VACUNAS: MEDICINA MOLECULAR AL SERVICIO DE LA EQUIDAD EN SALUDPROFESOR JORGE JIMENEZ MD MPHDEPARTMENTO DE SALUD PUBLICA, UNIVERSIDAD CATOLICA DE CHILEMARZO 2006BIO 275-2006

EQUIDAD Y POBREZAIn-Equidad prevalece en el mundoAfecta 2/3 de la poblacin mundialLucha contra la Pobreza es la Misin declarada de Gobiernos, Agencias de NU,Bancos Multilaterales y pases donantesLucha contra la Pobreza es a menudo neutralizada por la Corrupcin y la falta de Aplicacin de los conocimientos disponibles

INEQUIDAD en SALUD: Expectativa de Vida al nacer, Ricos y Pobres

Inequality in life expectancy at birth, by sex, in six countries

Chart1

054

0.135415624155

0.123939909656

0.099147322157

0.580636062558

0.677907135459

1.156770662260

2.03540904350

3.11269297470.0364251131

4.2768315610.195349229

10.31497530080.2259098298

13.39920652970.5550945105

27.23852781920.9533867882

24.1838823312.096883344

9.55715925092.4996200623

3.02135440214.3543707652

0.0861440719.686074346

017.4334909423

7236.3261017105

7321.8972576705

743.7087305097

750.0313051789

760

7777

7878

7979

8080

8181

8282

8383

8484

8585

8686

8787

8888

8989

9090

Mexico males 1993

Mexico females 1993

E(o)

% Population

Mexico

charts

charts

054

0.135415624155

0.123939909656

0.099147322157

0.580636062558

0.677907135459

1.156770662260

2.03540904350

3.11269297470.0364251131

4.2768315610.195349229

10.31497530080.2259098298

13.39920652970.5550945105

27.23852781920.9533867882

24.1838823312.096883344

9.55715925092.4996200623

3.02135440214.3543707652

0.0861440719.686074346

017.4334909423

7236.3261017105

7321.8972576705

743.7087305097

750.0313051789

760

7777

7878

7979

8080

8181

8282

8383

8484

8585

8686

8787

8888

8989

9090

Mexico males 1993

Mexico females 1993

E(o)

% Population

Mexico

males and females

5454

5555

5656

5757

5858

5959

060

0.01054915461

0.224703771762

0.417874320563

0.735452988264

0.708951883565

1.940207123266

2.920953307467

5.997800024168

6.86392511580

10.67504967450.0103537033

19.86651281810

18.12410492960

15.11465057090.5587596293

10.85241606461.2546539928

3.86684853773.1765667268

1.6224519045.1484750242

0.057547812313.3265838527

027.9529365541

7925.6030801379

8017.8470202737

814.0197656602

821.0288880216

830.0729164232

840

8585

8686

8787

8888

8989

9090

US males 1990

US females 1990

E(o)

%Population

US

5454

5555

5656

5757

5858

5959

6060

6161

6262

6363

6464

6565

6666

6767

6868

6969

7070

071

0.300751879772

4.060150375973

13.834586466274

35.187969924875

34.586466165476

11.127819548977

0.902255639178

00

806.3829787234

8134.9544072948

8246.2006079027

8311.8541033435

840.6079027356

850

8686

8787

8888

8989

9090

Japan males 1990

Japan females 1990

E(o)

%Populaition

Japan

5454

5555

5656

057

0.054379094758

0.069102899659

060

0.188563686661

062

00

0.61187926480.0613333153

0.04897211760.0977808974

0.10300476980.1217132005

0.13717884470

0.64998793640.0463560142

0.8448989440.0371958437

1.48707955190

4.35801117280

11.91634651670.1156064202

20.25279164580.0704210734

24.00705257880.4235884889

14.72954597480.3080786186

12.87726656890.8358927099

5.71456852454.8299201339

1.25856362489.519094671

0.442976188323.407204456

0.247830094725.0525955506

021.4887702827

827.6536301792

833.4903508044

841.0210753919

850.528646834

860.1622038091

870.0841915009

880.3050252285

890.2333369379

900

Australia males 1992

Australia females 1992

E(o)

% Population

Australia

5454

5555

5656

5757

5858

5959

6060

6161

6262

063

0.046664557864

0.15375029465

0.091226098666

1.15128522267

2.625470542668

12.580550633569

21.31440028260.0068466165

17.03981942960.0008759981

14.4076003560.0823755154

12.58098126530.0675181272

4.97226038181.112589582

6.32171881074.1653275759

2.70779790115.9551233107

0.88079537124.5820156502

0.642390537316.577761988

0.554467915415.4170328545

0.21933020547.0189460228

0.00455702813.96474419

04.7001676182

00.9695540821

0.06741157121.8214996609

1.63752159611.4720110118

00.1868181137

871.7212151718

880.1775769104

8989

9090

Chile males 1993

Chile females 1993

E(o)

%Population

Chile

5454

5555

5656

5757

5858

5959

6060

6161

0.045392350462

0.029624971663

0.186832957864

0.055709852365

0.111070353566

0.115635207667

0.147379575868

0.348792118669

0.615859374570

1.17628837770.0816631364

2.13602566570.0551067557

3.79101818370.1469891137

23.036373270.2801788794

17.45730638670.5573894262

22.55808835090.4785133502

13.98794738770.8156570257

6.2046847983.1052158363

3.60611830196.0703762214

1.736973571625.3998412055

0.977088391621.3442377639

0.89312768216.6852923876

0.322823688313.2194128049

0.16391552694.6267922158

0.07278147512.6329563777

0.03982602321.7216329364

0.18331615691.1594171373

880.7995237979

890.3406558248

900.2965613566

910.1825864465

Norway males 1996

Norway females 1996

E(o)

% Population

Norway

54555657585960616263646566676869707172737475767778798081828384858687888990

Mexico males 19930.000.140.120.100.580.681.162.043.114.2810.3113.4027.2424.189.563.020.090.00

Mexico females 199300.040.200.230.560.952.102.504.359.6917.4336.3321.903.710.030

54555657585960616263646566676869707172737475767778798081828384858687888990

US males 19900.000.010.220.420.740.711.942.926.006.8610.6819.8718.1215.1110.853.871.620.060.00

US females 199000.010.000.000.561.253.185.1513.3327.9525.6017.854.021.030.070

54555657585960616263646566676869707172737475767778798081828384858687888990

Japan males 19900.000.304.0613.8335.1934.5911.130.900.00

Japan females 199006.3834.9546.2011.850.610

54555657585960616263646566676869707172737475767778798081828384858687888990

Australia males 19920.000.050.070.000.190.000.000.610.050.100.140.650.841.494.3611.9220.2524.0114.7312.885.711.260.440.250.00

Australia females 199200.060.100.120.000.050.040.000.000.120.070.420.310.844.839.5223.4125.0521.497.653.491.020.530.160.080.310.230

54555657585960616263646566676869707172737475767778798081828384858687888990

Chile males 19930.000.050.150.091.152.6312.5821.3117.0414.4112.584.976.322.710.880.640.550.220.000.000.000.071.640.00

Chile females 19930.010.000.080.071.114.1715.9624.5816.5815.427.023.964.700.971.821.470.191.720.18

5455565758596061626364656667686970717273747576777879808182838485868788899091

Norway males 19960.0450.0300.1870.0560.1110.1160.1470.3490.6161.1762.1363.79123.03617.45722.55813.9886.2053.6061.7370.9770.8930.3230.1640.0730.0400.183

Norway females 19960.080.060.150.280.560.480.823.116.0725.4021.3416.6913.224.632.631.721.160.800.340.300.18

5455565758596061626364656667686970717273747576777879808182838485868788899091929394

Poland males 19960.0340.0330.0780.2780.2410.4460.8632.0072.6094.4268.23613.60815.88821.53610.3427.7834.4321.7281.5170.4950.3760.1900.8200.4490.0780.9940.0270.0510.0310.0440.0200.0240.0150.0210.279

Poland females 19960.04130.05720.04290.07570.16680.66980.53751.11532.59265.87239.727621.647822.622013.85537.24244.59842.49002.03370.85000.42311.21310.56400.69620.10980.11030.19150.36290.02210.01540.0529

Source: WHO based on data provided by countries, 2000

Chart2

5454

5555

5656

5757

5858

5959

6060

6161

6262

6363

6464

6565

6666

6767

6868

6969

7070

071

0.300751879772

4.060150375973

13.834586466274

35.187969924875

34.586466165476

11.127819548977

0.902255639178

00

806.3829787234

8134.9544072948

8246.2006079027

8311.8541033435

840.6079027356

850

8686

8787

8888

8989

9090

Japan males 1990

Japan females 1990

E(o)

%Populaition

Japan

charts

charts

054

0.135415624155

0.123939909656

0.099147322157

0.580636062558

0.677907135459

1.156770662260

2.03540904350

3.11269297470.0364251131

4.2768315610.195349229

10.31497530080.2259098298

13.39920652970.5550945105

27.23852781920.9533867882

24.1838823312.096883344

9.55715925092.4996200623

3.02135440214.3543707652

0.0861440719.686074346

017.4334909423

7236.3261017105

7321.8972576705

743.7087305097

750.0313051789

760

7777

7878

7979

8080

8181

8282

8383

8484

8585

8686

8787

8888

8989

9090

Mexico males 1993

Mexico females 1993

E(o)

% Population

Mexico

males and females

5454

5555

5656

5757

5858

5959

060

0.01054915461

0.224703771762

0.417874320563

0.735452988264

0.708951883565

1.940207123266

2.920953307467

5.997800024168

6.86392511580

10.67504967450.0103537033

19.86651281810

18.12410492960

15.11465057090.5587596293

10.85241606461.2546539928

3.86684853773.1765667268

1.6224519045.1484750242

0.057547812313.3265838527

027.9529365541

7925.6030801379

8017.8470202737

814.0197656602

821.0288880216

830.0729164232

840

8585

8686

8787

8888

8989

9090

US males 1990

US females 1990

E(o)

%Population

US

5454

5555

5656

5757

5858

5959

6060

6161

6262

6363

6464

6565

6666

6767

6868

6969

7070

071

0.300751879772

4.060150375973

13.834586466274

35.187969924875

34.586466165476

11.127819548977

0.902255639178

00

806.3829787234

8134.9544072948

8246.2006079027

8311.8541033435

840.6079027356

850

8686

8787

8888

8989

9090

Japan males 1990

Japan females 1990

E(o)

%Populaition

Japan

5454

5555

5656

057

0.054379094758

0.069102899659

060

0.188563686661

062

00

0.61187926480.0613333153

0.04897211760.0977808974

0.10300476980.1217132005

0.13717884470

0.64998793640.0463560142

0.8448989440.0371958437

1.48707955190

4.35801117280

11.91634651670.1156064202

20.25279164580.0704210734

24.00705257880.4235884889

14.72954597480.3080786186

12.87726656890.8358927099

5.71456852454.8299201339

1.25856362489.519094671

0.442976188323.407204456

0.247830094725.0525955506

021.4887702827

827.6536301792

833.4903508044

841.0210753919

850.528646834

860.1622038091

870.0841915009

880.3050252285

890.2333369379

900

Australia males 1992

Australia females 1992

E(o)

% Population

Australia

5454

5555

5656

5757

5858

5959

6060

6161

6262

063

0.046664557864

0.15375029465

0.091226098666

1.15128522267

2.625470542668

12.580550633569

21.31440028260.0068466165

17.03981942960.0008759981

14.4076003560.0823755154

12.58098126530.0675181272

4.97226038181.112589582

6.32171881074.1653275759

2.70779790115.9551233107

0.88079537124.5820156502

0.642390537316.577761988

0.554467915415.4170328545

0.21933020547.0189460228

0.00455702813.96474419

04.7001676182

00.9695540821

0.06741157121.8214996609

1.63752159611.4720110118

00.1868181137

871.7212151718

880.1775769104

8989

9090

Chile males 1993

Chile females 1993

E(o)

%Population

Chile

5454

5555

5656

5757

5858

5959

6060

6161

0.045392350462

0.029624971663

0.186832957864

0.055709852365

0.111070353566

0.115635207667

0.147379575868

0.348792118669

0.615859374570

1.17628837770.0816631364

2.13602566570.0551067557

3.79101818370.1469891137

23.036373270.2801788794

17.45730638670.5573894262

22.55808835090.4785133502

13.98794738770.8156570257

6.2046847983.1052158363

3.60611830196.0703762214

1.736973571625.3998412055

0.977088391621.3442377639

0.89312768216.6852923876

0.322823688313.2194128049

0.16391552694.6267922158

0.07278147512.6329563777

0.03982602321.7216329364

0.18331615691.1594171373

880.7995237979

890.3406558248

900.2965613566

910.1825864465

Norway males 1996

Norway females 1996

E(o)

% Population

Norway

54555657585960616263646566676869707172737475767778798081828384858687888990

Mexico males 19930.000.140.120.100.580.681.162.043.114.2810.3113.4027.2424.189.563.020.090.00

Mexico females 199300.040.200.230.560.952.102.504.359.6917.4336.3321.903.710.030

54555657585960616263646566676869707172737475767778798081828384858687888990

US males 19900.000.010.220.420.740.711.942.926.006.8610.6819.8718.1215.1110.853.871.620.060.00

US females 199000.010.000.000.561.253.185.1513.3327.9525.6017.854.021.030.070

54555657585960616263646566676869707172737475767778798081828384858687888990

Japan males 19900.000.304.0613.8335.1934.5911.130.900.00

Japan females 199006.3834.9546.2011.850.610

54555657585960616263646566676869707172737475767778798081828384858687888990

Australia males 19920.000.050.070.000.190.000.000.610.050.100.140.650.841.494.3611.9220.2524.0114.7312.885.711.260.440.250.00

Australia females 199200.060.100.120.000.050.040.000.000.120.070.420.310.844.839.5223.4125.0521.497.653.491.020.530.160.080.310.230

54555657585960616263646566676869707172737475767778798081828384858687888990

Chile males 19930.000.050.150.091.152.6312.5821.3117.0414.4112.584.976.322.710.880.640.550.220.000.000.000.071.640.00

Chile females 19930.010.000.080.071.114.1715.9624.5816.5815.427.023.964.700.971.821.470.191.720.18

5455565758596061626364656667686970717273747576777879808182838485868788899091

Norway males 19960.0450.0300.1870.0560.1110.1160.1470.3490.6161.1762.1363.79123.03617.45722.55813.9886.2053.6061.7370.9770.8930.3230.1640.0730.0400.183

Norway females 19960.080.060.150.280.560.480.823.116.0725.4021.3416.6913.224.632.631.721.160.800.340.300.18

5455565758596061626364656667686970717273747576777879808182838485868788899091929394

Poland males 19960.0340.0330.0780.2780.2410.4460.8632.0072.6094.4268.23613.60815.88821.53610.3427.7834.4321.7281.5170.4950.3760.1900.8200.4490.0780.9940.0270.0510.0310.0440.0200.0240.0150.0210.279

Poland females 19960.04130.05720.04290.07570.16680.66980.53751.11532.59265.87239.727621.647822.622013.85537.24244.59842.49002.03370.85000.42311.21310.56400.69620.10980.11030.19150.36290.02210.01540.0529

Source: WHO based on data provided by countries, 2000

CAUSAS DE MUERTENios menores de 5 aos de edad,1995 (millones)Neumonia2.1Defectos cong.0.5Diarrea2.0Pertussis0.4Sarampin1.1Tetanos neon0.4Prematurez1.0Otros1.3Asfixia neo. 0.9TOTAL 10.4Malaria0.7SIDA0.5

PUNTOS ROJOS DE MORTALIDAD

Nio muertoCantoresBeben alcoholMadrepurperaEl Velorio del Angelito (1875)

INEQUIDAD EN SALUD: De las 10,4 millones de muertes en menores de 5 aos:70% est relacionada con un patgeno nico con vacuna til disponible.3 millones causadas por Sarampin, Hepatitis B,Hemofilus i.b., Ttanos y Coqueluche.99% de estas muertes ocurren en pases pobres.

SALUD Y DESARROLLOExiste un estrecho lazo entre Salud y DesarrolloMayor Productividad est relacionada con Buena salud.Ingreso se relaciona con salud a travs de distintos mecanismos: Fertilidad , Enfermedades del adulto y Salud Infantil.

RELACIONES ENTRE SALUD Y DESARROLLO SOCIAL

VACUNAS Y MEDICINA MOLECULARDesde el laboratorio, a la vacuna efectiva, a la cobertura, a la prevencinCae la mortalidad infantil de manera significativa cuando se alcanzan buenos niveles de cobertura con las vacunas disponibles

DECLINA LA MORTALIDAD INFANTIL EN CHILE

MortInf

91.6124.6

84.8107.4

85.1107

92.1117.7

98.8118

98.8115.8

98.5127.9

94.1121

89.3120.7

80.6120.3

75.8117

71.8106.9

66.3107.4

65.1107.7

64.896.8

62.2102.3

55.787.1

53.389.5

52.893.1

54.196.2

50.485.8

4883.5

43.774.1

38.261.3

39.376.3

40.978.3

36.272.9

36.979.8

36.486.3

3781.3

37.488.8

33.972.5

33.575.7

34.366

34.369.4

34.363

35.263.3

34.560.2

32.554.5

32.151

31.750.5

28.945

29.443.3

27.438.4

26.139.1

25.432.2

24.132.5

21.428.7

18.721.4

18.719.2

16.716.3

13.113.9

11.811.8

10.711.2

9.210.4

9.99.7

9.79.4

9.68.9

9.59.4

9.18

8.57.5

7.96.7

7.76.6

6.96.2

6.85.2

6.15

6.34.8

5.74.3

64.3

5.94.2

5.63.3

53.3

M NEONATAL

M TARDIA

Aos

Tasa x 1.000 NV

Mortalidad Infantil 1930-2001

Datos

AONATALIDAD% APPM GENERAL%CMDM NEONATALM TARDIAM INFANTILM MATERNM ABORTO

191743.329.4133.4120.8254.2

191841.929.3129.5109.3238.8

191941.636.6142.2141.8284

192041.330.5127.3120.5247.8

192141.732.5125.9132.3258.2

192242.728.1107.3107.1214.4

19234532.3118.6124.4243

192442.828.7118.7123.6242.3

192541.926.9114.1123.4237.5

192641.826.3111.3121.7233

192741.825.3106.3117.3223.6

192842.42497.6113.4211

192941.925.596.8121.2218

193042.125.691.6124.6216.2

193140.721.584.8107.4192.2

193240.722.285.1107192.1

193339.82692.1117.7209.8

193439.225.798.8118216.8

193538.123.998.8115.8214.6

193636.62498.5127.9226.4

19373522.594.1121215.1

193834.822.989.3120.7210

193936.222.780.6120.3200.9

194036.421.375.8117192.8

194135.419.471.8106.9178.7

194235.919.966.3107.4173.7

194335.619.365.1107.7172.8

194435.518.964.896.8161.6

194535.519.162.2102.3164.5

194634.316.455.787.1142.8

194735.91653.389.5142.8

194835.716.852.893.1145.9

194935.217.154.196.2150.3

195034.314.850.485.8136.2

195133.914.848.083.5131.5

195234.612.743.774.1117.8

195337.312.038.261.399.5

195436.412.839.376.3115.6

195535.112.940.978.3119.2

195636.312.136.272.9109.1

195736.112.836.979.8116.7

195835.612.136.486.3122.7

195935.112.537.081.3118.3

196035.312.337.488.8126.2

196138,1*11.833.972.5106.4

196238.111.933.575.7109.2

196337.712.134.366100.3

196436.411.334.369.4103.7

196535.510.834.36397.3

196633.910.535.263.398.5

196730.99.834.560.294.7

1968299.432.554.587

196927.49.232.15183.1

197026.58.731.750.582.2

1971278.628.94573.9

197227.48.929.443.372.7

197326.88.127.438.465.8

197425.97.726.139.165.2

197524.27.225.432.257.6

1976237.724.132.556.6

197721.46.921.428.750.1

197821.36.718.721.440.1

197921.46.818.719.237.9

198022.26.616.716.333

198123.46.213.113.927

198223.96.111.811.823.6

198322.36.410.711.221.9

198422.46.39.210.419.6

198521.76.19.99.719.6

198622.35.99.79.419.1

198722.55.79.68.918.5

198823.45.99.59.418.9

198923.65.99.1817.1

199023.568.57.516

199122.55.67.96.714.6

199221.75.57.76.614.3

199321.15.56.96.213.1

199420.65.46.85.212

199519.75.56.1511.1

199619.35.56.34.811.1

199718.75.45.74.310

199818.35.46.04.310.3

199917.65.55.94.210.1

200017.25.25.63.38.9

200116.85.03.38.3

Mortalidad

19171917

133.4120.8

129.5109.3

142.2141.8

127.3120.5

125.9132.3

107.3107.1

118.6124.4

118.7123.6

114.1123.4

111.3121.7

106.3117.3

97.6113.4

96.8121.2

91.6124.6

84.8107.4

85.1107

92.1117.7

98.8118

98.8115.8

98.5127.9

94.1121

89.3120.7

80.6120.3

75.8117

71.8106.9

66.3107.4

65.1107.7

64.896.8

62.2102.3

55.787.1

53.389.5

52.893.1

54.196.2

50.485.8

4883.5

43.774.1

38.261.3

39.376.3

40.978.3

36.272.9

36.979.8

36.486.3

3781.3

37.488.8

33.972.5

33.575.7

34.366

34.369.4

34.363

35.263.3

34.560.2

32.554.5

32.151

31.750.5

28.945

29.443.3

27.438.4

26.139.1

25.432.2

24.132.5

21.428.7

18.721.4

18.719.2

16.716.3

13.113.9

11.811.8

10.711.2

9.210.4

9.99.7

9.79.4

9.68.9

9.59.4

9.18

8.57.5

7.96.7

7.76.6

6.96.2

6.85.2

6.15

6.34.8

5.74.3

64.3

5.94.2

5.63.3

53.3

Neonatal mortality

Posneonatal mortality

YEARS

RATE x 1.000 LB

Datos2

AONeonatal mortalityPosneonatal mortalityM INFANTIL

1917133.4120.8254.2

1918129.5109.3238.8

1919142.2141.8284

1920127.3120.5247.8

1921125.9132.3258.2

1922107.3107.1214.4

1923118.6124.4243

1924118.7123.6242.3

1925114.1123.4237.5

1926111.3121.7233

1927106.3117.3223.6

192897.6113.4211

192996.8121.2218

193091.6124.6216.2

193184.8107.4192.2

193285.1107192.1

193392.1117.7209.8

193498.8118216.8

193598.8115.8214.6

193698.5127.9226.4

193794.1121215.1

193889.3120.7210

193980.6120.3200.9

194075.8117192.8

194171.8106.9178.7

194266.3107.4173.7

194365.1107.7172.8

194464.896.8161.6

194562.2102.3164.5

194655.787.1142.8

194753.389.5142.8

194852.893.1145.9

194954.196.2150.3

195050.485.8136.2

195148.083.5131.5

195243.774.1117.8

195338.261.399.5

195439.376.3115.6

195540.978.3119.2

195636.272.9109.1

195736.979.8116.7

195836.486.3122.7

195937.081.3118.3

196037.488.8126.2

196133.972.5106.4

196233.575.7109.2

196334.366100.3

196434.369.4103.7

196534.36397.3

196635.263.398.5

196734.560.294.7

196832.554.587

196932.15183.1

197031.750.582.2

197128.94573.9

197229.443.372.7

197327.438.465.8

197426.139.165.2

197525.432.257.6

197624.132.556.6

197721.428.750.1

197818.721.440.1

197918.719.237.9

198016.716.333

198113.113.927

198211.811.823.6

198310.711.221.9

19849.210.419.6

19859.99.719.6

19869.79.419.1

19879.68.918.5

19889.59.418.9

19899.1817.1

19908.57.516

19917.96.714.6

19927.76.614.3

19936.96.213.1

19946.85.212

19956.1511.1

19966.34.811.1

19975.74.310

19986.04.310.3

19995.94.210.1

20005.63.38.9

20015.03.38.3

2002

Hoja3

CHILE Vacunas como Bien PblicoJunta Nacional de Vacunas 1890Vacunaciones masivas en 1950Erradicacin Viruela 1953Erradicacin de Polio 1975Programa Ampliado 1970Erradicacin de Sarampin 1992

VACUNAS EFECTIVAS PERO.. POCO UTILIZADASInmunizaciones son el mayor xito de la historia de la salud pblica mundialExisten vacunas disponibles para las seis enfermedades mayores: sarampin, ttanos, coqueluche, TBC, polio y difteria.Cobertura lejana al 100%, slo 64%Ms pobres y vulnerables no cubiertos

OMS Vacunas y BiolgicosNueva estructura y programacinBasada en :Derechos del nioReduccin de PobrezaEquidad y Costo Eficacia Dos importantes Lecciones aprendidas:Funciones Esenciales deben mantenerse a nivel centralDescentralizacin genera oportunidades

OMS-V&B Tres ObjetivosInnovacin: investigacin y desarrollo de nuevas vacunas contra enfermedades de relevancia en salud pblica, que sean de fcil incorporacin a planes rutinarios.Sistemas de Inmunizacin deben ser fortalecidos, atencin a Reforma SaludControl Acelerado de Enfermedades: concentrar esfuerzos en mtodos ordinarios y extraordinarios. (Rutina+ Campaas)

OMS-V&B:Tres PrioridadesIntroduccin Acelerada de VacunasSeguridad en la inmunizacinPolio: Iniciativa de Erradicacin

OMS-V&B: Costo de Mejorar CoberturaAlcanzar 80% en 43 pases pobres. Costo adicional para vacunar a 35,7 mm de nios

CHILE: expansin programa de vacunas, 1990-2000Introduccin de MMR y Hib en programas habitualesUso de vacuna Hepatitis B engrupos de riesgo y Meningococo A-C en brotes epidmicos localizadosSarampin:Segunda dosis y CampaasIncremento de gasto por 6 (1.5 a 14,5 millones US)

CHILE: control del SarampinDosis rutinaria a los 12 meses desde 1963Primer pas en el mundo Cada pero no control circulacin de virus2 dosis en campaa en 1992, difcil pero acertada decisin de poltica.

Sarampin, su curva

FIGURA N 7 Morbilidad y Mortalidad por Sarampin CHILE 1961 - 2002

F de I: Anuarios de Enfermedades de Notificacin Obligatoria. MINSAL. Tasa por 100.000 habitantes

Inicio del Programa:1963

CampaasMasivas- Seguimiento

92 96 2001

OMS V&B Lecciones de PolioCompromiso PolticoPartenariados InternacionalesAcceso equitativo es posibleNecesaria Capacidad de VigilanciaIntegracin de prestaciones: entrega de Vitamina A y otros procedimientos de salud infantil

Introduccin Acelerada de VacunasOMS/V&B dentro de su proyecto prioritario tiene en componente de INNOVACION :facilitar la introduccin de vacunas nuevas de importancia y vacunas de baja utilizacin en el mundo menos desarrollado

Introduccin Acelerada de Vacunas: META

Implementar un mecanismo para acelerar la introduccin de vacunas nuevas y menos usadas de importancia en salud pblica por el ao 2003OMS/V&B

WHO - V&B

Efficacy

Burden

Product/control

Efficacy

Burden/CE

Introduction

Supp/Financing

Coordinate and fund critical efficacy projects for developing countries

Develop defensible burden data and CE tools for relevant diseases

Develop guidelines for production andcontrol of new vaccines

Provide technical assistance with introduction of appropriate new vaccines

Establish reliable supply and financial mechanisms and funding sources

Stages of vaccine introduction

WHO - V&B

Efficacy

Burden/CE

Product/control

Supp/Financing

Introduction

Rota

Pneumo

Hib

Hep b

Stages of vaccine introduction

NUEVO MILENIO: El Mundo reaccionaConstruccin de RedesAlianzasPartenariadosBsqueda de nuevas ideas y estrategiasNueva Solidaridad Internacional con colaboracin Pblico-Privada

GAVI: nombre de mujer,ni chica ni chicoGlobal Alliance Vaccines ImmunizationSocios : OMS, UNICEF, Banco Mundial, Bill & Melinda Gates Foundation,pasesRpida maduracinAcumulacin de recursos sin precedentesGlobal Fund for Childrens Vaccines: GFCV: 1000 millones USD

GAVI : primeras asignaciones y mtodosAdopta principios desarrollados por OMS y UNICEF:PAI,Inyeccin segura,incorporar nuevas vacunas y mayor uso antiguas, erradicacin polio, combatir sarampin y tetanos neonatal.Compatibilidad con desarrollo de Sistemas de Salud

GAVI:alcances del primer aoOrganizacin en Grupos de Trabajo, Abogaca, Coordinacin pases, Financiamiento, Investigacin Pases elegibles 74, AL: Bolivia, Cuba,Hait, Honduras,Nicaragua, faltan?39 propuestas recibidas, 21 aprobadasUS 300 millones asignados

Modelo GAVI: ventajas y objecionesNo todas las soluciones son fciles ni aceptadas inmediatamenteTemor a prdida soberana institucionalRelacin pblico privada es un tema nuevo y emergente, con defensores y detractoresVentajas mayores que eventuales prdidas

VACUNACIONES: siempre hayuna Experiencia Personal que nos marca1950, un nio pequeo con su padre,el desafo de la Viruela: Compromisos adquiridos a temprana edad.1991 un adulto que enfrenta una amenaza de brote de sarampin: la experiencia y la pasin trabajando juntosLa Vacuna tiene Mstica, Ciencia y Eficacia comprobadas:SON INSTRUMENTO DE EQUIDAD

GRACIAS