# Presentation: 664213

## How Should We Prioritize? 

- Routine Immunization Team

## Why Prioritize?

- Team has limited staff and resources
- Developing targets, monitoring progress
- GIVS
- >90% fully vaccinated in all countries (DTP3)
- >80% in each district (DTP3)
- GFIMS
- Program monitoring
- Too **BIG** for our team
- External Review of Research Agenda (Spring 2009)

## Ways to Prioritize...

## Populations/Locations

- “Top 10” List
- # Unvaccinated children (absolute)
- % Unvaccinated children (relative)
- Most VPD cases or deaths

## Slide 5

| # Unvaccinated (DTP3, 2007) |
| --- |
| India (9.7m) |
| Nigeria (2.4m) |
| China (1.2m) |
| Indonesia (1.1m) |
| Ethiopia (0.8m) |
| Pakistan (0.7m) |
| Uganda (0.5m) |
| Niger (0.4) |
| Bangladesh (0.4m) |
| DRC (0.4m) |

## Slide 6

| # Unvaccinated (DTP3, 2005) | % Unvaccinated 
(DTP3, 2007) |
| --- | --- |
| India (9.7m) | Chad (80%) |
| Nigeria (2.4m) | Eq. Guinea (67%) |
| China (1.2m) | Gabon (62%) |
| Indonesia (1.1m) | Niger (61%) |
| Ethiopia (0.8m) | Somalia (61%) |
| Pakistan (0.7m) | Lao PDR (50%) |
| Uganda (0.5m) | Haiti (47%) |
| Niger (0.4) | CAR (46%) |
| Bangladesh (0.4m) | Nigeria (46%) |
| DRC (0.4m) | PNG (40%) |

## >25% unvaccinated

| # Unvaccinated (DTP3, 2005) | % Unvaccinated 
(DTP3, 2007) |
| --- | --- |
| India (9.7m) | Chad (80%) |
| Nigeria (2.4m) | Eq. Guinea (67%) |
| China (1.2m) | Gabon (62%) |
| Indonesia (1.1m) | Niger (61%) |
| Ethiopia (0.8m) | Somalia (61%) |
| Pakistan (0.7m) | Lao PDR (50%) |
| Uganda (0.5m) | Haiti (47%) |
| Niger (0.4) | CAR (46%) |
| Bangladesh (0.4m) | Nigeria (46%) |
| DRC (0.4m) | PNG (40%) |

**>25% unvaccinated**

## Slide 8

| # Unvaccinated (DTP3, 2005) | % Unvaccinated 
(DTP3, 2007) | VPD Child Deaths (2002) |
| --- | --- | --- |
| India (10m) | Chad (80%) | Africa (1,113,000) |
| Nigeria (3.8m) | Equatorial Guinea (67%) | SE Asia (757,000) |
| China (2.1m) | Gabon (62%) | East Med (353,000) |
| Indonesia (1.2m) | Niger (61%) | W Pacific (251,000) |
| Pakistan (1.2m) | Somalia (61%) | Americas (44,000) |
| Ethiopia (0.8m) | Lao PDR (50%) | Europe (32,000) |
| DRC (0.7m) | Haiti (47%) |  |
| Sudan (0.5m) | CAR (46%) |  |
| Bangladesh (0.4m) | Nigeria (46%) |  |
| Philippines (0.4m) | PNG (40%) |  |

## Populations/Locations

- “Top 10” List
- # Unvaccinated children
- % Unvaccinated children
- Most VPD cases or deaths
- Assumes numbers are accurate
- Countries change each year
- Partner priorities
- 		(Polio/Measles, others)
- Countries with limited resources
- 		(low GNP, no GAVI, etc)
- Opportunities and requests for help
- Practicality, cost, and chance of success
- Political / develop relationships

## Thematic (methods)

- Global questions
- Programmatic/research questions
- Denominators
- Coverage assessment
- Reaching the hard-to-reach
- Missed opportunities
- Integration
- Lessons learned from success stories
- RED and other strategies
- Capacity building
- Technical expertise in the team

## Others?

- Threat to the U.S.
- Importation
- Immigration/visitors
- Follow the money
- Bird flu
- Pandemic influenza
- Partners (Gates, PMI, HIV, etc)

## Next Steps for RIT...

- Develop scoring matrix
- Evaluate current and potential projects/activities
- Identify gaps
- Research agenda
- Staff growth