. Salisbury An important theme discussed throughout the conference was the need for all immunization managers to continually assess their competencies and/or acquire new ones to maintain and advance program performance. To improve managerial competencies, IAIM funded three international peer-to-peer exchanges in 2014 as a part of the IAIM Peer-toPeer Exchange Program. This unique benefit offers members the opportunity to spend one week learning from a peer in another country about a specific component of their immunization program. The results of the first three awards were presented during this session. Objectives of the three visits included learning about: the composition and function of National Immunization Advisory Technical Groups (NITAGS), effective implementation of an HPV program rollout, and managing vaccine wastage by sharing best managerial practices of cold chain.

Dr. Kelly Moore, Director, Tennessee Immunization Program, Tennessee Department of Health, USA Dr. Moore traveled to Tirana, Albania for her Peer-to-Peer Exchange. Dr. Silvia Bino at the Institute for Public Health in Albania (along with her colleagues Dr. Erida Nelaj and Dr. Iria Preza) hosted Dr. Moore. During her visit, Dr. Moore learned about the use of VVMs to prevent vaccine wastage in Albania. The goal of her visit was learning about the challenges and successes of Albaniaâ&#x20AC;&#x2122;s vaccine cold chain management strategies at the level of the end user, including learning about vaccine transport and management of vaccine storage failures. She was also particularly interested in the application of vaccine vial monitors (VVM). She presented lessons learned from her exchange (see Figure 7 below), and noted that this exchange provided her with an opportunity to see immunization practices from a different angle. She encouraged all eligible members to apply for upcoming Peer-to-Peer Exchange Program opportunities.

Figure 7: Lesson learned during Dr. Mooreâ&#x20AC;&#x2122;s Peerto-Peer Exchange in Albania

Dr. Aisha Alshammary, National Manager of EPI, Ministry of Health, Saudi Arabia

Another important outcome of this visit was development of a plan to introduce influenza sentinel site surveillance for respiratory pathogens. See Figure 8 below. Dr. Alshammary concluded her presentation by encouraging members to apply to the Peer-toPeer Exchange Program.

Dr. Alshammary traveled to the United States for her Peer-to-Peer Exchange. Dr. Melinda Wharton, Director of the Immunization Services Division at the United States Centers for Disease Control and Prevention (CDC), served as her host. Dr. Alshammary’s primary goal was to learn about disease surveillance, and particularly disease surveillance after the introduction of new vaccines. Her main objective was to become familiar with ACIP (structure, meeting and voting process, evaluation of vaccines) which serves in the U.S. as the National Immunization Advisory Technical Groups (NITAG). She also wished to learn about CDC surveillance activities surrounding vaccine-preventable diseases. She visited CDC 2 day ACIP meeting held in Atlanta in October 2014. Based on this experience, the Saudi Arabian NITAG is being restructured and new policies are currently being instituted.

Dr. Brenda Corcoran, National Immunisation Office, Dublin, Ireland conducted, on behalf of Ms. Molly Howell, Immunization Program Manager and Assistant Director, Division of Disease Control, North Dakota Department of Health, USA, the presentation.

Ms. Howell traveled to Ireland for her Peer-toPeer Exchange, where she was hosted by Dr. Corcoran. The main objective for Ms. Howell’s exchange was to learn about implementing and achieving high rates of HPV vaccination amongst adolescents, through the use of effective and innovative methods. Dr. Corcoran discussed key issues regarding the HPV rollout in Ireland, and how her program has served as a model for rollout of HPV in other European countries based on its success. See Figure 9 below. On behalf of Ms. Howell, Dr. Corcoran reported that a pilot school clinic to administer HPV vaccine to adolescents in North Dakota is now planned, thanks to her Peerto-Peer Exchange. If this pilot clinic Figure 8. Follow up actions being taken in Saudi Arabia demonstrates after Dr. Alshammary’s Peer-to-Peer Exchange improvements in

HPV vaccine uptake, then this model will be used throughout North Dakota. In addition, they will be conducting a media/educational campaign focusing on preventing cervical cancer. Finally, Dr. Corcoran noted that the Peerto-Peer Exchange is a two-way learning process during which the host also learns valuable information about immunization program management. Figure 9. Lessons learned from Ms. Howell’s Peer-to-Peer Exchange in Ireland.

ITEM 15: Managing the delivery of immunization services in the private and public sectors: A pediatrician’s perspective and an immunization manager’s perspective. Presented by Dr. Simon Strachan Pediatrician, Bedford Gardens Hospital, South Africa. Dr. Anne Romanowicz, Pediatrician, Switzerland, and Dr. Silvia Bino, Head of the Control of Infectious Diseases and Immunization Department, Albania The presentation highlighted that immunization services are considered a public good. Like the lighthouse that protects ships at night, vaccines protect children and their families. However, how a country goes about delivering this ‘good’ is different when comparing government offered immunization services with the delivery of services by the private sector. Dr. Strachan illustrated that in some countries, such as South Africa, the private market is robust and beneficial to the public sector. Yet, financing vaccination activities in this private market is costly. Dr. Romanowicz spoke about the important role played by pediatrician in educating/informing parents of the benefit of vaccination. In many settings, people don’t trust

the healthcare system, the government, or the pharmaceutical industry, making it difficult to immunize the population. She concluded that building long-term relationships with parents and their families is crucial to build trust around immunization. Dr. Bino also spoke about the important role that the private sector plays in immunization services delivery. She emphasized the importance, however, of having national authorities overseeing and managing every component of the system. All presenters concurred on the need for having: 1) adequate patient interface programs and communication materials; 2) constant attention to training human resources training

and certification programs; 3) assessment of all components of immunization program performance in all sectors; 4) quality data that needs to be shared by public and private

services, and 5) coordination of norms and performance standard measurements on the part of national authorities in collaboration with private sector.

ITEM 15 continued: Panel discussion moderated by Dr. Jon Andrus, panelists included: Dr. Kelly Moore, Director of State Immunization Program, Tennessee, USA; Ms. Joanne Yarwood, National Immunisation Programme Manager, Department of Health, United Kingdom; Dr. George Bonsu, National Programme Manager EPI, Ghana Health Service; and Dr. Carla Vizzotti, Head of the Immunization Program, National Ministry of Health, Argentina Jon Andrus moderated this session, and began by saying that the session opened his perspective toward the important role played by the private sector in many countries with regards to vaccine delivery. During this session all four managers provided a general overview of how vaccines are delivered in each of their countries and they all concurred regarding the following issues:  Vaccines are a public social good.  There are multiple pathways to deliver this public good.  In some settings, there is a need to reassess immunization-financing data to ensure that vaccines are reaching all

   

sectors with cost-containment approaches. National guidelines should inform all service providers (public, private, semiprivate) Need for standardization of vaccine management systems across sectors Training and Certification of private and public providers is instrumental Unified communication protocols and materials to inform the community and healthcare providers

IAIM members Maggy Majenge and Mary Mahole, South Africa, sharing a lighthearted moment between presentations.

ITEM 16: Management Information Systems (MIS) for EPI: Where do I want to be? And where do I start? Conducted by Ms. Liz Peloso, Global Director Better Immunization Data (BID) PATH 

Ms. Peloso’s presentation began with a video illustrating the importance of having quality, timely data to drive decision-making and assist immunization managers and their programs in achieving stated vaccination goals. She added that, in some settings, there is not a culture of using data in aligning program goals.



Following this introduction, Ms. Peloso stated that one should start the process of improving a country’s information system by identifying the programmatic and informational gaps at hand. An understanding of the gaps present will directly inform the appropriate information system solution. To identify gaps, she advised immunization managers to start by recognizing the overall goals of the immunization program, and its immediate objectives; to then compare these goals and objectives to what is being done currently; and at that point, noting what additional functionality is needed in the information system to elevate the performance of the program and help the program achieve its goals.

Once an information system solution is identified, Ms. Peloso advised that immunization managers take a three-step systematic approach to implementing it:  Identifying the requirements of the intended information system solution: in other words, what do we need this new system solution to do (functionally)?  Comparing options: in other words, comparing requirements against current system functionality, and using that information to create an RFP to send to potential vendors  Planning for implementation: once the RFP has been awarded, creating a work plan and budget for the implementation of the solution agreed upon

Once a program has identified the gaps in its information system, Ms. Peloso explained, the program can identify possible information system solutions that will address those gaps. She helpfully provided a few examples of information solutions to common gaps in a system. The following are some of the examples she gave: 

Local data use issues can be addressed through creating data use guides or video-based training for field staff in the EPI program, and by performing targeted supportive supervision Supply chain issues can be addressed through the use of barcodes, facility stock management tools, or automated ordering based on inventory

Ms. Peloso stated that the three steps above will require both IT staff and immunization program staff to complete. Programmatic staff must explain what they want the information system to collect, store, process and analyze and what type of data they want it to generate (programmatic requirements). IT staff must then translate the programmatic requirements into their information system requirements and assure that both data and the required reports are captured and produced.

Denominator issues can be addressed through creating immunization registries (tied to birth registries; or through redefining immunization targets for areas with inconsistent populations

ITEM 16 Continued: Discussion During the question and answer session, several members expressed concern that it was difficult to estimate the amount of funding needed to make improvements to information systems, and to obtain that funding thereafter. Ms. Peloso responded to that by mentioning that PATH is creating a costing tool to help estimate these types of information system improvements. Dr. Salisbury requested Karen Lewis-Bell to comment on a similar effort conducted in the Caribbean countries coordinated by PAHO. Dr. Lewis-Bell confirmed this assertion.

providers – service; b) network of depots; c) population database by service providers; d) surveillance data: national, subnational, and by service provider; e) database of immunization personnel by profession, place of work, skill, training history; f) database of supervisors: name, type of transport, place arranged to supervise; g) data base of supply chain; database of cold-chain by service provider; and h) financial data). Mr. Carrasco also emphasized the need for each program to articulate what reports it wants to generate (at national and sub-national levels), and how frequently each of those reports should be generated for review and decision-making.

Mr. Carrasco commented on the different types of information that should be part of an MIS for immunization programs: a) network of

ITEM 17: Breakout Session around data/MIS: What are the three areas in your MIS that you would target resources towards to improve decision-making? Participants were randomly assigned to three breakout groups. The only exception to the random assignment of participants was that all French-speaking participants were grouped into the same room- which was the main room where the translators were operating. This was done so that translation could continue through the breakout session.

each came up with different aspects of MIS that they would target for improvement (see results by group, below), all groups seemed to agree on the need for the following: improvements to data quality, collecting birth registry data , linking vaccine supply information with vaccine stock management information, implementing financial management information systems and integrating that information with the MIS for the immunization program, and training of human resources engaged at any stage of the MIS.

The IAIM Secretariat assigned a moderator and a rapporteur to each group, as follows.  Group 1: Moderator Dr. Audry Mulumba, Rapporteur Dr. Brenda Corcoran  Group 2: Moderator Dr. Sandra Diah Ratih, Rapporteur Ms. Nancy Ejuma  Group 3: Moderator Dr. Jose Ignacio Santos Preciado, Rapporteur Ms. Gabrielle Hafalia

Summary of Group 1, presented by Rapporteur Dr. Brenda Corcoran What are the three areas in your MIS that you would target resources towards to improve decision-making? 1. Improving data collection (for denominator in coverage calculations) by creating an electronic system for birth registry data.

Overall, members expressed that improvements to MIS are critical to advancing their immunization programs. While the three groups

2. Linking data on vaccine supply and vaccine stock management 3. Creating a financial management information system. Having this data will allow immunization managers to demonstrate how effective immunization is.

essential for good programmatic decisionmaking, and agreed that the delivery of this data must be timely. The group also agreed that field workers reporting this data must be trained to report it correctly. Further, the group agreed that the reporting formats must be standardized to the extent possible, and easy to follow.

In addition to targeting these three specific MIS improvements, an overarching theme discussed by this group was the need for quality training of human resources that work with the MIS.

Summary of Group 3 presented by Rapporteur Ms. Gabrielle Hafalia What are the three areas in your MIS that you would target resources towards to improve decision-making?

Summary of Group 2, presented by Rapporteur Dr. Sandra Diah Ratih What are the three areas in your MIS that you would target resources towards to improve decision-making?

1. Data collection: There is a need to define how to collect the data and analyze it in order to improve system performance. To improve the way data is reported and analyzed, the program must put thought behind which information is crucial for decisionmaking, which data collection forms should be used, and which indicators will be collected. 2. Education of healthcare workers regarding data collection, developing a culture of using the data for decisionmaking purposes. 3. Having an MIS that it is comprehensive, uniform, and integrated (ideally at all levels of the system). This requires political will at a country level.

1. Advocating for increased resources to improve MIS 2. Improving the way that data from the MIS is used to communicate with other ministries (health, population, etc.) and other stakeholders 3. Improving MIS infrastructure (software) and training of staff to use the software In addition to mentioning these as the top three areas that the group would target for improvement, the group also emphasized the need to improve data quality. In this discussion, the group emphasized that quality data is

ITEM 18: Unplugged discussion with IAIM members. Moderated by Dr. Karen Lewis-Bell This session served as an open forum for IAIM members to give feedback on IAIM as an association, and discuss areas in which they would like the association to expand its support.

1) IAIM members would like the association to continue supporting learning opportunities for immunization managers (and other immunization professionals), and expand this support to a broader set of learning opportunities. Specifically, IAIM members wish to have the following additional learning opportunities:

The following is a summary of what was discussed.

Learning how to deal with anti-vaccine groups Learning managerial approaches for dealing with vaccine wastage prevention (particularly in terms of vaccine handling and temperature excursion) Learning how to build their managerial skills as immunization managers. Developing a Handbook guideline for immunization managers. Advocacy, training, managerial evaluation. Learning from regional neighbors because their degree of development level

immunization managers and minimize the need to conduct more pilot studies o Under this theme, a specific need was mentioned to share lessons learned from GAVI countries for non-GAVI middle income country managers o Advocating to government and international stakeholders on behalf of immunization Representing the practical needs of immunization managers o Managers suggested that future IAIM meetings and conferences should feature more presentations from developing countries (not just developed countries) o Aggregating and disseminating immunization managersâ&#x20AC;&#x2122; success stories

2) IAIM members emphasized that IAIM serves as a critical platform for them, and is already fulfilling important functions. Membersâ&#x20AC;&#x2122; emphasized specific functions that they would like to see the IAIM platform fulfill: - Sharing best practices and country experiences, to accelerate learning among

ITEM 19: Conference Feedback All members in attendance were given the opportunity to provide feedback on their experience at the conference and also regarding factors related to membership to IAIM. A set of questions in multiple choice format was presented to the audience at the end of the conference. Feedback was reviewed with participants in real-time with the use of electronic polling devices. Participant feedback indicated that the establishment of the first global professional association dedicated to immunization managers fosters professional development by accessing training opportunities; participating in regional meetings and association conferences; sharing management tools, and networking with their

peers across the globe. Using interactive polling technology, 90% of members at the meeting indicated that the organization of the meeting was excellent to very good. Members also indicated that 95% would renew their membership. Members also provided feedback on relevancy and usefulness of informational content of the presentations with respect to their day to day work; over 80% of respondents indicating the they found meetingâ&#x20AC;&#x2122;s content either somewhat useful to extremely useful; 74% of respondents indicated that they found the informational content of the presentations with respect to their day to day work very useful to extremely useful.

ITEM 20: Association Awards Dr. Andrus presented three types of awards during this session:

Service Awards were given to ad hoc Governing Council members, in recognition for their service in the founding and startup of IAIM.

Leadership Awards were given to the Peer Supporters in recognition for their leadership in hosting the three IAIM Peer-to-Peer Exchanges that have taken place to date.

Lastly, a Recruitment Award was presented to Dr. Salah Al-Awaidy in recognition of his outstanding efforts to recruit members to join IAIM.

Closing Remarks & Adjournment by Dr. David Salisbury, President of the IAIM Governing Council; and Dr. Jon Andrus, Executive Vice President of the Sabin Vaccine Institute Dr. Salisbury stated that IAIM and its members had covered a lot of important ground during the last two days. Electing a Governing Council (for the first time), passing the associationâ&#x20AC;&#x2122;s Bylaws, and hosting the first international conference (which provided members with the chance to meet one another and begin sharing information and best practices)- all of these were critical milestones that IAIM has now achieved. The association is well on its way to becoming the forum it has been envisioned to be. Dr. Salisbury commented that Dr. Ciro de Quadros, one of the founders of IAIM and leaders in international immunization who has since passed away, would be proud of all that IAIM has accomplished so far, and the strong path it has paved for itself moving forward.

Governing Council members and IAIM Secretariat for their hard work and contributions to date which resulted in a successful association and a successful conference.

Dr. Salisbury thanked the event company, K2 Conference and Events Management, and the staff of the InterContinental Istanbul hotel, for their support throughout the conference. He thanked all members for their participation in the conference. He also thanked the IAIM

Dr. Jon Andrus then concluded the meeting with words of thanks to all who made the conference a success, and his statement of confidence that IAIM will continue to grow and thrive in the future.

Dr. Jon Andrus also made a final remark regarding the role of the Sabin Vaccine Institute (Sabin) in terms of IAIM. He reiterated what was said in a previous presentation- that Sabin is a non-profit organization dedicated to supporting countries in strengthening their immunization programs. Dr. Andrus emphasized that Sabin takes an â&#x20AC;&#x153;all society-inclusiveâ&#x20AC;? approach, and that is sole vision is to prevent unnecessary deaths and morbidity caused by vaccinepreventable diseases.

Final Note: Members are advised that all presentations from the Inaugural Conference can be accessed

on the IAIM website. Photos from the event are available here.

APPENDICES 1. Conference Agenda

Day 1

Topic

8:00 A.M. 8:30 A.M.

Agenda for Inaugural IAIM Conference Istanbul, Turkey, 3-4 March 2015

Moderator/Presenter

MORNING COFFEE Welcome and opening remarks

Mr. Peter Carrasco, Director, IAIM Secretariat Mr. Mike McQuestion, Sustainable Immunization Financing, Sabin Vaccine Institute Dr. Prof. David Salisbury, President, ad hoc Governing Council Ms. Katie Waller, Senior Program Officer, IAIM Secretariat (administrative announcements)

8:55 A.M.

Keynote speech

Dr. William Foege, Professor Emeritus, Emory University

9:05 A.M.

ITEM 1: Call to order and vote on the meeting agenda

Dr. Prof. David Salisbury

9:15 A.M.

ITEM 2: Overview of the Sabin Vaccine Institute

Mr. Mike McQuestion

9:35 A.M.

10:10 A.M 10:30 A.M.

Question and answer session ITEM 3: Introduction to IAIM  Goals  Membership benefits  Governance and leadership  Review of IAIM current membership  Review of income received from dues Question and answer session ITEM 4: Presentation of Governing Council candidates

Mr. Peter Carrasco

COFFEE BREAK

10:50 A.M.

ITEM 5: Election of the Governing Council

Mr. Peter Carrasco

11:20 A.M.

ITEM 6: Summary of the Inaugural Regional Meeting of Middle East, North African, and sub-Saharan African members

Dr. Jalila Jawad, Vice President, IAIM Governing Council

11:50 A.M.

ITEM 7: Presentation of newly elected Governing Council

Mr. Peter Carrasco

12:00 P.M.

LUNCH

Day 1 Continued 1:30 P.M.

2:50 P.M.

Topic

Moderator/Presenter

ITEM 8: Ratification of IAIM bylaws  Overview of bylaws  Any comments or suggested amendments  Ratification of bylaws

Ms. Alison Maassen, Program Officer, IAIM Secretariat (presentation of bylaws) Mr. Peter Carrasco (ratification of bylaws)

COFFEE BREAK

3:20 P.M.

ITEM 9: Global Vaccine Action Plan (GVAP): Update on country progress; challenges in meeting GVAP goals and objectives

Dr. Thomas Cherian, Coordinator, Programme and Impact Monitoring, WHO Department of Immunization, Vaccines and Biologicals

3:50 P.M.

ITEM 9 continued: A discussion on the major management challenges that require attention to assure GVAP goals and objectives are achieved

Moderated by Dr. Prof. David Salisbury

4:25 P.M.

ITEM 10: Role of the immunization manager:

Dr. Carlos Franco-Paredes, IAIM Member

What core competencies should immunization managers have for managing today’s challenges? 5:15 P.M.

ITEM 11: Networking session

All members

Which of the following IAIM objectives is most important to you? a) Providing a forum for immunization managers to discuss their work and share best practices b) Building regional and international networks of immunization managers c) Providing opportunities for immunization managers to build managerial and leadership skills through training and peer-to-peer exchange d) Promoting the benefits of immunization with governments and other stakeholders 5:45 P.M. 6:00 P.M. 6:30-8:00 P.M.

Feedback from networking session

Moderated by Mr. Peter Carrasco

ADJOURNMENT COCKTAIL RECEPTION

Day 2 8:00 A.M.

Topic

Moderator/Presenter

MORNING COFFEE

8:30 A.M.

ITEM 12: Public health emergencies: from rapid response to understanding and prevention

Dr. David Heymann, Head of the Centre on Global Health Security, Chatham House

8:55 A.M.

ITEM 12 continued: Discussion

Moderator: Dr. Karen Lewis-Bell, Secretary, IAIM ad hoc Governing Council

9:10 A.M.

ITEM 13: Ensuring success in national immunization programs

Ms. Joanne Yarwood, National Immunisation Programme Manager, Public Health England

10:00 A.M. 10:30 A.M.

Question and answer

COFFEE

ITEM 14: Presentation of first round Peer-to-Peer Exchanges Question and Answer session

Dr. Kelly Moore, Director, Tennessee Immunization Program, Tennessee Department of Health, USA Dr. Aisha Alshammary, National Manager of EPI, Ministry of Health, Saudi Arabia Dr. Brenda Corcoran, National Immunisation Office, Dublin, Ireland on behalf of Ms. Molly Howell, Immunization Program Manager and Assistant Director, Division of Disease Control, North Dakota Department of Health, USA

12:00 P.M.

LUNCH

1:50 P.M.

ITEM 15: Managing the delivery of immunization services in the private and the public sectors: A pediatrician’s perspective and an immunization manager’s perspective

Dr. Simon Strachan, Pediatrician, Bedford Gardens Hospital, South Africa Dr. Anne Romanowicz, Pediatrician, Switzerland Dr. Silvia Bino, Head of the Control of Infectious Disease and Immunization Department, Albania

2:35 P.M.

ITEM 15 continued: Panel discussion

Moderator: Dr. Jon Andrus Panelists:  Dr. Kelly Moore, Director of State Immunization Program, Tennessee, USA  Ms. Joanne Yarwood, National Immunisation Programme Manager, Department of Health, United Kingdom  Dr. Carla Vizzotti, Head of the Immunization Program, National Ministry of Health, Argentina  Dr. George Bonsu, National Programme Manager, Expanded Programme on Immunization (EPI), Ghana Health Service

Day 2 Continued

Topic

2:50 P.M.

Moderator/Presenter

COFFEE BREAK

3:20 P.M.

ITEM 16: Management Information Systems (MIS) for EPI: Where do I want to be? And where do I start?

Presenter: Liz Peloso, Global Director, Better Immunization Data (BID) Initiative, PATH

4:00 P.M.

ITEM 17: Breakout Session around data/MIS: What are the three areas in your MIS that you would target resources towards to improve decision making?

One moderators for each of three breakout groups

4:35 P.M.

ITEM 17 continued: Feedback from Breakout Session

Rapporteurs: Ms. Gabrielle Hafalia, Ms. Nancy Ejuma and Dr. Brenda Corcoran

4:50 P.M.

ITEM 18: Unplugged discussion with IAIM Members

Moderator: Dr. Karen Lewis-Bell

Moderators: Dr. Jose Ignacio Santos, Dr. Sandra Diah Ratih and Dr. Audry Mulumba

Open forum for IAIM members to ask or discuss issues pertaining to the association and their role 5:10 P.M.

ITEM 19: Conference Feedback Survey

5:30 P.M.

ITEM 20: Association awards  Leadership awards – Peer Supporters 

5:55 P.M. 6:00 P.M.

Service awards – ad hoc GC members

Closing Remarks

Presenter: Dr. Jon Andrus Supported by: Ms. Katie Waller (for Leadership awards) Ms. Alison Maassen (for Service awards) President of IAIM Governing Council

ADJOURNMENT

2. List of Participants

Americas/Amériques Membership Type/Type d'adhésion

Last Name/Nom

First Name/Prénom

Country/Pays

Abbruzzese Andrus

Molly Jon

United States United States

Arroba

Roberto

Costa Rica

IAIM Secretariat Immunization Manager

Bloland

Peter

United States

Associate Member

Cane

Alejandro

Argentina

Associate Member

Carlson Carrasco

Andrew Peter

United States United States

Associate Member

Carvalho

Ana

United States

IAIM Secretariat Associate Member

Cochran

Erin

United States

Associate Member

Ejuma

Nancy

United States

Immunization Manager

Franco-Paredes

Carlos

United States

Associate Member

Garcia

Diego

Colombia

Immunization Manager

Hafalia

Gabrielle

United States

IAIM Secretariat

Hannan

Claire

United States

Immunization Manager

Hodasi

Adwoa

United States

Associate Member

Im Lewis-Bell Maassen McQuestion

Sunkyo Karen Alison Mike

United States Jamaica United States United States

Associate Member

Morio

Matt

United States

Immunization Manager IAIM Secretariat Associate Member Associate Member

Moore

Kelly

United States

Immunization Manager

Nader

Alice

United States

Associate Member

Pereyra

Carmen

Argentina

Associate Member

Richart

Vanessa

United States

Associate Member

Santos

Jose Ignacio

Mexico

Immunization Manager

Shortell

Amanda

United States

Associate Member

Spence Symenouh

Simone Emi

Jamaica United States

Immunization Manager

Toves

Kelly

United States

IAIM Secretariat IAIM Secretariat

Tytel

Brad

United States

Associate Member

Vizzotti

Carla

Argentina

Immunization Manager

Waller

Katie

United States

IAIM Secretariat

Associate Member

Middle East and North Africa/Moyen-Orient et Afrique du Nord

Last Name/Nom

First Name/Prénom

Country/Pays

Membership Type/Type d'adhésion

Abu Ramadan

Mona

Palestinian Territories

Immunization Manager

al-Abaidani

Idris

Oman

Immunization Manager

al Awaidy

Salah

Oman

Immunization Manager

al-Sayyad

Adel

Bahrain

Immunization Manager

Almgadmi

Ali Masoud

Libya

Immunization Manager

Alshammary

Aisha

Saudi Arabia

Immunization Manager

Awad Juda Ahmed

Jehad

Palestinian Territories

Immunization Manager

Bawikar

Shyam

Oman

Immunization Manager

Benazzouz

Mohammed

Morocco

Immunization Manager

Hassan

Mohamed Badi

United Arab Emirates

Immunization Manager

Jawad

Jaleela

Bahrain

Immunization Manager

Khamisani

Mazhar Ali

Pakistan

Immunization Manager

Khan

Lalwali

Afghanistan

Immunization Manager

Memon

Rizwana

Saudi Arabia

Immunization Manager

Obeid Hajaija

Dia

Palestinian Territories

Immunization Manager

Suleimani

Walaa

Saudi Arabia

Immunization Manager

Surour

Mohamed Ratib

Jordan

Immunization Manager

Zahran

Mohammed

United Arab Emirates

Immunization Manager

Europe and Central Asia/Europe et Asie Centrale

Last Name/Nom

First Name/Prénom

Country/Pays

Membership Type/Type d'adhésion

Melnic

Anatolie

Moldova

Immunization Manager

Bino

Silvia

Albania

Immunization Manager

Canevari

Andrea

Italy

Associate Member

Cherian

Thomas

Switzerland

Speaker/Orateur

Corcoran

Brenda

Ireland

Immunization Manager

da Silva

Alfred

France

Associate Member

Franzel

Lauren

Switzerland

Associate Member

Heymann

David

United Kingdom

Speaker/Orateur

Jabidze

Lia

Georgia

Immunization Manager

Manders

Maarten

Netherlands

Associate Member

Miller

Dan

Switzerland

Associate Member

Nelaj

Erida

Albania

Immunization Manager

Olivé

Jean-Marc

France

Associate Member

Paatashvili

Eka

Georgia

Associate Member

Pearman

Jon

Switzerland

Associate Member

Pehlivan

Hasan

Turkey

Associate Member

Preza

Iria

Albania

Immunization Manager

Romanowicz

Anne

Switzerland

Associate Member

Sahakyan

Gayane

Armenia

Immunization Manager

Salisbury

David

United Kingdom

Immunization Manager

Yarwood

Joanne

United Kingdom

Immunization Manager

South and Southeastern Asia/Asie du sud et du Sud-est

Last Name/Nom

First Name/Prénom

Country/Pays

Membership Type/Type d'adhésion

Bari

Tajul Islam

Bangladesh

Immunization Manager

Gautam

Mukunda

Nepal

Immunization Manager

Gnawali

Devendra

Nepal

Associate Member

Kaung

Kyaw

Myanmar

Immunization Manager

Palihawadana

Paba

Sri Lanka

Immunization Manager

Ratih

Theresia Sandra Diah

Indonesia

Immunization Manager

Tamang

Tshewang

Bhutan

Immunization Manager

Upreti

Shyam Raj

Nepal

Immunization Manager

Sub-Saharan Africa/Afrique subsaharienne

Last Name/Nom

First Name/Prénom

Country/Pays

Membership Type/Type d'adhésion

Adamou

Hamadou Ousseini

Niger

Immunization Manager

Antwi-Agyei

K.O.

Ghana

Immunization Manager

Bagoro

Didier

Burkina Faso

Immunization Manager

Baharadine

Cherif

Chad

Immunization Manager

Bonsu

George

Ghana

Immunization Manager

Botha

Sonia

South Africa

Immunization Manager

Botham

Lindsay Ann

South Africa

Immunization Manager

Brou

Aka Noel

Cote d'Ivoire

Immunization Manager

Dali

Serge

Cote d'Ivoire

Immunization Manager

de Sousa

Alda Morais Pedro

Angola

Immunization Manager

Gatera

Maurice

Rwanda

Immunization Manager

Gouws

Anne-Marie

South Africa

Immunization Manager

Kalenga

Kazadi

Botswana

Associate Member

Kamara

Cliff

Sierra Leone

Associate Member

Kiabilua

Kapinga Juliette

Botswana

Associate Member

Kirbak

Anthony Laku Stephen

South Sudan

Immunization Manager

Kizza

Diana

Uganda

Associate Member

Kobela

Marie

Cameroon

Immunization Manager

Lyimo

Dafrossa

Tanzania

Immunization Manager

Maboko

Ruth

South Africa

Immunization Manager

Mahole

Mary

South Africa

Immunization Manager

Maiga

Aguissa Mahamane

Mali

Immunization Manager

Maitournam

Souley

Niger

Immunization Manager

Majenge

Maggy

Immunization Manager

Mambu-Ma-Disu

Helene

South Africa Democratic Republic of the Congo

Mbwangue

Jonas

Cameroon

Associate Member

Monyatsi

Ndibo Joyce

Botswana

Immunization Manager

Mothibi

Goitsemang

Botswana

Immunization Manager

Mugoya

Isaac

Associate Member

Mulumba

Audry Wakamba

Kenya Democratic Republic of the Congo

Myeni

Ntombenhle Judith

South Africa

Immunization Manager

Mzengeza

Temwa

Malawi

Immunization Manager

Naco

Alimata

Mali

Immunization Manager

Nion

Samuel Anawe

Burkina Faso

Immunization Manager

Nteo

Meseho Dorothy

South Africa

Immunization Manager

Ntjona

Popo

Lesotho

Immunization Manager

Nuhu

Adamu

Nigeria

Immunization Manager

Onwu

Nneka

Nigeria

Immunization Manager

Ould Houmeid

Mbarek

Mauritania

Immunization Manager

Ousseynou

Badiane

Senegal

Immunization Manager

Peloso

Liz

Canada/Zambia

Speaker/Oratrice

Rakotomanga

Louis

Madagascar

Immunization Manager

Segage

Seefane Grace

South Africa

Immunization Manager

Shearley

Adelaide

Zimbabwe

Immunization Manager

Silwimba

Obert

Zambia

Immunization Manager

Associate Member

Immunization Manager

Sowe

Dawda

Gambia

Immunization Manager

Strachan

Simon

South Africa

Associate Member

van den Heever

Johann

South Africa

Immunization Manager

Woldie

Sintayehu

Ethiopia

Immunization Manager

Zeba

Sylvain

Burkina Faso

Immunization Manager

Western Asia and Pacific/Asie Occidentale et le Pacifique

Last Name/Nom Dari Dari Kheong Mengjuan Nguyen

First Name/PrĂŠnom Khongorzul Otgontuya Chong Chee Duan Tran Hien

Country/Pays Mongolia Mongolia Malaysia China Vietnam

Membership Type/Type d'adhĂŠsion Associate Member Immunization Manager Immunization Manager Immunization Manager Immunization Manager