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Incumbent will create visual concepts, by hand or using computer software, to communicate ideas that inspire, inform, or captivate consumers. They develop the overall layout and production design for advertisements, brochures, magazines, and corporate reports.
Creative and Technical Expertise:
Create design solutions for projects assigned and supervised by the Design Director that are practical, on brand, relevant and address the needs of the client, having ensured that all resource and information has been clearly defined and implemented.
Actively participate in the creative development and design execution of internal and donor facing marketing materials using best practices and principles of design.
Leverage fluency in InDesign, Illustrator, Photoshop, Acrobat, and other design tools to quickly and clearly translate ideas into solutions that meet client needs and expectations.
Maintain high design and production standards with the ability to work under pressure and tight deadlines.
Communicate clearly, promptly and professionally throughout the design process.
Clearly document design details, material needs and specifications with the appropriate leaders/staff.
Inform team of additional support needs as required in order to meet scheduled deadlines.
Thoroughly, accurately, and succinctly document tasks and hours invested.
Participate in creative and client meetings to help develop ideas/solutions that meet client needs and exceed expectations.
Work closely with writers and other creative staff to ensure the highest quality products.
Work collaboratively with team members when assigned to work as part of a team.
Review progress with Supervisor.
Keep Christ central in individual and corporate life. Actively participate in and contribute to the spiritual disciplines of the organization (Christian conduct, devotions, chapel, prayer, worship); incorporate WV Core Values into decisions within scope of role.
Maintain awareness of corporate goals, objectives, organizational announcements, and activities. Reference and follow organizational policies and procedures, seeking clarity as needed.
Bachelor's degree or equivalent work experience (eight years).
Experience in computer graphics and production; 2 years.
Knowledge of design, with ability in software programs to produce written and design materials is required, as is a knowledge of Photoshop, Illustrator, InDesign and Acrobat.
General knowledge in Microsoft Office Suite preferred.
Additional familiarity with After Effects, Premier or Dreamweaver is also preferred.
Preferred Skills, Knowledge and Experience:
Demonstrates ability to adapt to new ways of doing things; is willing to attempt new ways to solve problems and maximizes performance and opportunity in a constantly changing work environment.
Accomplishes tasks thoroughly, showing concern for all the areas involved no matter how small, at the appropriate level for the task.
Effectively expresses ideas, thoughts and concepts verbally and in writing, using correct grammar, organization and structure, and effective presentation media and techniques. Use appropriate media and approach.
Work Environment/Travel:
The position requires ability and willingness to travel domestically and internationally up to 10% of the time.
*Position location: Washington, D.C. or Dakar Senegal where V.F.I. is registered to operate. No relocation assistance available.
The VisionFund International (VFI) Regional Programme Funding Manager will develop and manage funding opportunities through grants, major donors and through National office programmes that support VFI's network of microfinance institutions (MFIs) in keeping with VFI global strategy and funding priorities. This position will manage third party regional grant and major donor acquisition and compliance. The role will focus on largely on East Africa and Latin America but may need to support other regions as required. This includes contributing to and managing grant and donor funding opportunity pipeline, providing technical support, capacity building, project monitoring, and donor impact reporting. This role will ensure successful performance in identifying funding opportunities and building relationships with funders and World Vision Support and National offices, writing proposals, acquiring funding, monitoring donor funded projects and maintaining close relationships with MFI project staff, and managing projects for VFI's ministry.
Funding Acquisition:
Manage all components of RFP response process -- review RFPs, profile opportunities, and ensure alignment with MFI funding priorities; vet with senior leadership and obtain approval.
Research and assess funding organizations.
Develop opportunity pipeline aligned with VFI strategic funding priorities.
Set up and support proposal development teams; create project workplan and ensure proposals and supporting documents are prepared to technical specifications and submitted on time.
Provide technical support and capacity building to field staff, Support Office staff and other members of the Fundraising team on proposal development, monitoring, reporting, and project management.
Support Programme Funding Director in identifying and achieving annual funding targets.
Within strategy, develop and manage key regional funder relationships with new and existing funders and World Vision Offices to achieve long-lasting global fundraising support.
Project Monitoring, and Management:
Monitor project compliance and implementation to ensure projects are delivered to specifications.
Support MFIs and ensure project impact reports are of high quality and submitted on time.
Build capacity of MFIs for managing projects.
Ensure contracts are reviewed and risks managed and funds flow effectively to MFIs.
Relationship Development and Networking:
Network with major regional third party funders to establish collaborative relationships, learn of opportunities, and enhance VFI's ability to gain donor funding and enhance VFI's reputation in the marketplace.
Develop and maintain relationships with key World Vision support and national office funding staff ensuring that the microfinance project model is understood and fundraising opportunities are maximized.
Attend sector seminars, training, communities of practice and forums where industry staff and/or funders meet with the objective of leveraging funding and partnerships for the VFI network.
Maintain knowledge of microfinance industry and trends including focus of targeted donors.
Systems, Processes, and Capacity Development:
Ensure outcomes of projects are high-quality and high-impact through ongoing monitoring and the execution of mid-term and final evaluations, operations research, etc.
Review field reports and findings/recommendations to determine and replicate best practices and apply lessons learned.
Support Programme Funding Director in developing fundraising processes, tools, and templates.
Contribute to proposal content libraries.
Contribute to streamlining Funding processes and documenting protocols and policies.
University degree in international development, economics, or related field.
5-8 years experience in grant making field, fundraising or corporate management setting dealing with senior management.
This role requires 5-8 years in Grants, major donor fundraising, or corporate management setting dealing with senior management. Preferably experience in humanitarian, international development, microfinance or financial institutions. Able to work in complex corporate culture and financial systems and ensure procedures internally and with third parties are well documented, monitored and executed. Creative and helpful at problem solving for both VFI and MFI's. Able to work well with granting agencies, Support Offices, MFIs, and other VFI groups.
Excellent research skills and experience in developing funding opportunities.
Strong proposal-writing skills, persuasive writing, and complex document creation.
Knowledge of French (in addition to the requirement for English) would be an advantage.
MS Office competency.
Excellent management, communication, and relationship-building skills; must lead through influence and establish effective working relationships within MFIs in the region, with external partners, agencies and leaders in the microenterprise development field.
International experience is an important asset, particularly in emerging/developing countries.
Demonstrated good judgment and diplomacy, particularly in different cultures.
Creates processes with greater efficiency in mind, eliminating bureaucracy wherever possible.
Able to travel to remote areas where MFI's work.
Effective coach, able to train people in VisionFund policies and procedures formally and informally.
Must be able to simultaneously manage multiple priorities and projects; ability to navigate complex stakeholder relationships effectively.
Must be cross-culturally sensitive as will work with associates from every area of the world.
Flexibility on hours to contact people within wide time zone differences is required.
Experience within the World Vision Partnership.
Work Environment:
The position requires ability and willingness to travel domestically and internationally up to 30% of the time.
*Preferred position location: Washington D.C., USA. Other locations to be determined by home country of successful candidate in Latin America & Caribbean, Africa or Asia Pacific Region.
Individuals working in an Application Developer II role work on multiple small to large, complex projects as a team member, sometimes as a project lead. Individuals working as an Application Developer II require increased skill in multiple technical environments and possess knowledge of a specific business area.
Individuals must be able to adjust to constant business change and as needed to proactively plan for changes that are likely to occur. Common types of changes include introduction of new organizations through mergers and acquisitions, the separation of parts of organization (as subsidiaries, or when the business changes direction), evolving goals and strategies and emerging technologies. These changes require integration of solutions that can impact the overall system development activity. Application Developers also provide client support, consultation and subject matter expertise for system development, maintenance and support.
Individuals within the Application Development job family work closely with clients, business analysts and team members to understand the business requirements that drive the analysis and design of quality technical solutions. These solutions must be aligned with business and IT strategies and are in compliance with the organization's architectural standards. Application Developers are involved in the full systems life cycle and therefore are responsible for designing, coding, testing, implementing and supporting application software that is delivered on time and within budget. Responsibilities beyond development of software may include participation in component and data architecture design, technology planning, product evaluation, advanced testing processes and buy vs. build recommendations. Individuals also provide input to project plans related to the Application Development initiative.
Application Developers have a strong knowledge of programming languages used by the organization. They have experience in systems design and have a solid understanding of development, database development, testing, and integration methodologies. Knowledge of current and emerging IT products, services and processes is required.
Project Planning:
Participates in project planning process with IT business analysts and team members.
May develop work plan timelines and manages work flows to meet project timeframes.
Identifies technical requirements.
Creates technical design specifications and assists in sizing technical requirements.
Code and Test:
Codes applications using a disciplined development process and in accord with the company's standard development process (SDLC).
Integrates solutions with other applications and platforms outside the framework.
Creates data extracts and reports from system based requirements.
Develops, executes and documents test plans.
Assists in the deployment of new modules, upgrades and fixes to the production environment.
Makes modules production-ready by moving them to libraries, completing forms, following procedures, completing version control documents, etc.
Maintenance (Break/Fix):
Provides ongoing maintenance of applications.
Participates in review sessions where patterns of development and break/fix metrics are reviewed as part of standard process for optimizing IT development processes.
Production Support:
Provides Level 2 and 3 production support.
Troubleshoots existing information systems to identify errors or deficiencies and develops solutions.
Performance Management:
Evaluates existing applications and platform and provides recommendations for improving application performance by conducting gap analysis, identifying feasible alternative solutions, and assisting in the scope of modifications.
Documentation/User Guides:
Documents functions and changes to new or modified modules and test activities/results.
Assists in the development of user guides and training documentation for systems.
Adheres to standards and procedures.
Reviews modules for quality assurance and checks compliance with applications standards and Service Level Agreements (SLAs).
Technology Evalution and Research:
May evaluate new application packages and tools and perform research on best practices.
Provides recommendations for solutions.
Provides technical coaching and mentoring to less-experienced team members.
Bachelor's degree in Programming/Systems, Computer Science, or other related field. Or equivalent work experience.
Requires knowledge of advanced programming techniques and application design on the Mulesoft cloudHub platform (version 4.x).
Typically requires 3 – 5 years of Mulesoft 3.x – 4.x programming experience.
Willingness and ability to travel domestically and internationally, as necessary.
Familiarity with industry development best practices.
Effective in written and verbal communication in English.
Experience on Java, ESB, API or Mule.
Preferred Skills, Knowledge and Experience:
Knowledge of distributed systems architecture, middleware or object oriented analysis and design.
Preferred experience with dev Ops tools as a developer, some experience with continuous integration/continuous deployment (CICD) and GIT.
Work Environment/Travel:
The position requires ability and willingness to travel domestically and internationally up to 20% of the time.
*Position location to be determined by home country of successful candidate in a jurisdiction (US state or country) where WVI is registered to operate.
Primary role; to design and implement security structures for World Vision International (WVI) Disasters Managements (DM) - Humanitarian Emergency Affairs (HEA) response operations in medium to high risk conflict and fragile contexts in alignment with WVI security policies and procedures that will allow WVI to deliver humanitarian aid & relief programmes securely and in a timely manner while maximizing staff safety.
Secondary role; when directed provide direct and indirect security support across the WVI partnership to include; security incident management and investigations, technical security advice and training, security context analysis, and crisis management.
Strategy Development:
Contribute to the development and implementation of global security strategies for humanitarian emergency response operations. Ensure security management procedures are in alignment with WV Security policy and international best practice.
Collaborate with Response Directors to ensure that the response security strategy is appropriately aligned with the Office of Corporate Security (OCS) regional priorities.
Operational Support:
Initial Global Response Operations
Deploy as a member of the Global Rapid Response Team (GRRT) in accordance with the WVI Emergency Management System (EMS) in order to establish initial response operations.
Provide sound technical assistance to humanitarian response senior management teams in the assessment of security risks and the development of security planning to mitigate assessed threats in accordance with the Terms of Reference as outlined in the WVI EMS manual.
Sustaining Global Response Operations:
Deploy to WV operational areas to provide initial security management in emergency situations and to augment existing security management structures as required. Provide guidance for Response Security Managers as required.
Review Security Risk Ratings with OCS Analysis Unit and assist in the development of mitigation strategies for responses that are compliant with WV's Core Security Requirements (CSR).
Assess capacity & operational gaps WV's Core Security Requirements (CSR) in DM-HEA Reponses and develop work plans to implement mitigation strategies in collaboration with Response Security Managers.
Support crisis management and business continuity including impact analyses to accurately define critical time-sensitive security activities and assist the design, development, and documentation of work area recovery plans.
Technical Support:
Provide ongoing technical support to the DM-HEA Response Security Managers and National Security Managers in the assessment of security risks and the development of security planning to mitigate assessed threats in WV operations.
Provide support in the development of operational security and contingency plans as requested by the Office of Corporate OCS, Director of Operations.
Work closely with Regional Security Directors and Response Security Managers to provide independent assessment of 'Medium – High Risk' response contexts and the application of WV's security risk rating system.
Assist in providing civil-military-police operations policy oversight and technical support to Regional/National senior leadership.
Contribute to development of global policies, guidelines and standards relating to security management and provide leadership in contextualizing and mainstreaming them within WV's global operations.
Provide technical support and oversight of incident case management and provision of after action reviews/lessons learned exercises and security investigations for complex and serious cases and ensure knowledge capture.
Capacity Building:
Assist in the assessment, development and implementation of global capacity building plan for security management in the context of HEA responses.
Engage with Response Managers and HEA staff to raise the awareness of security management as per WV Corporate Security policies.
Identify, share / facilitate access to security tools, resources and materials as well as learning and support opportunities for Regional & National Offices. These may include facilitating and conducting training, engagement of trainers, establishing institutional links, identifying opportunities for staff exchange or mentoring.
Identify and mentor staff as future Response Security Managers.
Internal/External Liaison & Coordination:
Regular liaison with Response Managers, Response Security Managers (RSM), Regional Security Directors (RSD's) and other key stakeholders.
Act as a strategic link for the promotion of security assessment & planning standards connecting National Offices, Regional Offices, Support Offices and Global Centre.
Regularly liaise with WV security network on emerging security issues and provide analysis on potential impact on WV operations.
Actively contribute to partnership forums, working Groups and networks related to security management.
Work closely with members of the Corporate Security team promoting mutual learning, support and accountability.
Regular liaison with the United Nations (UN) security departments, other INGO security departments and agencies to include international security forums and security centers of excellence to develop best practices and lessons learned.
Knowledge Management:
Participate in the process of continuous learning on international best practice in security management & analysis and identify tools and processes that can be implemented into WV operations globally.
Encourage mutual learning on security management issues within the region and globally.
Assist in the facilitation of and coordination of global security information sharing forum/network that promotes the embedding of security information management into all layers of WV's programmes.
Facilitate the documentation of best practices and contribute to the community of practice and centre of excellence.
Support activities that will enrich and develop World Vision's Core Values.
Practice an inclusive leadership style that will be a role model for staff, peers and others.
Perform any other tasks assigned by the Partnership Leader.
Relevant Bachelor's degree in Security Management, Risk Management, Strategic Studies, International Relations or Emergency Management. (General Management studies also considered).
Previous experience in the professional security arena (INGO, Corporate, Military, Law Enforcement, or Emergency Services).
Sound knowledge of INGO security practices with proven experience in Security Risk Assessments (SRA), security planning and crises management in the humanitarian context.
Understanding of setting threat or risk levels for specific contexts, considering the strategic and tactical situation as applied to humanitarian response operations.
Internationally recognized qualifications in Risk Management or Business Continuity would be an advantage.
Preferred Skills, Knowledge and Experience:
Relevant bachelor's degree in Security Management, Risk Management, Strategic Studies, International Relations or Emergency Management. General Management studies also considered.
Previous experience in the professional security arena (INGO, Corporate, Military, Law Enforcement, or Emergency Services).
Sound knowledge of INGO security practices with proven experience in Security Risk Assessments (SRA), security planning and crises management in the humanitarian context.
5+ yrs in a relevant security management role in INGO, Private or Govt Sectors.
International security management experience in humanitarian disaster responses.
Work Environment/Travel:
The position requires ability and willingness to travel internationally up to 40% of the time.
Must be prepared to travel to 'high risk' security environments at short notice.
Will be expected to manage high stress security events.
Flexibility in work hours is expected.
VisionFund is seeking a Financial Planning and Analysis Manager to assist the Controller in development and execution of financial planning, reporting and forecasting for the Microfinance Institutions globally. This position takes direction from the Controller and works closely with the CFO, and senior management to design and implement the annual forecasts in line with the organizational strategy. This will require continued development of the budgeting process, monthly reporting and forecasting models, including funding forecasting and ongoing cash and liquidity management reporting. This position also manages the MFI lending and investment forecasting process. Experienced in banking accounting and procedures (min. 7 years), this person will also communicate and train the financial staff in the MFI's and work with them to ensure timely submissions and accurate numbers.
MFI Budget and Forecast:
Design forecast model templates to be used by all MFIs.
Own and implement global process for review and consolidation of forecasts.
Seek continual improvement and refinement of process.
Train MFIs and regional staff on use of the models.
Distribute monthly rolling reforecasts.
Work with VFI finance staff to ensure proper budget to actual reporting.
VFI Budget and Forecast:
Design and implement global financial model and 10+ departmental budgets.
Work with SET to develop accurate assumptions aligned with strategy.
Work with Finance and Funding staff to develop portfolio and income drivers and cash flow assumptions.
Prepare quarterly reforecasts and provide commentary on changes.
Work with VFI finance staff to ensure proper budget to actual reporting.
Financial Analysis:
Provide support in the analysis and implementation of projects for the network.
Create financial models to support management decision making processes.
Engage with all levels of staff to gather necessary information for required analysis.
Finance, Accounting or Business degree.
Thorough knowledge and extensive experience in financial accounting control and operational risk assessment, management/performance reporting, and budgeting principles and practices.
Advanced Excel Knowledge.
Demonstrated ability to implement and use business intelligence tools for large datasets.
Ability to create complex financial models.
Good communication and influence skills in both oral and written forms.
Effective ability to train people in VisionFund policies and procedures formally and informally.
Must be experienced in use of accounting computer software systems.
Must be able to simultaneously manage multiple priorities and projects.
Must be cross-culturally sensitive as will work with associates from every area of the world.
Flexibility on hours to contact people within wide time zone differences is required.
7 years related work experience preferably in banking environment.
Effective in written and verbal communication in English.
Spanish fluency desirable.
Preferred Skills, Knowledge and Experience:
MBA and/or CPA and/or CFA preferred.
Multi-national, multi-currency work experience strongly preferred.
Work Environment/Travel:
The position requires ability and willingness to travel domestically and internationally up to 15% of the time.
*Country location to be determined based on response.
*Please make sure to answer all questions on the application in order to be considered for the Emergency Response Roster.
The Response Programmes Director oversees/leads the Sector Programming Team, including Program Officer(s), Design Monitor Evaluation (DME), Humanitarian Accountability and Information Management. The Programme Director supports the Response Director (RD) and Operations Director (OD) in designing the response strategy and operations plan and works in close coordination with both.
The Response Programmes Director is responsible to manage grant acquisition, assessments, monitor and humanitarian accountability and liaises with Support Offices (SOs), and international donors.
Response Programmes Director is part of the Response Senior Leadership Team. Response Programmes Director will coordinate/advise with Response Director (RD)/Senior Leadership Team (SLT) go or no go for proposals.
Establish, lead, resource and staff the programmes unit to meet response needs:
Lead team/individual development and provide direction and support as needed to enable effective performance.
Contribute to National Office (NO) capacity building in the area of emergency response in coordination with NO leadership and Human Resources (HR).
Determine Programmes organisational structure and staffing plan with HR.
Work with HR to recruit and deploy Programmes staff and plan for capacity development.
Ensure Programmes staff handovers are conducted.
Develop Programmes budget in coordination with Finance.
Support RD and Finance in developing Response Budget, ensuring strong alignment and coordination with Operations team during budgeting and budget management process.
Plan for Programmes Unit transition/integration with NO, where applicable.
Lead the programme planning process to ensure alignment with context, humanitarian needs, response strategy as well as operational feasibility and technical quality:
Support development of operational intent plan to align with funding allocations ensuring operational feasibility and
technical quality.
Support Sectors and Operations Director to draft response plan.
Work with Grants, Acquisition and Management (GAM) to coordinate grant acquisition.
Write Operational Intent inclusive of targets.
Prepare project RACIs (responsible, accountable, consulted, informed) for new grants.
Oversee donor liaison and advocacy is undertaken to resource operations plan to address humanitarian needs. The Response Programmes Director will ensure that the GAM team undertake the following activities:
Monitor and analyse donor opportunities to ensure they align with operational intent.
Communicate humanitarian needs identified through assessments, monitoring data and community feedback to in-country donors and Support Offices International Programmes Groups.
Represent World Vision with potential donors (ECHO, DFID, EU, OFDA, etc.) including bilateral, multilateral and corporate.
Collaborate with Advocacy to influence donor funding strategies when appropriate.
Liaises with SOs regarding donor priorities and opportunities for funding.
Support Finance in the allocation and tracking of response funding to ensure response strategic priorities are funded and effective leveraging of available funding.
Support mapping of all funding sources with Finance.
Support funding allocation process (Private Non Sponsorship & grant opportunities) in coordination with Finance, Response Director and Operations to reflect response strategic priorities, operational realities and ensure compliance with relevant funding regulations.
Support Finance to track donor funding allocation and commitments to ensure response strategic priorities are funded.
Oversee development and submission of project proposals to donors to resource operations plan.
Develop project proposals with Operations, Advocacy, Finance and relevant Support functions and ensure stakeholders have the opportunity to review proposals and raise issues prior to submission to donors.
Ensure proposals are aligned with the operational plan, sector DADDs and standards.
Ensure proposals are aligned with accountability standards and basic DME requirements.
Maintain donor and SOs communications to facilitate funding acquisition.
Support Finance to ensure an up-to-date funding matrix.
Ensure support for Finance to establish grant management system to guarantee fulfillment of donor requirements:
Support Finance to conduct grant orientation or grant start-up workshops for relevant staff.
Plan and manage donor reporting to ensure that all donor requirements are met.
Support Finance with monitoring of grants for compliance with grant requirements.
Oversee planning, implementation, analysis and sharing of findings from assessments and program monitoring.
The Response Programmes Director will ensure that the DME team undertake the following activities:
Design and implement community consultation processes to ensure understanding of World Visions role, planned interventions and provide opportunities for input and feedback into programme and project designs.
Design and implement Information Provision plan to ensure that accurate and reliable information about the programme is made available and shared with communities in a timely and accessible manner.
Establish and support implementation of complaint and feedback mechanisms:
Document, implement and monitor complaint and feedback systems to ensure timely responses to communities.
Consolidate and analyse community complaint information to inform Operations and response management of key issues raised by beneficiaries.
Coordinate Humanitarian Accountability planning and learning with other accountability focused INGOs and LNGOs.
A minimum of 3-5 years in leadership role in the humanitarian assistance and development sector, with a significant portion of this in INGOs.
5 years experience in humanitarian assistance work.
Demonstrated understanding of key humanitarian principles, standards and best practices.
University degree in Humanitarian Studies or relevant field. Masters degree preferred.
Experience in program management and implementation of multi-sectoral emergency response projects.
Intensive experience in leading a multi-cultural team of professionals.
Experience working in a cross-cultural environment.
Experience working in war zones / fragile contexts.
Experience in engaging with governmental institutions and multilateral agencies.
Experience in managing humanitarian operations that facilitate innovation and calculated risk taking.
Work experience as Program Officer at least for 1-3 years in a country other than the home country.
Strong team leadership skills.
Emotional Intelligence (self awareness, managing emotions and those of others, remaining calm/composed, dealing with ambiguity and change).
Understand Humanitarian Industry and have proven experience within a relief setting.
Effective in written and verbal communication in English.
Ability to express ideas and concepts clearly and persuasively with senior internal and external stakeholders.
Previous experience working in complex emergency/rehabilitation settings.
Experience coordination with INGOs and other key stakeholders-High degree of negotiation and persuasion skills.
Ability to work with a reasonable level of comfort in high tension and high security risk situations.
Ability to maintain performance expectations in diverse cultural contexts psychologically stressful environs and physical hardships.
Ability to facilitate the creation of cross-functional project teams and the development of national strategies.
Excellent time-management and prioritization.
Demonstrates openness and transparency.
*Country location to be determined based on response.
*Please make sure to answer all questions on the application in order to be considered for the Emergency Response Roster.
The Response Director (RD) has primary responsibility for directing the response from strategy to implementation, inclusive of performance and oversight of all aspects of the response. She/he should develop and maintain an efficient, cohesive team, while ensuring effective coordination and relationships with the other agencies, officials, beneficiaries, donors and all areas of the Partnership.
Develop and monitor implementation of response strategy that addresses WV strategic goals to meet humanitarian needs:
Lead response strategy development with National Director (ND), Regional Leader (RL), Partnership Executive Team
(PET) and other senior stakeholders.
Ensure primary and secondary information on needs inform strategy formulation.
Ensure context analysis informs strategy development.
Consult with ND and RL to ensure National Office (NO) strategy and plans (including Child Wellbeing targets) are taken into account in
response strategy formulation.
Ensure strategy aligns with anticipated capacity.
Monitor appropriateness of strategy in addition to implementation of strategy and transition plans.
Ensure response is staffed to meet response needs:
Lead team/individual development and provide direction and support as needed to enable effective performance.
Contribute to NO capacity building in the area of emergency response in coordination with NO leadership and Human Resources (HR).
Determine response organization structure with ND and HR.
Conduct high-level workforce planning with HR and mobilise surge functions as required.
Oversee the recruitment of the RDs direct reports.
Ensure defined accountabilities under the Emergency Management System (EMS) are clear for each function including Term of Reference (TOR) objectives and qualitycriteria.
Ensure HR works with EMS functions to identify workforce requirements.
Ensure HR plans for capacity building with EMS functions.
Ensure HR develops performance planning and review processes that include quality criteria.
Ensure HR establishes a staff care function and mechanisms that support staff well-being.
Consult ND to plan Response team transition/integration.
Ensure adequate internal communications mechanisms are in place to ensure policies, information and decisions are shared with staff as appropriate.
Establish and maintain effective working relationships with humanitarian actors, government representatives, World Vision stakeholders, the media and general public:
Represent the response in Partnership Executive Team and Partnership Coordination Team (PCT) (where activated).
Identify and highlight areas of conflict to Response Senior Management Team (SMT), ND, RL and Partnership
Executive Committee (where activated).
Create and maintain collaborative relations and where appropriate partnerships with government, other NGOs, UN
agencies, civil society, churches, bi-lateral missions and donors.
Participate in consortium meetings and Response related national coordination meetings.
Ensure World Vision is represented at relevant technical and coordination mechanisms in-country.
Serve as an organizational spokesperson for media interviews, advocacy initiatives and other public events.
Develop and plan response to achieve response strategy goal and objectives:
Provide oversight to funding allocation (i.e. Private Non-sponsorship or PNS, grants, etc) to ensure alignment with
strategy and humanitarian needs.
Ensure response programme development meets World Vision and international standards.
Ensure that adequate funding to address humanitarian needs is acquired.
Ensure Advocacy staff are empowered to integrate advocacy across sectors and to develop child-focused advocacy positions which are aligned with strategy and organisational priorities, in strong alignment with NO and Response
Operations teams.
Facilitate the signing of MOUs and contracts, with donors, Support Offices (SOs) and other relevant stakeholders.
Ensure appropriate waivers are in place to facilitate timely response implementation.
Implement response programme in accordance with commitments to meet international and WV standards:
Ensure that accessible beneficiary feedback mechanisms are established and functioning.
Ensure staff establish community accountability methods across all of the response program.
Monitor and identify risks to programme quality and coordinate resources to address them.
Ensure that all programmes are implemented, monitored and evaluated according to set plans and that agreements
with donors, SOs and other stakeholders are adhered to.
Ensure management meetings address quality risks, relevant monitoring data and community feedback.
Initiate resourcing mechanisms and ensure financial and material (in-kind) resources are managed according to WV
standards, donor and SO agreements.
Initiate response funding mechanisms with support of ND, RL & Regional HEA Director (RHEAD):
Ensure that funding is managed and accounted for in compliance with donors and Support Offices agreements and WV standards.
Ensure that programme and projects audits are planned and conducted as per WV audit regulations and donor government requirements.
Ensure that audit reports are responded to and recommendations implemented.
Ensure that response meets World Vision minimum quality standards and supports program improvement, reflection, learning and innovation:
Ensure previous response learnings from Global learning facilitator are reviewed in program design.
Encourage the incorporation of best practice and innovation in program design.
Ensure all functions have quality planning sessions to meet quality objectives of their TOR.
Ensure achievement level of all function quality objectives is monitored monthly and reported.
Ensure risks that prevent the achievement of quality objectives are reported and rapidly addressed.
Ensure mechanisms are established to identify, document, and share lessons learned with Partnership.
Oversee Security function, planning and implementation to ensure response staff and organisational safety and security:
Ensure staffing of Security function.
Provide oversight to implementation of security protocols as per CSR.
Facilitate inter-agency coordination for information sharing and intelligence sharing.
Ensure response internal and external reporting requirements are met:
Liaise with Programmes and Info Management to ensure internal and external reporting requirements are planned for
and reports are prepared.
Review and submit partnership programme reports.
Prepare and submit monthly management reports.
Ensure internal response coordination & information sharing mechanisms are functioning.
Ensure that response staff have appropriate housing, offices and information/communication systems:
Ensure that staff have access to appropriate office space/equipment, information/communication systems/equipment
and other facilities which enable them to carry out their responsibilities.
Ensure that all response vehicles and other equipment are well managed and maintained.
Where necessary, ensure that relevant staff have access to appropriate housing.
A minimum of 5-7 years in leadership role in the humanitarian assistance and development sector, with a significant
portion of this in INGOs.
5 years experience in humanitarian assistance work.
Demonstrated understanding of key humanitarian principles, standards and best practices.
University degree in Humanitarian Studies or relevant field. Masters degree preferred.
Intensive experience in leading a multi-cultural team of professionals.
Experience working in a cross-cultural environment.
Experience working in war zones / fragile contexts.
Experience in engaging with governmental institutions and multilateral agencies.
Experience in managing humanitarian operations that facilitate innovation and calculated risk taking.
Experience in serving as an organizational spokesperson to media and other external audiences.
Effective in written and verbal communication in English.
Ability to express ideas and concepts clearly and persuasively with senior internal and external stakeholders as well
as staff.
Ability to work in coordination with other humanitarian organizations.
Ability to analyse and make decisions in challenging situations in the absence of specific guidance and/or full
Ability to communicate and model to staff positive behaviours which help them remain resilient and effective in dynamic and high pressure environments.
Work Environment:
Work hours are often in excess of 12 hours per day during difficult periods of the response.
Responses are often mounted in insecure or natural disaster-prone contexts, which may disrupt normal work patterns
and generate staff safety issues.
Work and housing environments may at times be well below normal standards in terms of facilities, equipment, food availability and hygiene.
*Country location to be determined based on response.
*Please make sure to answer all questions on the application in order to be considered for the Emergency Response Roster.
Response Operations Director leads the Operations team and oversees the implementation of the response activities. He/she transforms the response strategy into implemented reality, managing day-to-day sector activities and providing technical guidance to the Programmes team for design and programme quality.
Ensure program planning is informed by technical standards and operational viability:
Contribute to planning of sector requirements for people, funding and supplies.
Ensure all program designs are based on needs assessment findings (primary & secondary data) and analysis,
targets the most vulnerable/chronically and is operationally viable.
Ensure all programs refer to technical standards, consider government standards and are aligned with Strategic
Guidance and Do-Assure Dont Do (DADDs) for the First Phase of Emergency Responses and Sector Packages.
Ensure inclusion of advocacy issues and cross cutting themes are considered in design.
Ensure programs and projects are measured according to technical standards and Child Well-being targets.
Ensure Operations Plans are developed and implemented with community engagement, taking into account local capacities and utilising Do No Harm/Local Capacities for Peace (DNH/LCP).
Establish, lead, resource and staff Operations unit to meet response needs:
Lead team/individual development and provide direction and support as needed to enable effective performance.
Contribute to National Office (NO) capacity building in the area of emergency response in coordination with NO
leadership and Human Resources (HR).
Determine Operations organisational structure and staffing plan with HR.
Monitor recruitment and deployment of Operations staff and plan for capacity development.
Ensure Operations staff handovers are conducted.
Develop Operations budget in coordination with Finance, ensuring strong alignment and coordination with
Programming team during budgeting and budget management process.
Plan for Operations transition/integration.
Conduct response operational planning to ensure effective coordination and timely delivery of response activities:
Plan and facilitate detailed operational plan and delegate responsibilities to carry out plan.
Ensure Accountability mechanisms are in place for Community and stakeholder feedback.
Planning process considers community requirements (i.e. timelines) and progress is monitored by Design, Monitoring & Evaluation (DME).
Facilitate planning between sectors to meet overall program goals.
Facilitate requirements planning with Support Services.
Ensure collaborative planning with external stakeholders such as UN Agencies, other NGOs and Government ministries where possible through coordination mechanisms.
Oversee implementation and monitoring of operations to ensure achievement of response goals and objectives and inform operational improvement:
Monitor results against sector plans and address identified issues.
Monitor expenditure reports and take corrective action with Finance and Programs.
Review Monitoring & Evaluation (M&E) and Accountability data with Sectors and Programs to identify and address any issues for operational improvement.
Review context analysis with Programs and Liaison for Operational Intent adaptation.
Review findings of learning events and evaluations with Programs to make operational improvements.
All evaluations of sector interventions are planned with DME to assess effectiveness and timeliness.
Oversee development and implementation of operations reporting systems to support timely and accurate reporting:
Establish and implement internal reporting system in coordination with DME.
Ensure Operations provide input for grant/donor and program milestone and reports to Programs.
Write report on quality risks and their resolution and submit to Response Director on regular basis.
Ensure that Operations meets reporting requirements for Clusters, Ministries and/or in-country stakeholders.
Ensure implementation of response operations according to safety standards with support from the Security function:
Organise security assessments for all field operations that inform a security plan.
Implement the recommendations of the security plan for all field operations.
Ensure security incident reporting protocols are complied with by operations staff.
Ensure Operations staff adhere to security standards for staff movement and communications.
Work with Security to ensure safe and effective Civil/Military relationships with armed actors.
Ensure operations meet WV minimum quality standards and support improvement, reflection, learning and innovation in sectors:
Ensure previous sectors learning from Global Learning Facilitator are reviewed.
Encourage the incorporation of sector best practice and innovation.
Ensure sector have a quality plan to meet quality criteria and minimum sector standards.
Ensure achievement of all function quality criteria is monitored and reported regularly.
Ensure risks limiting achievement of objective to quality criteria are reported & rapidly addressed.
Ensure mechanisms are established to identify, document, and share function lessons learned.
Coordinate with Support Services function for ongoing provision of funds, staff, equipment, vehicles and supplies to ensure timely implementation of operations:
Ensure Ops submit clear and timely budgets and funds requests to Finance.
Ensure Ops submit clear and timely staff plans to HR and immediately advises on changes.
Ensure Ops follow Finance procedures to rapidly process payments to suppliers.
Ensure Ops submit vehicle requirements to logistics and follow vehicles management guidelines.
Ensure Ops submit communications requirements to ICT and follow ICT procedures.
Address delays in Support Services to Response Manager for rapid resolution and waivers.
Identify, report and refer operational blockages caused by external actors to Liaison to be addressed through external advocacy:
Establish operation team protocols where sector and geographic leads identify and report where external actors are
delaying/preventing implementation.
Refer issues delaying implementation to Liaison to resolve through inter-agency coordination and/or government
Ensure protection issues are reported and addressed in coordination with Advocacy.
A minimum of 5-7 years in leadership role in the humanitarian assistance and development sector, with a significant
portion of this in INGOs.
5 years experience in humanitarian assistance work.
Demonstrated understanding of key humanitarian principles, standards and best practices.
University degree in Humanitarian Studies or relevant field. Masters degree preferred.
Experience in program management and implementation of multi-sectoral emergency response projects.
Intensive experience in leading a multi-cultural team of professionals.
Experience working in a cross-cultural environment.
Experience working in war zones / fragile contexts.
Experience in engaging with governmental institutions and multilateral agencies.
Experience in managing humanitarian operations that facilitate innovation and calculated risk taking.
Strong team leadership skills.
Emotional intelligence (self awareness, managing emotions and those of others, remaining calm/composed, dealing
with ambiguity and change).
Effective in written and verbal communication in English.
Academic and on-the-job training in at least one of the support services or response-sector relevant areas.
Understanding of the international humanitarian system, particularly the systems, structures and key actors.
Understanding of the key accountabilities that must be maintained in a response (beneficiaries, donors, peers).
Ability to lead operational planning processes.
Strong communication skills (oral and written) with ability to express ideas and concepts clearly and persuasively with
senior internal and external stakeholders.
Ability to express ideas and concepts clearly and persuasively with senior internal and external stakeholders as well
as staff.
Ability to work in coordination with other humanitarian organizations.
Ability to analyse and make decisions in challenging situations in the absence of specific guidance and/or full information.
Ability to communicate and model to staff positive behaviors which help them remain resilient and effective in
dynamic and high pressure environments.


text:
New Vaccines Against Otitis Media: Projected Benefits and Cost-effectiveness
OBJECTIVE. New vaccines that offer protection against otitis media caused by nontypeable Haemophilus influenzae and by Moraxella catarrhalis are under development. However, the potential health benefits and economic effects of such candidate vaccines have not been systematically assessed.
METHODS. We created a computerized model to compare the projected benefits and costs of (1) the currently available 7-valent pneumococcal conjugate vaccine, (2) a candidate pneumococcal–nontypeable H influenzae vaccine that has been tested in Europe, (3) a hypothetical pneumococcal-nontypeable H influenzae–Moraxella vaccine, and (4) no vaccination. The clinical probabilities of acute otitis media and of otitis media with effusion were generated from multivariate analyses of data from 2 large health maintenance organizations and from the Pittsburgh Child Development/Otitis Media Study cohort. Other probabilities, costs, and quality-of-life values were derived from published and unpublished sources. The base-case analysis assumed vaccine dose costs of $65 for the 7-valent pneumococcal conjugate vaccine, $100 for the pneumococcal-nontypeable H influenzae vaccine, and $125 for the pneumococcal-nontypeable H influenzae–Moraxella vaccine.
RESULTS. With no vaccination, we projected that 13.7 million episodes of acute otitis media would occur annually in US children aged 0 to 4 years, at an annual cost of $3.8 billion. The 7-valent pneumococcal conjugate vaccine was projected to prevent 878000 acute otitis media episodes, or 6.4% of those that would occur with no vaccination; the corresponding value for the pneumococcal–nontypeable H influenzae vaccine was 3.7 million (27%) and for the pneumococcal–nontypeable H influenzae–Moraxella vaccine was 4.2 million (31%).
Using the base-case vaccine costs, pneumococcal–nontypeable H influenzae vaccine use would result in net savings compared with nontypeable 7-valent pneumococcal conjugate use. Conversely, pneumococcal–nontypeable H influenzae–Moraxella vaccine use would not result in savings compared with pneumococcal–nontypeable H influenzae vaccine use, but would cost $48 000 more per quality-adjusted life-year saved. The results were sensitive to variations in assumptions on vaccine effectiveness and vaccine dose costs but not to variations in other assumptions.
CONCLUSIONS. New candidate vaccines against otitis media have the potential to prevent millions of disease episodes in the United States annually. If priced comparably with other recently introduced vaccines, these new otitis vaccines could achieve cost-effectiveness comparable with or more favorable than that of the 7-valent pneumococcal conjugate vaccine.
Otitis media is a leading cause of childhood morbidity. Its occurrence is the most common reason for prescribing antimicrobial agents1,2 and serves as the main basis for undertaking tympanostomy-tube insertion, the most frequently performed operation in children in the United States.3 Pneumococcal conjugate vaccine is somewhat effective against acute otitis media (AOM) but prevents only a small percentage of all episodes.4–6 Before this vaccine's introduction, Streptococcus pneumoniae was identified in ∼25% to 40% of all AOM cases, whereas nontypeable Haemophilus influenzae (NTH) was found in 23% to 30% and Moraxella catarrhalis was found in 10% to 15%.7,8 Because of the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, the proportion of AOM episodes caused by S pneumoniae has decreased, whereas the proportion of AOM episodes caused by NTH has increased.9,10
Vaccines anticipated to be more effective against otitis media are under development.11 These include candidate vaccines with activity against NTH and M catarrhalis, which, together with S pneumoniae, constitute the leading bacterial causes of AOM. In a recent prelicensure trial in the Czech Republic, a combination vaccine against S pneumoniae and NTH reduced the occurrence of AOM episodes by 34%.12
For otitis media vaccines to be widely administered, their use needs to be accepted by parents, clinicians, and policy makers. One study suggests that parents would readily accept otitis media vaccines for their children, even if effectiveness were limited.13 National policy-making groups, including the Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention, routinely request information on the projected health benefits and economic impact of new vaccination programs being considered. Thus, economic evaluations of candidate vaccines against otitis media are needed to inform choices regarding their additional development and clinical use.5,14–16
Estimating the projected health benefits and economic effects of new otitis media vaccines is complex for a number of reasons. First, AOM is often recurrent to a varying degree, and recurrent AOM is a main indication for tympanostomy-tube insertion.14 Second, studies of PCV7 suggest that vaccination may have different degrees of effectiveness against recurrent AOM and against tympanostomy-tube insertion than against single episodes of AOM.5,15,16 And third, vaccine effectiveness may wane over time. Thus, developing accurate projections of the effects of new otitis media vaccines requires decision-analytic modeling as well as the availability of detailed empirical data on the natural history of otitis media.
We developed a decision-analytic model to address the lack of information concerning the potential benefits and cost-effectiveness of current and candidate vaccines against otitis media. Our aims were to (1) evaluate their projected benefits and cost-effectiveness, and (2) describe the requirements for effectiveness and costs that would make such vaccines economically viable.
We developed a model to estimate the health benefits, costs, and cost-effectiveness of 3 different vaccines against pathogens causing AOM in infants and young children. The model compared (1) PCV7, (2) a candidate pneumococcal-NTH (pneumo-NTH) vaccine that has been tested in Europe, (3) a hypothetical pneumo-NTH–Moraxella vaccine, and (4) no vaccination. The analysis was conducted for a US birth cohort of 4.2 million children. Each child was followed via the model from birth to 48 months of age for acute events including otitis media (both AOM and otitis media with effusion [OME]), meningitis, bacteremia, and pneumonia. In addition, the analysis included the lifetime health consequences of death or disability because of meningitis that occurred during the period covered by the model.
Model Structure
We created a microsimulation model of the natural history of otitis media that included 3 stable health states (well, AOM, and OME) and 1 temporary health state, tympanostomy-tube insertion (Fig 1). The model incorporated monthly cycles in which each child could transition to AOM, OME, or well, on the basis of the probabilities specified below. Each month the child's probability of being in each health state was determined by several demographic factors as well as the child's clinical history of AOM and OME. In addition, each child who had experienced 3 or more episodes of AOM during the preceding 6 months of life had a specified probability of having a tympanostomy-tube operation during a given month. To analyze other relevant vaccine-preventable conditions, including meningitis, bacteremia, and pneumonia, we linked the otitis media model to data from an existing model of PCV7 vaccine.17
Table 1 shows the probabilities of otitis-related events and the estimates of vaccine effectiveness used in the model.
Natural History of Otitis Media
The monthly probabilities of making transitions among the stable health states (well, AOM, and OME) were generated on the basis of logistic regression analyses by using 3 primary data sources. The base-case analysis used probabilities generated from the computerized medical charts from January 1996 to December 1999 of Northern California Kaiser Permanente, an integrated healthcare delivery system with an annual birth cohort of ∼30 000. In alternative analyses, we used probabilities from (1) the data sets of the Pittsburgh Child Development/Otitis Media Study, which enrolled 6350 children between 1991 and 1995 and followed 2747 of them with monthly observations through the 36th month of life,18,19 and (2) the computerized medical charts from January 1996 to July 2000 of Harvard Vanguard Medical Associates (HVMA), a large provider group in the greater Boston area whose population had ∼3500 births annually during this period. From each population, we created data sets that indicated the monthly number of visits or diagnoses relevant to otitis media.
We developed 1 set of logistic regression models to predict a child's having AOM in the current month, given the child's otitis media history and other variables, and another set to predict the child's having OME in the current month. For each outcome, we conducted extensive preliminary analyses to identify associated demographic and clinical variables. We formulated and tested many independent variables on the basis of the child's clinical history of otitis media (eg, whether the child had AOM in the preceding month); the number of months with AOM during the preceding 3 or 6 months; whether the child had ever had AOM between birth and the preceding month; and the child's age at the time of the first AOM episode. Lagged disease state variables were created to account for correlation between serial observations of the same child. We created similar independent variables using OME, and using otitis media of either type (AOM or OME). A child predicted to have both AOM and OME in a given month was classified as having AOM. Logistic regression models were developed by using the data set from Kaiser Permanente. Final model specifications were tested and refined for application to the data from Pittsburgh and from HVMA.
Likelihood ratio tests were used to compare alternative models with different predictors. The final logistic regression models were selected on the basis of a combination of statistical measures, such as the area under the receiver operating characteristic curve and the statistical significance of the variables in the model, as well as clinical judgment about the importance of each variable. The final models (Table 2) included age in months, gender, race, whether the child had any history of AOM (yes or no), age at the time of the first AOM episode, the number of months with otitis media in the previous 6 months (or, if the child was <9 months of age, the proportion of months with otitis media in the previous 6 months), the child's health state 1 month earlier (AOM, OME, or well), the child's health state 2 months earlier, and calendar month. The models also included interaction terms for the different possible combinations of health states in the previous 2 months. Age was included in the logistic model as a higher-order polynomial based on goodness of fit.
The hypothetical population for the analysis was assumed to have demographic characteristics similar to those of the general US population in terms of gender, race, and birth-month distributions, as reported in the US census.20–22 The probability of a child having an episode of AOM or OME was calculated at the beginning of each month by using the β coefficients from the logistic regression models.
Children who experienced 3 episodes of AOM in 6 months or 4 episodes in 1 year were considered eligible for tympanostomy-tube insertion.23 In the otitis media model, 18% of such subjects were assumed to actually receive tubes. This estimate was derived by calibrating the model to fit the expected incidence of tube insertion in the total population, based on national statistics.3 Tympanostomy tubes were assumed to be 75% effective in preventing AOM episodes,24and to remain in place for an average of 1 year.25
Vaccine Effectiveness
The effects of 3 different vaccines were evaluated: (1) PCV7; (2) a candidate pneumo-NTH vaccine that has been tested in Europe12; and (3) a hypothetical pneumo-NTH–Moraxella vaccine. We assumed that each vaccine would be administered at 2, 4, 6, and 18 months of age, with maximum effectiveness reached after the second dose. For each vaccinated child, the monthly probability of having AOM was reduced by a defined percentage, which we termed the monthly vaccine-effectiveness factor. This factor was empirically derived by testing a range of percentages and choosing the 1 that produced model results that best matched vaccine-effectiveness estimates from 2 published studies.5,12
Studies of PCV7 have suggested that, as would be predicted mathematically, the vaccine reduces the risk of frequent episodes of AOM to a greater degree than the risk of single episodes.5,15 In the Fireman et al5 study, vaccine use resulted in an 8% reduction in the risk of single otitis visits, a 10% reduction in the risk of 2 otitis visits in 6 months, and a 26% reduction in the risk of 10 otitis visits in 6 months. Our decision model was structured to predict each child's health state (AOM, OME, or well) each month. This structure required that vaccine effectiveness and other factors that affected the probability of otitis media be specified on a monthly basis. Our model's estimates of monthly PCV7 effectiveness were calibrated to reproduce the empirical results reported by Fireman et al5 for both single AOM episodes and recurrent AOM. Estimates of the monthly effectiveness of the pneumo-NTH vaccine against single AOM episodes were calibrated to reproduce the empirical results reported by Prymula et al.12 The relative effectiveness of the pneumo-NTH and pneumo-NTH–Moraxella vaccines against recurrent AOM compared with single episodes of AOM was assumed to be similar to the relative effectiveness of PCV7 against recurrent AOM compared with single episodes of AOM.
Vaccine effectiveness was assumed to wane to 50% of its original level in the third year of life and to 25% in the fourth year of life, based on the consensus of an expert panel assembled to advise on key assumptions in the model.
Costs and Quality-Adjusted Life-Years
Table 3 shows the assumptions we used regarding costs and quality-adjusted life-years (QALYs) in the decision-analysis model.
Costs were estimated by analyzing existing health care use data from the study populations and from other published and unpublished sources. All costs were estimated in 2006 US dollars; costs from previous years were adjusted for inflation by using the medical component of the Consumer Price Index.26
Otitis Media Costs
The cost of each episode of otitis media included direct medical costs and parental time costs. In the base case, the direct medical costs attributable to AOM and OME were estimated by applying estimated unit costs to the utilization identified in the computerized medical charts of HVMA and included the costs of outpatient visits and antimicrobial agents. Episodes of AOM resulted in an average of 1.2 outpatient visits, and episodes of OME resulted in an average of 1.08 outpatient visits. The antimicrobial costs attributable to AOM were derived by taking a weighted average of the average wholesale prices of the antimicrobial agents actually prescribed in the HVMA population.27 Because the actual costs of producing antimicrobial agents are unknown, the average wholesale price was used as a proxy for the actual reimbursement rate. Antimicrobial costs were stratified by age and by whether the AOM episode was recurrent. Recurrent episodes, each defined as 1 of 3 or more episodes in 6 months, were assigned higher costs for antimicrobial agents.
The parental time cost for each office visit was assumed to be 2 hours.28 The value of parental time was based on average wage data from the Bureau of Labor Statistics.29 Travel time and time off from work to care for a child with AOM were not included in the numerator when calculating the cost-effectiveness ratios, because the value of this lost time had already been included in the calculations of QALYs lost because of AOM, as described below. The cost of tympanostomy-tube insertion included the cost of the procedure on the basis of the Medicare Fee Schedule, parental time costs, and costs arising from potential complications.30,31 The only cost for treatment of a complication that we considered was the cost of tympanoplasty,3 generally undertaken because of residual tympanic membrane perforation.
Vaccination Costs
Vaccination costs included the costs of vaccine doses, vaccine administration, and vaccine reactions. In the base case, published public- and private-sector costs were used to calculate a weighted value of $64.84 for the dose cost of PCV7. Costs were estimated at $100 per dose for the combined pneumo-NTH vaccine and at $125 per dose for the combined pneumo-NTH–Moraxella vaccine, based on expert opinion. The range for sensitivity analysis was $5 to $200 per individual vaccine dose. Each vaccine was assumed to require 4 doses. We assumed that the vaccines would be administered during routine well-child visits and that vaccine administration would not involve additional parental time costs. Two percent of all vaccine doses were assumed to result in moderate vaccine reactions.32 Assumed costs associated with such reactions consisted of the cost of a physician visit and 1.5 days of parental time.32
Quality-Adjusted Life-Years
The primary measure of health benefit was the number of QALYs saved. The QALY estimates used in this analysis were based on time-trade-off values (the amount of time persons were willing to give up to avoid a given illness) collected from community members in a study of preferences regarding pneumococcal disease (meningitis, bacteremia, inpatient and outpatient pneumonia, and AOM) and vaccination.33 The values of QALY losses for these conditions took into account both the child's and the parents' pain and suffering and the family's inconvenience from these diseases.33 As shown in Table 3, an AOM episode was estimated to result in the loss of 0.011 QALYs (4 days). An OME episode that was detected clinically was estimated to result in the same QALY loss, whereas an OME episode not detected clinically was not counted in the model. Tympanostomy-tube insertion was estimated to result in the loss of 0.11 QALYs (40 days). The latter estimate was based on the estimated value of 0.011 QALYs for AOM, together with the report from another study that participants were willing to trade-off 10 otitis episodes for 1 tympanostomy-tube insertion.34
The base-case analysis was conducted from the societal perspective, which includes all costs, with both health benefits and costs discounted by 3% per year. The analysis used first-order Monte Carlo simulations of 150 000 trials and was conducted by using TreeAge Pro (TreeAge Software Inc, Williamstown, MA). The number of trials was chosen on the basis of acceptable convergence of model results.
The primary outcomes were AOM and OME episodes and tympanostomy-tube insertions averted, QALYs saved, costs, cost-effectiveness ratios (ie, the cost per QALY saved), and incremental cost-effectiveness ratios (ie, the additional cost per additional QALY saved when a vaccination strategy was compared with the next most effective strategy). The numerator in the cost-effectiveness ratio was the net cost of the vaccination program (ie, the cost of vaccine doses and administration minus the cost of savings from disease averted). The denominator was QALYs saved. As noted earlier, the study from which we derived QALYs asked parents to incorporate their work time lost when answering the time-trade-off questions.33 Thus, when we calculated the cost per QALY saved, we excluded from the numerator the cost of parent work-loss associated with otitis media, because it had already been accounted for via the QALYs in the denominator.
One-way sensitivity analyses were completed for all key model parameters by using ranges described in Table 1. We also conducted analyses in which vaccine effectiveness was assumed to wane more slowly or more rapidly than in the base-case analysis. Two-way sensitivity analyses and threshold analyses were performed for several key variables including vaccine effectiveness, vaccine dose cost, and QALY assumptions.
Health Benefits
Table 4 shows the projected health benefits of existing and hypothetical otitis media vaccines for 4.2 million healthy US infants from birth to 48 months of age. During that age period, with no vaccination, the birth cohort of US children was projected to experience 13.7 million episodes of AOM and 350 000 tympanostomy-tube insertions. Of the 13.7 million AOM episodes, PCV7 was estimated to prevent 878 000 episodes (6.4%), the pneumo-NTH vaccine to prevent 3.7 million episodes (27%), and the pneumo-NTH–Moraxella vaccine to prevent 4.2 million episodes (30%). With no vaccination, the cohort would lose 210 000 QALYs because of otitis-related outcomes. PCV7 would save 27 000 (13%) of these QALYs, the pneumo-NTH vaccine would save 71 000 (34%), and the pneumo-NTH–Moraxella vaccine would save 78 000 (37%).
Each of the vaccines was projected to prevent higher proportions of tympanostomy-tube insertions and of lost QALYs than of AOM episodes. Thus, PCV7 was projected to prevent 6.4% of the AOM episodes, 12% of the tympanostomy-tube insertions, and 13% of the QALYs projected to be lost in the absence of vaccination. The corresponding values for the pneumo-NTH vaccine were 27%, 44%, and 34%, respectively, and for the pneumo-NTH–Moraxella vaccine were 31%, 49%, and 37%, respectively.
Costs and Cost-effectiveness
As shown in Table 5, the medical cost savings attributable to averting episodes of otitis media (both AOM and OME) by means of vaccination were estimated at $147 million for PCV7, $574 million for the pneumo-NTH vaccine, and $642 million for the pneumo-NTH–Moraxella vaccine. The 3 vaccines were estimated to save an additional $139 million, $582 million, and $651 million, respectively, in parental time costs. The total savings, because of otitis episodes averted, were $286 million, $1.2 billion, and $1.3 billion, respectively. Table 5 shows that for each of the 3 vaccines, the projected savings from averting otitis media episodes was greater than the $220 million in projected savings from averting all other pneumococcal diseases combined.
We assumed base-case costs per individual vaccine dose of $65 for PCV7, $100 for the pneumo-NTH vaccine, and $125 for the pneumo-NTH–Moraxella vaccine. Compared with no vaccination, vaccination with any of the vaccines would result in additional financial cost. The net costs of the vaccination programs, after accounting for the savings realized from averting otitis media and other pneumococcal diseases, were estimated at $954 million for PCV7, $944 million for the pneumo-NTH vaccine, and $1.3 billion for the pneumo-NTH–Moraxella vaccine.
The base-case analysis was incremental in nature. We thus compared the benefits and costs of the pneumo-NTH vaccine with those of PCV7, and the benefits and costs of the pneumo-NTH–Moraxella vaccine with those of the pneumo-NTH vaccine. Compared with PCV7, the pneumo-NTH vaccine would avert an additional 2.8 million AOM episodes, an additional 113 000 tympanostomy-tube insertions, and the loss of an additional 44 000 QALYs. Thus, at a base-case cost of $100 per dose, the pneumo-NTH vaccine would be preferable to PCV7 because of both greater health benefits and lower net costs.
Compared with the pneumo-NTH vaccine, the pneumo-NTH–Moraxella vaccine would avert an additional 400 000 AOM episodes, an additional 17 000 tympanostomy-tube insertions, and the loss of an additional 7000 QALYs. However, use of the Pnuemo-NTH–Moraxella vaccine would entail an additional $220 million in vaccination program costs and, after subtracting savings from additional disease prevented, would result in an additional net cost of $325 million. Thus, compared with the pneumo-NTH vaccine, the pneumo-NTH–Moraxella vaccine would cost an additional $48 000 per additional QALY saved as shown in Table 6.
In an alternative analysis, we compared each vaccine with no vaccination. Compared with no vaccination, the cost per QALY saved was projected to be $13 000 for the pneumo-NTH vaccine, $16 000 for the pneumo-NTH–Moraxella vaccine, and $35 000 for PCV7.
Sensitivity Analyses
One-Way Sensitivity Analyses
In 1-way sensitivity analyses comparing the pneumo-NTH vaccine and PCV7, the results were most sensitive to the effectiveness and to the dose cost of the pneumo-NTH vaccine. With vaccine effectiveness held constant at base-case estimates, the pneumo-NTH vaccine would be cost-saving relative to PCV7 if the cost per dose of the pneumo-NTH vaccine were ≤$101. On the other hand, if its cost were $167 per dose, the pneumo-NTH vaccine would cost, relative to PCV7, an additional $25 000 per additional QALY saved, and if its cost were $200 per dose, an additional $38 000 per additional QALY saved.
In other sensitivity analyses, we varied the effectiveness of the pneumo-NTH vaccine with the vaccine cost held constant at $100 per dose. If monthly effectiveness were reduced to 15% in the first 2 years of life and were reduced commensurately in subsequent years of life, the pneumo-NTH vaccine would cost an additional $20 000 per additional QALY saved relative to PCV7. If its monthly effectiveness were reduced to 10% in the first 2 years of life with commensurate reductions in subsequent years of life, it would cost an additional $63 000 per additional QALY saved relative to PCV7.
In 1-way sensitivity analyses, results were found to be somewhat sensitive to the incidence of AOM. When the incidence of AOM was set at the highest end of the plausible range, vaccination with pneumo-NTH became cost saving compared with no vaccination, and compared with the pneumo-NTH vaccine, the pneumo-NTH–Moraxella vaccine had an incremental cost-effectiveness ratio of $8000 per additional QALY saved. The results were not sensitive to variations in other key assumptions, including those concerning the number of QALYs lost per otitis media episode, the cost of an otitis media visit, the cost of tympanostomy-tube insertion, and the probability of vaccine adverse events. When these assumptions were varied over plausible ranges, the pneumo-NTH vaccine remained cost-saving relative to PCV7 in most instances. Where pneumo-NTH was not cost-saving relative to PCV7, its incremental cost-effectiveness (ie, the additional cost per additional QALY saved) ranged from $300 to $7000 per QALY saved.
Two-Way Sensitivity Analyses
Figure 2 shows the results of a 2-way sensitivity analysis in which vaccine effectiveness and dose cost were varied simultaneously. As shown, the pneumo-NTH vaccine was cost-saving compared with PCV7 over a wide range of assumptions (area to the left of the cutoff line between cost and cost-saving [the "$0" line]). Thus, if the monthly effectiveness of the pneumo-NTH vaccine for children 4 to 24 months of age were 20% (instead of 28% as in the base case), it would be cost-saving relative to PCV7 at a cost of $85 per dose. However, with monthly effectiveness remaining at 20% and at a cost of $131 per dose, the cost per QALY saved would be $25 000 greater than that of PCV7. Similarly, if the monthly effectiveness of the pneumo-NTH vaccine were 10%, it would be cost-saving relative to PCV7 at a cost of $70 per dose, and at a cost of $82 per dose the cost per QALY saved would be $25 000 greater than that of PCV7.
Waning of Vaccine Effectiveness
The base-case analysis assumed that vaccine effectiveness waned to 50% of its original level in the third year of life, and to 25% of its original level in the fourth year of life. Two additional waning patterns were examined: (1) no waning; and (2) more rapid waning, defined as a decrease to 25% of the original effectiveness in the third year of life and to 6.25% of the original effectiveness in the fourth year of life. The results were not sensitive to the rate at which vaccine effectiveness waned; irrespective of the rate examined, the pneumo-NTH vaccine remained cost-saving compared with PCV7. These results seemed most likely attributable to the fact that most episodes of otitis media occur within the first 2 years of life.
Analyses Using Alternative Populations
To test the robustness of our results, we conducted alternative analyses using assumptions derived from 2 alternative populations: the Pittsburgh Child Development/Otitis Media Study, and the HVMA population.
In the Pittsburgh analysis, the predicted number of AOM episodes for the US birth cohort under no vaccination was 18 million during the first 36 months of life, which was higher than in the base-case analysis (which predicted 13.7 million AOM episodes during the first 48 months of life). In the Pittsburgh analysis, the pneumo-NTH–Moraxella vaccine was projected to have greater benefits and lower net costs than both PCV7 and pneumo-NTH, making it the preferred strategy. The cost of pneumo-NTH–Moraxella compared with no vaccination was $16 000 per QALY saved.
In the HVMA analysis, the predicted number of AOM episodes for the US birth cohort under no vaccination was 16 million during the first 48 months of life. The pattern of cost-effectiveness results in the HVMA analysis was similar to that in the base-case analysis. Compared with PCV7, pneumo-NTH prevented more otitis media episodes and had lower net costs, making it the preferred strategy. The incremental cost-effectiveness ratios were $13 000 per QALY saved for pneumo-NTH relative to no vaccination, and $49 000 per QALY saved for pneumo-NTH–Moraxella relative to pneumo-NTH.
These alternative analyses suggest that the results are sensitive to the incidence and natural history of otitis media in the population. In a population with a much higher incidence of AOM than in the base case, the pneumo-NTH–Moraxella vaccine would be the preferred strategy.
Major Findings
This study found that candidate combination vaccines against otitis media have the potential to prevent millions of episodes of AOM in the United States each year. The candidate pneumo-NTH vaccine would be cost-effective or even cost-saving relative to the PCV7 vaccine, provided its price were within a range comparable to that for other vaccines introduced in the United States since 2000, which is approximately $30 to $125 per dose.35 At prices of up to $200 per dose, both the pneumo-NTH and pneumo-NTH–Moraxella vaccines would most likely cost $25 000 or less per QALY saved. This cost-effectiveness ratio is within the range of values for other recently introduced vaccination programs, most of which have costs of approximately $10 000 to $50 000 per QALY saved.36–41
Comparisons With Other Studies
We believe the current study to be unique in its focus on the population benefits and the economic viability of new candidate vaccines against otitis media. Other studies have described the cost-effectiveness of PCV7 but have not evaluated new combination vaccines.17,33,42,43
Our analysis suggests that AOM in US children between birth and 48 months of age leads to annual costs of more than $3.8 billion. Other published estimates of the annual costs of otitis media in the United States are more than a decade old and have ranged from $3.5 billion in a 1989 report to more than $5 billion in a 1996 report.44,45 Our estimate was conservative in that it did not include costs for AOM occurring after the 48th month of life. We chose this cutoff because the incidence of AOM decreases after this age and because it is not clear how much the effectiveness of infant vaccination might wane after this age. Relatly, some studies using computerized diagnostic data suggest that the observed incidences of AOM, treatment failure, and relapse have been decreasing over the past several years.46–49 Should this actually be the case and should such a trend continue, the costs of AOM might decrease, and vaccination against otitis media might accordingly be less cost-effective than suggested in the present analysis.
We estimate that the savings from AOM prevented by pneumococcal conjugate vaccines, and the projected savings from AOM prevented by candidate otitis media vaccines, far outweigh the savings from other pneumococcal diseases prevented. Our estimate of the cost per QALY saved by pneumococcal conjugate vaccination, approximately $35 000, was higher than in past studies, in which the estimated costs ranged from $4000 to $6500.33,50 Most of this difference can be accounted for by differences in several key assumptions. The present study's assumptions were based on more recent data that suggest that vaccine effectiveness may wane over time.5 The present study also gave vaccination credit for preventing disease for the first 4 years of life, whereas past studies assumed that it would be efficacious for the first 5 years of life. In addition, the estimate of vaccine effectiveness against recurrent AOM (≥3 episodes in 6 months) was calibrated to empirical data from the study by Fireman et al,5 whose results were not available when the previous studies33,50 were conducted. Finally, the current study used a more conservative estimate of the QALY losses associated with recurrent AOM than did the previous studies, to avoid double-counting the QALY losses we assigned to tympanostomy-tube insertion.
In this analysis we used assumptions about the effectiveness of the pneumo-NTH vaccine based on a recent randomized, controlled trial.12 That trial's definition of AOM was based on the presence of a middle ear effusion alone, so that some of the counted episodes might have been OME rather than AOM. In addition, no active surveillance for otitis media was conducted; instead, children were seen by doctors when symptomatic, according to standard local clinical practice, so that the frequency of occurrence of AOM may have been under-ascertained. The lack of precision in diagnosis and the limited follow-up in the trial may raise questions about the true effectiveness of the vaccine being studied. The results of the current analysis should be interpreted with this caveat in mind.
This study was focused on 2 candidate vaccines against otitis media that, on the basis of recent research, seem most likely to be developed.11,12 We did not conduct extensive analyses of other hypothetical vaccines, namely, vaccines against NTH alone, Moraxella alone, respiratory syncytial virus, and influenza virus. In view of the bacterial and viral etiologies of AOM, each of these vaccines would likely prevent smaller numbers of AOM episodes than the vaccines we evaluated in our final analysis. Thus, they would be far less viable candidates for effectively and cost-effectively preventing AOM.
An alternative to the routine vaccination strategy evaluated here would be to selectively vaccinate only those children who have already experienced recurrent AOM. The target population would likely be relatively small: during the period from 1988 to 1994, only 8.2% of infants in the first year of life were reported to have experienced recurrent AOM, defined as ≥3 episodes,51 and after 2 years of age the incidence of AOM begins to decline.52 Be that as it may, studies suggest that, in previously unvaccinated young children with a history of recurrent AOM, PCV7 is not effective in reducing additional recurrences of AOM.53,54 In addition, our preliminary analyses suggested that this would be a less effective and less cost-effective approach than routine vaccination of all infants.
This analysis offers an assessment of the benefits and cost-effectiveness of candidate otitis media vaccines at the present time. However, future shifts in overall pathogen distribution could lead to different findings. We did not attempt to evaluate the cost-effectiveness of a vaccine that included pneumococccal serotype 19A, which is an emerging otopathogen that is resistant to multiple antimicrobial agents.55 Studies of the population-based dynamics and economics of antimicrobial resistance, and of its possible prevention via vaccination, are complex, and are an important area for future research but were beyond the scope of the present study. Our analysis did not give any of the vaccines credit for preventing disease in unvaccinated persons via herd immunity. This might have led to conservative estimates of the vaccines' cost-effectiveness but probably would not have affected the comparative results for the 3 vaccines. In addition, our analysis is based on assumptions that may not be applicable universally to all populations. However, our alternative analyses using populations from the Pittsburgh and Harvard cohorts suggest that our findings are relatively robust.
This analysis suggests that new candidate vaccines against otitis media have the potential to prevent millions of disease episodes in the United States annually. If priced comparably with other childhood vaccines recently introduced in this country, these new vaccines could achieve, in relation to the pneumococcal conjugate vaccine, comparable cost-effectiveness or even cost savings.
We are grateful to our expert panelists, Steve Black, MD, M.Elizabeth Halloran, MD, MPH, DSc, Jerome Klein, MD, Marc Lipsitch, MD, DPhil, and Henry Shinefield, MD. We thank Howard Rockette, PhD, for advice at the inception of the study.
- Accepted September 26, 2008.
- Address correspondence to Tracy A. Lieu, MD, MPH, Harvard Medical School and Harvard Pilgrim Health Care, Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, 133 Brookline Ave, 6th Floor, Boston, MA 02215. E-mail: tracy_lieu{at}harvardpilgrim.org
The authors have indicated they have no financial relationships relevant to this article to disclose.
What's Known on This Subject
New vaccines with enhanced effectiveness against otitis media are under development, but very scant information exists about how much benefit they would provide or whether they would be economically viable if recommended in large populations.
What This Study Adds
This study shows that new candidate vaccines against otitis media could prevent millions of disease episodes in the United States annually and would have cost-effectiveness comparable with the current pneumococcal conjugate vaccine if priced similar to other recently introduced vaccines.
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subset: commoncrawl