5, but in 2011 had decreased distribution by about 40%. Other countries like France and Greece had similar decreases in distribution: 55% and 47% respectively. In all, in EURO, 27/48 (56%) countries had lower distribution rates in 2011 than in 2008. In WPRO (Fig. 4), the trend was the opposite to the EU, with the majority of countries 10/14 (71%) increasing doses distribution between 2008 and 2011 but the change was not significant (p = 0.11). The distribution rates ranged from a high of 460.6 per 1000 population in Japan to a low of 1.96 in Cambodia in 2011. The rate in China increased Protein Tyrosine Kinase inhibitor from 8.58 in 2008 to 19.49 in 2011. Surprisingly, Hong Kong was one of the few states in the region to have decreased

distribution between 2008 and 2011, dropping from 180.1 to 138.1 per 1000 population, or a decrease of 23%. In EMRO, AFRO and SEARO (Fig. 5), doses were distributed unevenly within the region with only 4 countries having distributions of >70 doses per 1000 population C59 wnt purchase (Mauritius, 185.5; DPR Korea, 84.2; Lebanon 70.3;

Qatar 70.9) in 2011. In AFRO, 12/20 (60%) countries had distributions of <1 dose per 1000 population. Change in all three regions combined was not significant between 2008 and 2011 (p = 0.11). Overall 65/115 (48%) countries increased doses distributed per 1000 population between 2008 and 2011. However, there was wide variance in the numbers of doses distributed between countries for both increases and decreases in distribution. Thus, some countries with very low distribution numbers in 2008 had very high percent positive change

in 2011 but still relatively low distribution numbers. Montenegro, for instance, had a 1376% change in dose distribution between 2008 and 2011, but increased doses distributed per 1000 population from 3.2 to only 47.5. And India, which had a 452% increase in 2011, only moved from 0.2 to 1.1 doses distributed per 1000 population. Likewise, countries with high percent negative change in doses distributed per 1000 population may have distributed relatively few doses in both 2008 and 2011. Guatemala, for instance, had a 71% decrease in doses GBA3 distributed in 2011 but numbers of doses fell from only 15 to 4.3 per 1000 population. There were 28/115 (24%) countries that distributed ≥159 doses per 1000 population (the hurdle rate), in 2008, and an identical number in 2011, although these were not always the same countries. We compared the 9 countries with the highest proportional increases in each of the hurdle groups to the 9 countries with the greatest proportional decreases in each of the hurdle groups. Eleven out of 18 countries (61%) with the greatest proportional decreases in the two hurdle groups, between 2008 and 2011, are in EURO. By contrast the countries with the highest proportional increases in the 2 hurdle groups are more evenly distributed by region: AMRO 5; EURO 4; WPRO 4; SEAR 3; and AFRO 2.