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Board Chair of the GAVI Alliance
Why global health needs a private sector touch
GAVI Alliance Board Chair Dagfinn Hoybraten addresses a crowd of more than 12,000 attendees at the plenary session of the Lions Clubs International Convention in Toronto, Canada. Credit: Lions Clubs/2014.
Prime Minister Stephen Harper made an important commitment on the world stage a few weeks ago to maternal, newborn and child health (MNCH). His was not an idle statement. Canada committed C$3.5 billion to the effort between 2015-2020.
Harper said something else notable during his address to the global summit on MNCH: “private sector organisations … will play a critical role in shaping and delivering on Canada’s top development priority.”
This caught my attention as a longtime government minister because government does not typically invite the private sector to deliver on government priorities and also because it aligns with some of the most innovative projects in global health, including one that I chair: the GAVI Alliance.
The GAVI Alliance provides vaccines to children in poor countries. It is a true alliance, including donors like Canada and the countries that receive vaccines, as well as organisations such as UNICEF, the World Health Organisation, World Bank, the Bill & Melinda Gates Foundation and the private sector.
This is a model that is working extraordinarily well. Since 2000, the GAVI Alliance has helped immunise more than 440 million children, saving 6 million lives. Even with this success, 22 million children still do not receive a full course of the most basic vaccines each year, leading to 1.5 million preventable deaths.
We all are stakeholders in this tragedy, including the private sector. Diseases such as pneumonia, measles and deadly diarrhea take an enormous toll in developing countries. Companies recognise that their competitiveness and the health of communities where they do business are mutually dependent. Global health means economic health.
Canada has been a strong partner of the GAVI Alliance, including as part of our Advance Market Commitment, an initiative that has worked with one type of private sector partner – the pharmaceutical industry – to bring developing countries an appropriate pneumococcal vaccine and thereby reduce the price by 95% for the poorest countries.
Another type of GAVI private sector partner is Lions Clubs International, which has brought 20,000 members to Toronto this week for its annual convention. The GAVI Alliance and Lions Clubs Foundation have created a remarkable partnership geared toward ending child deaths caused by measles.
Lions Club International Foundation is not only is raising US$30 million for GAVI – an amount being matched by the Gates Foundation and the UK government – but it also is deploying an army of 1.35 million volunteers globally to help us roll out the measles-rubella vaccine in 49 countries by 2020. Its cash contribution alone will help protect 60 million children from measles and rubella.
The GAVI Alliance recognises, alongside PM Harper, that government cannot do this alone. GAVI has actively worked with private sector partners like Lions Clubs to bring significant funding, expertise and visibility to our work, overcoming barriers that once seemed intractable. They are helping us tackle pressing operational challenges, such as improving the vaccine supply chain, stock management and health records as well as bringing significant advocacy and visibility to our work.
This fits in squarely with PM Harper’s commitment at the May global summit on MNCH, building on the Muskoka Initiative launched at the G8 meeting in 2010 to help save the lives of 1.3 million children and 64,000 mothers. In April, Canada took another step when Health Minister Rona Ambrose announced C$20 million in funding to GAVI to support our immunisation supply chain strategy. This will help us work with the private sector to increase the availability of vaccines, building human resource capacity and increasing the availability and use of data on vaccine stocks.
Building partnerships with the private sector to leverage innovation, financing, and expertise is among the critical steps to breaking the cycle of poverty and saving the lives of mothers and children in the developing world. That is why it is central to PM Harper’s call to action around maternal, newborn and child health. And that is why the Lions Clubs and others in the private sector have partnered with us.
The GAVI Alliance model is designed as a sustainable approach that puts countries on track to self-sufficiency. If the public and private sectors collectively seize the moment, we can accelerate progress toward a world where every child, everywhere, is fully immunised. And we all will be better for it.
Aristide A. DjendaExecutive Director of the Union of Non-Governmental Organizations in Togo (UONGTO)
Mothers wait to vaccinate their babies at the Kpele-Eleme Health Centre in Togo.Credit: 2013/TOMETY Mawli-Dodi.
My cousin Mada, who lives in Atakpamé, Togo (about 160 km from the capital Lomé), tragically lost her son Dissirama to severe diarrhea. After the baby fell ill, my cousin took him to a traditional healer who prepared a potion and told my cousin to pour it on her ancestors’ graves and ask for their blessing to spare her son’s life. The traditional healer did not advise my cousin to give her son oral rehydration salts (ORS) or to take him to the hospital to receive intravenous fluids, which are necessary to treat severe dehydration from diarrhea. Because Dissirama did not receive ORS or intravenous fluids, he passed away.
Consultation of traditional healers is deeply rooted in Togo’s culture, especially in rural areas. While traditional healers may play important roles in Togolese society, children suffering from severe diarrhea need to be treated with ORS or intravenous fluids. Sadly, parents and caregivers in rural areas often lack access to information about the importance of taking children to health centers for medical treatment. In addition, health centers are often located far away from rural communities and may be out of reach of parents and caregivers.
I am the chair of the Union of Non-Governmental Organizations (NGOs) in Togo (UONGTO), a national umbrella organization of NGOs that works to strengthen advocacy and communication capacities of Togolese NGOs. UONGTO is a member ofthe GAVI Civil Society Organisation (CSO) Constituency Steering Committee and the focal point for the GAVI-funded CSO Platform that promotes immunization in Togo. CSOs such as UONGTO are vital in the efforts to educate rural communities about proper medical treatment of diseases and to mobilize and motivate parents to get their children vaccinated to prevent disease. CSOs also work to encourage policymakers to financially support the introduction of new vaccines and to strengthen existing health systems.
In 2009, with funding from GAVI, UONGTO conducted a census of maternal and child health CSOs in Togo to increase CSO engagement in promoting routine immunization. This effort earned us a prize at the 2009 GAVI Alliance Partners' Forum. With this momentum, UONGTO raised funds to train CSOs in advocacy and community mobilization. In 2011, with the support of the World Health Organization, our CSO platform wrote to the Ministry of Health asking the Government to submit an application to GAVI for support to introduce pneumococcal and rotavirus vaccines.
Today, three years after our CSO platform wrote to the MoH, Togo finally celebrates the historic dual introduction of pneumococcal and rotavirus vaccines! These new vaccines prevent the most severe forms of pneumonia and diarrhea - killer diseases devastating our children. Pneumonia causes 16% of deaths of Togolese children under five and diarrhea causes another 10%. With the introduction of these lifesaving vaccines, Togo’s government and CSOs have an opportunity to work in partnership to help our communities by providing the knowledge and tools to prevent and treat these diseases. Going forward, CSOs in Togo will aim to increase outreach to rural communities with important health information, including news that these lifesaving vaccines are available free of charge. That is why today is a day of glory for Togo!
I thank my Government for taking this critical step, because the introduction of these vaccines will permit Togo to significantly reduce childhood diseases and deaths linked to pneumonia and diarrhea. I hope my Government will use today’s introductions as a catalyst to increase communication efforts in rural communities to help them understand that vaccination is the best way to prevent the most severe forms of these diseases. I also thank donors and the GAVI Alliance for their financial support, which enables Togo to continue our efforts to achieve the Millennium Development Goals.
Parents and caregivers, when children are suffering from severe illness, it is important to take them to health centers for treatment. This way, we can avoid we can avoid unnecessary deaths like that of my little cousin Dissirama. It is even better to prevent disease in the first place through vaccination, so please go to your nearest health center where these lifesaving vaccines are now available! Protect your children against deadly diseases like diarrhea and pneumonia! Vaccinate your children and save their lives!
John MahamaPresident of the Republic of Ghana
In 2012 Ghana became the first African country to introduce vaccines against both rotavirus and pneumococcal disease at the same time with GAVI support.Credit: GAVI/2013/Evelyn Hockstein.
Africa is changing and growing faster than ever, and today, every country on the continent is making efforts to enhance access to new and powerful vaccines, which a decade ago were not available to African children. Due to this access to much-needed vaccines, we are seeing child death-rates fall dramatically and the health of children improving across the continent. The number of children attending school is also increasing steadily as a result of the availability of these vaccines. This development is to be welcomed, but perhaps the biggest change or achievement is the fact that this progress is being achieved largely through African investments.
As African leaders recently gathered in the Nigerian capital, Abuja, for the World Economic Forum on Africa, we were able to take pride in the significant role we – the governments - are playing in this positive transformation. In addition to the billions of dollars we already spend on health services, from 2016 to 2020 African nations will commit more than US$ 700 million directly toward the cost of vaccines for our children, through the GAVI Alliance. Compared to the commitments of GAVI’s largest donors for the current funding period, (from 2011 to 2015), this significant investment would collectively make Africa’s 50-plus nations the fourth biggest investor in GAVI, behind the UK government, the Bill & Melinda Gates Foundation and the government of Norway.
What this means is that we are stepping up to the plate to ensure that our children have access to the best, life-saving interventions and resources, as we strive to achieve self-sufficiency. It also means that we recognise that economic growth has to be built on the foundations of healthy and productive populations, for which the preventative power of vaccines is critical.
In Ghana we are now seeing this first-hand, as we put people first, and continue to embrace vaccination so whole-heartedly in order to keep our people strong and well. In 2012 we, in Ghana, became the first GAVI country to introduce two different vaccines simultaneously, in order to provide protection from pneumonia and diarrhoea - the two biggest killers of children under five. And last year we became one of the first African countries to offer to girls the vaccines that protect them against the human papillomavirus, or HPV, which is the single biggest cause of cervical cancer on the continent. We have also implemented an innovative pilot mHealth project, where mobile phone-based applications notify or remind patients of upcoming appointments and act as an effective interface for health workers to record data and track records.
Just a few years ago it was very difficult for a country like Ghana to have access to such modern vaccines or to be using hi-tech solutions to improve immunisation services. But our partnership with GAVI has changed all that. It has proved that by working together we can achieve more, and indeed since 2000 when GAVI was formed, 440 million more people around the world have received new and additional vaccines. As a direct result the lives of some 6 million have been saved from vaccine preventable disease or death. That is the power of a modern development partnership.
But the job is far from done and we face new challenges every day. One of the biggest of these challenges is how to find ways to reach the ‘hardest to reach’ people. These vulnerable people are no longer only in rural areas. They are also in our cities, and more specifically in low-income and deprived communities, including some in Accra, which is one of the fastest growing metropolises in Africa. Today, as urbanisation gathers pace and more people live in such low-income areas, we will need to identify and use new ways to reach them.
We are determined to reach them. Through GAVI, and the way we maintain a strong sense of ownership by choosing our vaccines and paying for every dose, we should be able to reach everyone who needs the vaccines. We will do so with a sense of increasing ownership. As our economies grow across Africa, so too does our share of the cost of vaccines, until we eventually assume full responsibility for the cost of these life-saving and transformative immunisation programmes. As committed and focused leaders of this dynamic and youthful continent we are determined to ensure that our children grow into a healthy and thriving next generation. We cannot achieve this objective alone, just as foreign aid alone cannot solve the world’s problems. It is only through partnerships such as the one we are keeping with GAVI that we can make significant progress into a sustainable future.
In closing, I wish to pay tribute to the Founding Chair of the GAVI Alliance, our dearly departed colleague, world icon, and predecessor, President Nelson Mandela. It was part of his vision to ensure that the children of Africa have the opportunity of a healthy start to life, so that they can grow and prosper as productive citizens of their respective nations and of the world. Our current achievement and progress are bringing us closer to the realisation of that vision.
This blog was originally posted on the Impatient Optimists website.
Rt Hon Lord Boateng PC DLMember of the UK House of Lords
Africa has experienced tremendous growth in recent years. Ten of the top 20 fastest-growing economies in the world are on the continent, which is expected to maintain a 5% growth rate in 2014. With more than 1 billion people, Africa is central to the world’s future prosperity.
But the spread of disease, especially in areas of extreme conflict, threatens these achievements. Pneumonia and diarrhoea, the two most prolific killers of children under five, weigh heavily on the continent, as do other communicable diseases such as yellow fever and meningitis. Polio is endemic in Nigeria, and millions of African women are at risk of cervical cancer, caused by the human papillomavirus.
All of these diseases can be prevented with vaccines. Immunization has been proven to be the most cost-effective way to achieve better health for all, and is contributing to the achievement of the UN Millennium Development Goals. Our goal should be to make immunization routine and sustainable. Governments, with their squeezed budgets and on-the-ground challenges outside of their expertise, can’t do this alone.
I have been impressed by the accomplishments of the private sector in advancing global health. One of the most successful public-private partnerships on the African continent is the GAVI Alliance, whose mission is to protect health and save children’s lives by increasing access to immunization in developing countries. Since 2000, GAVI has helped vaccinate more than 440 million children and save six million lives.
It does this by working with both public and private sectors. In the public sphere, it works with donors and governments (including many throughout Africa); in the private sphere, it collaborates with a range of organizations, from technology and pharmaceutical companies to investment banks.
Through this model, GAVI has committed $5.3 billion to African countries over the past dozen years, through more than 130 vaccine introductions and campaigns. Basic vaccination coverage rates in the region increased from 10% in 1980 to 72% in 2012. By introducing MenAfriVac in the “meningitis belt” of sub-Saharan Africa, GAVI has protected 150 million people against meningitis A.
Besides saving lives and improving health, introducing such vaccines has the power to improve economic progress. This is because a healthy population is the cornerstone of a healthy economy. Vaccinating against a disease offers far better value than treating it. By keeping people healthy, vaccines help break the cycle of poverty; they enable children to eat better and go to school, and parents to work more productively. They create the sort of environment that attracts domestic and foreign investment.
Companies recognize that their success depends on the good health of the communities with which they do business. Vaccines have a significant impact on education, labour and the economy, because healthy kids mean healthy families, communities and societies.
In short, global health means economic health – and we all are stakeholders.
This is why companies are investing in the GAVI Alliance, because they know immunization is important for global health. Many are expanding beyond traditional philanthropy and favouring initiatives that make a measurable and long-term impact on individual lives, while at the same time contribute to their commercial success.
GAVI’s private-sector partners offer three important resources: “big skills, big voice and big money”. Three current examples, each of which has had the value of its contribution doubled under the GAVI Matching Fund, are:
I strongly support such private-sector contributions to global health and urge African business leaders to join me. In fact, I am impressed by the growing awareness among corporations that the world’s biggest health challenges – including how to reach the 22 million children who go unvaccinated each year – have profound economic implications.
As business leaders gather at the World Economic Forum on Africa in Abuja, Nigeria this week, I encourage them to think creatively about how their work, too, can be applied to global health. Governments can’t solve these issues alone. If we can collectively seize the moment, create shared value and inspire sustainable social and economic transformation on the African continent – we can push progress towards a world where every child, everywhere, is fully immunized. And we all will be better for it.
This blog was originally posted on the World Economic Forum website.
Lynne FeatherstoneUK Parliamentary Under Secretary of State for International Development
Investing in vaccines is the right thing and the smart thing to do
Measles, tetanus, whooping cough...these childhood vaccines are so readily available in the UK that we take them for granted.
But in many countries, parents and their children are denied access – even though it costs about £13 for a child in Sub-Saharan Africa to be immunised with pentavalent, pneumococcal and rotavirus vaccines.
Immunisation saves as many as three million lives every year. Yet, even in 2014, over 22 million children do not receive a full course of even the most basic vaccines. 1.5 million children under the age of five die from vaccine preventable diseases, mostly in developing countries.
World Immunization Week 2014 once again reminded us all how effective vaccines can be. It encouraged us to take action to help ensure everybody gets the life-saving vaccinations they need.
Vaccines not only prevent death they also help stop children catching diseases such as polio and rubella that can lead to life-long disabilities such as paralysis, deafness, blindness and learning disability.
This protection is vital as people with disabilities are some of the poorest and most marginalised in the world - part of an unseen great neglect, facing huge discrimination, including unequal access to education, employment, healthcare, social support and the justice system.
Investing in immunisation is the right thing to do. But it is also the smart thing to do: it gives people the chance to live productive lives so they can help pull themselves out of poverty. The economic benefits are huge with the benefit of a single vaccination outweighing the cost by twenty times.
In the UK, the Coalition Government’s vision is for all children everywhere to be fully vaccinated, ensuring that even the poorest, hardest to reach children receive the essentials. The UK is the largest donor to the GAVI Alliance which is leading the way in getting more people vaccinated in the world’s poorest countries, saving lives and preventing disability.
Since becoming Minister for International Development, I’ve travelled to numerous developing countries and seen first-hand just how essential vaccines programmes are to saving children’s lives - protecting them against some of the world’s deadliest diseases.
In 2011, the Government committed to immunise over 80 million children against preventable diseases by 2015 through the GAVI Alliance - saving one child’s life every two minutes. I am pleased to say that so far we are on track to meet this commitment. And I believe UK taxpayers can be incredibly proud of this important work they’re funding.
Dr. Clarisse Loe Loumou, paediatrician and member of the Steering Committee of the GAVI Civil Society Organisation (CSO) Constituency
Rotavirus vaccines reach Cameroon: the end of the long wait
Information Centre Alternative Santé, Cameroon.
When I was a paediatrician in charge of the gastroenterology and paediatric nutrition ward at the Centre Mère et Enfant—one of the largest paediatric recruitment centres in Yaoundé and all of Cameroon—severe and fatal diarrhoea was a regular part of my day. In my own country, Cameroon, diarrhoea is one of the top killers of children aged under five. Rotavirus, the leading cause of severe and fatal diarrhoea in children worldwide, kills more than 5,800 Cameroonian under fives each year. So it is big news today that rotavirus vaccines are finally being introduced into our national immunisation programme!
Rotavirus is an old story for us in Cameroon; it is a disease that sadly has already done too much damage.
More than 15 years have passed since initial studies (1995) demonstrated the prevalence of rotavirus diarrhoea. Years later, the heavy burden was confirmed by WHO's rotavirus surveillance led by Dr. Njiki Kinkela. This is why, when I wrote a blog three years ago about the GAVI Alliance's approval of Cameroon’s application for the introduction of rotavirus vaccines, I concluded on both a hopeful note, eagerly awaiting the arrival of the new vaccine, and a desperate note, saddened by the knowledge that thousands of children would unjustly die from rotavirus diarrhoea during the wait. Today, our children no longer have to wait: the vaccine is with us at last.
With this new vaccine, we are taking an important step towards reducing illness and death in our infants and young children. We owe this progress to the strong and sustained political commitment of the Minister of Health and the Expanded Program on Immunization (EPI) to introduce this vaccine. We should also not forget that none of this would have been possible without funding support from the GAVI Alliance, whose upcoming replenishment pledging conference will be crucial for our country's immunisation programme.
Civil society must take the message closer to the communities to be in line with the Global Vaccine Action Plan (GVAP), which calls for ownership of vaccination and vaccine campaigns by the communities they serve in order to achieve effective and optimal immunisation coverage.
We are already doing this through the PROVARESSC platform, a civil society forum for the promotion of vaccination and health system strengthening in Cameroon. This has been supporting the EPI for several months in social mobilisation and communication efforts particularly for vaccination campaigns against polio.
Cameroon has strong vaccination champions, including our former MP Amougou Mezang and my fellow paediatrician Dr. Ngosso Tetanye, who support civil society’s messages and are committed to increasing the visibility of vaccination among the general public and keeping vaccination prominent on the political agenda. There will be an opportunity later this year to raise the profile and importance of vaccination at the Congress of the UNAPSA (Union of National African Paediatric Societies and Associations), which will be hosted by Cameroon in November.
Much still remains to be done. Cameroon faces significant health immunisation challenges with a drop in national coverage rates, inequality in coverage between districts and cities, and most importantly, the recent resurgence of polio. The introduction of rotavirus vaccines should not be another missed opportunity to boost our routine immunisation programme alongside regular vaccination campaigns.
Resting on our laurels is not an option. Now that we have all the tools, we must strengthen efforts to promote vaccination!
GAVI Senior Programme Manager for South and South East Asia
A historical milestone in public health
Less than a decade ago Bihar’s immunisation rate was just 18%, but through innovative methods, it has found ways to reach the hardest to reach children, such as those of migrant families working the brick kilns such as these. Today Bihar’s routine immunisation coverage is higher than 85%.Credit: GAVI/2013/Duncan Graham Rowe.
As a paediatrician, I have encountered at close quarters the dread and panic in parents and children afflicted by polio. I have worked in rehabilitation centres, where I witnessed the despair and pain of those afflicted and their near-ones as the reality of long-term disability sinks in.
During the years I spent working in the slums of Delhi with civil society organisations, I also participated in the pulse polio campaign at the community level when it was still at a nascent stage. It was only later, when managing this programme on behalf of donors and working closely with ministries, United Nations agencies, Rotary and other partners that I realised how much the remarkable journey to banish polio from this region has become very much part of my own journey in public health. I am blessed to have witnessed and personally participated in such a momentous and historical journey.
Therefore, it gives me great pleasure on behalf of the GAVI Alliance to participate in the 7th Meeting of the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE). This is an historical milestone in public health in the South East-Asia region as it is certified polio-free.
The GAVI Alliance applauds the strong leadership from governments, the seamless partnership between implementing countries, civil society, donors and technical agencies combined with the dedication and hard work of millions of front-line workers. We salute this tremendous partnership and all the players within the scientific and public health community for their dedicated work in developing technological solutions and specifically the development of vaccines.
Let us remember also, the great scientist and pioneering researcher, Albert Sabin, who worked tirelessly to develop the oral polio vaccine. Forsaking any personal gain, he firmly believed that the vaccine should not benefit one man but the entire mankind and donated it to the World Health Organization.
Moving forward in support of the Polio Endgame Strategic Plan, the GAVI Alliance Board decided last November to open a funding window to help countries introduce injectable polio vaccine until June 2015, as part of the global polio eradication efforts. There has been a tremendous interest from countries and I am happy to note that we have received the first application recently from Nepal. Other countries from this region have also expressed their keen intent.
As a public-private partnership, the GAVI Alliance represents all the key stakeholders in global immunisation: implementing and donor governments, the World Health Organization, UNICEF, the World Bank, the Bill & Melinda Gates Foundation, civil society, the vaccine industry and private companies.
The Alliance exists to redress global inequities in access to new and underused vaccines. Since 2000, with generous support from donors and strong commitment from countries, we have helped to immunise an additional 440 million children which will save 6 million lives.
Our Alliance cannot emphasise enough the importance of strengthening routine immunisation and it fully aligns with the World Health Organization South-East Asia Region’s vision and countries’ resolution to intensify routine immunisation. The Alliance health system strengthening support provides an excellent opportunity to countries in this respect to strengthen health systems and services related to immunisation.
To this end in India, the WHO and UNICEF have agreed that 50% of their polio-supported staff time should be dedicated to strengthening routine immunisation services. The lessons learnt from decades of polio eradication efforts will help to reach the last child who still may not be receiving the basic vaccines in this region. Today as we mark a triumphant landmark in enabling the region to be certified polio-free, let us celebrate this historical milestone in public health.
Social Good/Global Voices Editor at worldmomsblog.com
Mention Polio to anyone over the age of seventy and most likely their eyes will grow wide, and they will shake their heads. Try this with your parents or grandparents and you will see what I mean. They remember the terror struck into communities by the highly contagious, potentially fatal, virus that impacts the nervous system. First appearing in the USA in the late 1800’s, according to the CDC the Poliomyelitis virus crippled 35,000 people in the US each year by the late nineteen forties into the early fifties.
My mother was one of those cases. She was one of the lucky ones. I could barely notice that it had left her with one leg shorter than the other unless she pointed it out. While polio can strike any age group, most cases, like my mother’s, occur in children under five years old. There is no cure for polio, but it can be prevented, and with the development of vaccines there have been no new cases of polio is the USA for thirty-five years. Though we have become complacent, a nightmarish truth lurks in the shadows. The fact is that as long as polio exists anywhere, it still remains a threat to children everywhere. In this ever-shrinking world, a polio resurgence is only one plane ride away. Today we are 99% of the way to eradicating the polio virus globally. Cases have dropped world wide from approximately 350,000 in 1988 to just over 400 in 2014. This is the final push and governments, non-profits, agencies, and private partners alike need to work together to see it through.
In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge turned into the eight Millennium Development Goals, and was written as the Millennium Goal Declaration .- United Nations Development Programme.
The eighth and final Millennium Development Goal is to implement a global partnership for development. This could not be more important in the global fight to wipe out polio across the board. For the past eight months World Moms blog has been committed to engaging our international community of mothers with organizations working towards the eight Millennium Development Goals. As we near the end of our eight-month Moms4MDGs campaign (link to: Moms4MDGs) the Millennium Developments Goals are closing in on their 2015 deadline as well. Great progress has been made in cutting vaccine preventable deaths in the most vulnerable population, children under the age of five.
Still there are almost 23 million children in the world that are not given the access to vaccines that they need. The majority of those children are in the 73 countries that GAVI programs support. Endemic polio can still be found in three of those countries, Afghanistan, Pakistan, and Nigeria.
In 2014 GAVI will start offering support for the introduction of inactivated poliovirus vaccine (IPV) as part of routine immunisation programmes in the world’s 73 poorest countries. The partnership with the World Health Organization and the Global Polio Eradication Initiative exemplifies one aspect of the MDG 8 global development partnerships. The United Nations Foundation Shot At Life campaign is also a partner in this goal, supporting its implementing partners the GAVI Alliance, WHO, and UNICEF. Together these organizations are working toward an endgame plan for polio eradication.
My personal connection with my mother’s polio inspired me to become an advocate with the Shot@Life Campaign to raise awareness in my community, and to encourage my government to continue to support Global Health initiatives. At the Shot@Life Summit in Washington, DC last week I caught up with Alison Brunier, Communications Officer for the World Health Organization, one of the implementing partners along with the GAVI Alliance. Alison beautifully summed up the role of the WHO in the following video.
The GAVI Director of US Strategy, Natasha Bilimoria, explained to the Shot@Life Champions in attendance the partnership strategy of the GAVI Alliance. As a public-private partnership, our Alliance represents all the key stakeholders in global immunisation: implementing and donor governments, the World Health Organization, UNICEF, the World Bank, the Bill & Melinda Gates Foundation, civil society, the vaccine industry and private companies. Together we work together to ensure vaccines get to where they are needed most.
We can put an end to polio by the year 2018 with the right support and circumstances. My mother was lucky to survive the polio virus and escape without a severe disability, but her experience inspired her to become a nurse who would work toward public health for the rest of her life. As her daughter and as the mother of my own four children now, I want to make sure that my children are safe, that their children are safe, and that the threat of polio to all children around the world is eliminated for good.
Join us for the final #Moms4MDGs Twitter party Wednesday March 19th 1-2pm EST.
Special Representative to GAVI-eligible Countries
Credit: GAVI/2014/Mercy Ahun
I was happy to be in Sokoto, northern Nigeria last month to see how the introduction of the latest batch of pentavalent vaccines funded by the GAVI Alliance was progressing.
I was encouraged by the words of mothers who had brought their young babies to be immunised at Ringin Sambo Urban Clinic. They welcomed the pentavalent vaccine because it means one injection instead of two for their children – a key message when Nigeria introduces two more injectable vaccines in the near future, inactivated polio vaccine and pneumococcal vaccine against the primary cause of pneumonia.
The mothers waited patiently for health staff to collect the five-in-one vaccines from the district cold store. The clinic had been given its own fridge two years ago to protect vaccines from high temperature, but a lack of solar panels to power the unit meant it was never installed. With GAVI-funded fridges due to reach Sokoto later in 2014, I was comforted to learn that both the State and the 23 LGA chairmen had signed a Memorandum of Understanding with the federal government stating clearly roles and responsibilities for cold store maintenance.
"This is the first time that we are putting such measures in place even before the arrival of the fridges," said the Executive Secretary of the Primary Health Care Board.
Unlike previous versions, the GAVI-funded ‘solar direct drive’ fridges do not need batteries to run. This new technology avoids the risk of batteries being stolen and requires minimal maintenance.
Sokoto State began introducing GAVI Alliance-supported pentavalent vaccine in December last year as part of Nigeria’s drive to roll out the vaccine over a record 18 months instead of the three-year period initially planned. Prior to the vaccine’s introduction in 14 Nigerian states in June 2012, there had been widespread stock outs of DTP (diphtheria, tetanus and pertussis) vaccine and other routine immunisation vaccines.
Pentavalent’s three-phase introduction across Nigeria underlines the power of public-private partnership. With the National Primary Health Care Development Agency in the lead, WHO, UNICEF,the Clinton Health Access Initiative, the GAVI Alliance, the Bill & Melinda Gates Foundation and other partners have worked together to plan, provide training and oversee the national rollout of the vaccine
This included biweekly partner conference calls connecting three continents- Africa, Europe and North America- to ensure partners were fully up to speed on supply chain, logistics, data issues, etc. across the country.
Such thorough preparation brought the opportunity to identify and fix potential issues in the national introduction. For example, during work by Alliance partners to support the procurement of new equipment, train staff and link supply chain to other parts of the health system, we discovered incorrect recordings of the new vaccine. This led to an estimated loss of one third of pentavalent data for the first group of States rolling out the vaccine. We were able to act promptly to address this.
At Basansan Rural Health Clinic, the officer-in-charge pointed to planning charts for immunisation sessions pinned to walls. These showed DTP3 coverage for 2013 was 67% and more than 90% in urban and rural clinics respectively.
I asked why the 2013 Demographic & Health Survey registered Sokoto with single digit coverage. ”Ha, many reasons,” said the TSHIP volunteer (a Maternal and Newborn Child Health project funded by USAID), “The denominator is too low for example – there are more babies in our catchment area than the projected figures we receive from authorities.” This would lead to an artificially high administrative coverage misleading health workers to believe that they have covered all existing children. A coverage survey usually reflects true coverage on the ground.
The Executive Secretary was also very clear on the challenges that Nigeria still faces in rolling out new vaccines:
With all of the above in mind, we discussed next steps and how we can improve coordination in the state.
Director, Media and Communications, GAVI Alliance
At the end of January we were taught a lesson in the power of social media in global health, as a striking interactive map of vaccine preventable outbreaks since 2008 went, well, viral on Twitter.
By the middle of the week more than 500,000 people had visited the map, and in an intriguing piece of research the trail of tweets led all the way back to a post by our own CEO, Dr Seth Berkley, a few weeks earlier.
As gratifying as the origins of this post’s spread may be, the unusual success of this map begs an important question about the important potential of using social media for communicating challenging global health issues like immunisation. Are we making the most of its responsive potential and huge reach?
With the social media platforms like Twitter constantly overflowing with a tangle of questions, concerns and misinformation surrounding vaccines, the rise of infographics and interactive visuals provides a unique opportunity for those with the data to back vaccine effectiveness to more effectively communicate the evidence that can save lives, as well as presenting the dangers of the anti-vaccine stance.
And that online communities can respond so positively to this exercise in data sharing should give us hope for the future of communication surrounding public health measures. The digital world of social media is primed and ready to share and interact with meaningful and engaging data sets and case studies, the challenge now is to ensure that those with the evidence grant social media enough importance to translate it engagingly to digital platforms, thereby making the most of social media as a public information tool.
To get our take on global health and immunisation on social media, like us on Facebook, follow us on Twitter, or join the conversation using #vaccineswork.
See you online!
Below are some popular posts to get you up to speed with global health on social media over the past couple of months.
Bill Gates & Jimmy Fallon make a viral video
Bill Gates and Jimmy Fallon’s clip, confidently named “viral video”, was created to drive traffic to Gates’ Annual letter on global poverty and health– and it looks like the silly headwear did the job!
#Endpolio now in India
The official announcement of India’s “polio-free” status created quite a storm online, but Rotary’s simple infographic was one of the most shared pieces of content.
Weeks after the post started its life as viral content, CFR’s map of preventable disease outbreaks is still going strong.
Vaccine introductions in 2013
GAVI’s own graph of vaccine introductions last year reached 90,000 people on Facebook at the end of 2013 – it didn’t quite go viral, but who knows who might share it in future?
Each of us has had the privilege of serving for many years as minister of state. Although we come from different parts of the world – one from Senegal, the other from Norway – we share the experience that good government can accomplish great things.
Good government can lift whole populations. It can support those in desperate need. It can help protect the innocent. It can enable amazing technological breakthroughs. What no government can do is single-handedly solve the world’s problems. It needs to work with others.
In particular, government needs to work with the private sector. Businesses have the ability to rally the public by providing solutions and applying know-how to problems of any size.
As business leaders gather in Davos, Switzerland, for the World Economic Forum Annual Meeting, we hope to engage them in thinking more creatively about how their work can be applied to global health.
We each serve as volunteer board members for the GAVI Alliance, a public-private partnership whose mission is to save children’s lives and protect people’s health by increasing access to immunization in developing countries. Since the year 2000, the GAVI Alliance has helped immunize more than 440 million children, saving six million lives.
We strongly support private sector contributions to this cause and urge other business leaders to join us. In fact, we are keenly impressed by the growing corporate awareness that the world’s biggest health challenges – including how to reach the 22 million children who go unvaccinated each year – also have profound economic implications.
Vaccine-preventable diseases such as pneumonia, measles and deadly diarrhea take an enormous toll on people in developing countries. We have both seen this first-hand. Companies recognize that their competitiveness and the health of the communities where they do business are mutually dependent. Global health means economic health. We all are stakeholders.
This is why it is imperative that both the public and private sectors work together. Businesses have invested in GAVI because they know that one of the strongest ways to promote global health is through immunization. Vaccines provide a strong return on investment (ROI). Among GAVI’s private sector partners:
Companies are expanding beyond traditional philanthropy and instead favour initiatives that make a measurable and long-term impact on individual lives and entire economies. Funding and supporting the delivery of life-saving vaccines is one proven way that the private sector can obtain measurable, long-term and extremely cost-effective results.
The GAVI model is designed as a sustainable approach that puts countries on track to self-sufficiency. If we – the public and private sectors – collectively seize the moment, we can accelerate progress toward a world in which every child, everywhere, is fully immunized. And we all will be better for it.
This blog was originally posted on the World Economic Forum.
Dr. Kathy Neuzil
Program Leader Vaccine Access and Delivery, PATH
Dr. Kathy Neuzil, Program Leader Vaccine Access and Delivery, PATH, is in Mali this week as the country introduces a vaccine against rotavirus, the most common cause of severe and fatal diarrhea in young children worldwide. Her report follows.
Credit: UNICEF Mali/2014/Cao.
As I watched the historic launch of rotavirus vaccines in Bamako, Mali, yesterday, I was reminded of an anxious time in my life more than a decade ago. I sat between two small beds in a hospital room in Seattle, Washington USA, where my daughter, 1, and my son, 6, were both receiving intravenous (IV) fluid for serious diarrhea. As a physician, I knew that rehydration with IV fluids is a simple and potentially lifesaving intervention. As a mother, I was worried.
Fortunately, my children were able to return home with me the following day, fully recovered. I was grateful that the hospital was an easy 15-minute drive from my home, and that advanced medical care was readily available.
Had I been a mother in Mali, I may not have been so fortunate—one or both of my children could have died from diarrhea. Mali is one of the poorest countries in the world. Mothers, fathers, and other caregivers often have to travel great distances over difficult terrain to reach health facilities. Depending on the location, IV therapy may not be available for their children. Lack of access to care is one reason more than 90 percent of diarrhea-related deaths occur in young children in countries with few resources.
Rotavirus is the most common cause of severe and fatal diarrhea in young children worldwide. In Mali, it kills more than 7,200 children each year and hospitalizes many more. Vaccination against rotavirus as part of a comprehensive approach to prevent and control diarrheal disease is the best way to protect infants from rotavirus disease and reduce its burden. In many countries that have introduced rotavirus vaccines, scientific studies have shown swift and significant declines in hospitalization and deaths due to diarrhea, as these tables on our rotavirus vaccine access and delivery website show.
While this is not my first visit to Mali, it is certainly my most gratifying. Yesterday’s momentous occasion is the culmination of more than seven years of hard work by a dedicated Malian team, my colleagues at PATH, and many other partners who paved the way for distribution of these lifesaving vaccines in Mali and in other low-resource countries.
In 2005, I joined PATH’s Rotavirus Vaccine Program, a partnership with the World Health Organization (WHO) and the US Centers for Disease Control and Prevention that was funded by the GAVI Alliance. We worked with rotavirus vaccine manufacturers and in-country partners to design and execute clinical trials of rotavirus vaccines in Africa and Asia, including here in Mali. The strong evidence generated from these trials was pivotal to the 2009 WHO recommendation that all countries introduce rotavirus vaccines into their childhood immunization programs.
Mali is the 20th GAVI-eligible country and the 53rd worldwide to introduce rotavirus vaccines into its national immunization program. While this is cause for celebration, there is a lot more work to be done. Many children still do not have access to the lifesaving benefits of rotavirus vaccines. While 14 countries—13 of them in Africa—plan to introduce rotavirus vaccines with GAVI support in the next two years, more than 15 other GAVI-eligible countries have yet to apply for rotavirus vaccine support. In addition, numerous middle-income countries, where childhood diarrhea is a huge problem, have yet to include rotavirus vaccines in their national immunization programs.
The incredible, positive health effects and related reduction in health costs due to the introduction of rotavirus vaccines is one of the most remarkable public health achievements of the past decade. Mali’s decision to proceed with rotavirus vaccine introduction despite recent devastating political and social turmoil underscores the country’s commitment to the health and lives of its children. Mali’s leadership should inspire other countries to take action in the fight against rotavirus and help ensure that all children worldwide have access to these lifesaving vaccines.
This blog was originally posted on the Path Blog.
Prof. François H. Tall
President of Burkina Faso Pediatric Society (SO.B.PED)
October 31st is a big day for my country, Burkina Faso, because we are finally going to introduce vaccines against rotavirus and pneumococcal disease in our routine vaccination program! Thanks to these new vaccines, we will be able to save thousands of children’s lives.
As a pediatrician, not a single day goes by where I do not see children suffering from vaccine-preventable diseases, and specifically from pneumonia or diarrhoea. Currently, thousands of children less than five years of age die each year from pneumonia and diarrhoea in Burkina Faso, as well as in most countries in sub-Saharan Africa. In 2010, 21,764 child deaths were caused by pneumonia and 14,648 were caused by diarrhoea in Burkina Faso. Today we know that prevention through vaccination is the most effective way to guard against these diseases.
As President of the Burkina Faso Pediatric Society (SO.B.PED), I would like to congratulate my Government on this major advancement that allows us to fight these two diseases, which are the most deadly among our children who are less than five years of age, and a true blight in our country. By introducing these vaccines together, Burkina Faso is taking a step forward in promoting the approach of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), which advocates for the introduction of both vaccines as part of a comprehensive and integrated strategy to combat these two diseases.
I rejoice that my country will finally introduce these long-awaited vaccines. Burkina Faso has just joined several other countries in the sub region that have already introduced these two vaccines, thanks to the support of the GAVI Alliance. Globally, 16 of the 48 countries that have introduced rotavirus vaccines into their national immunization programs, and 33 of the 72 countries that have introduced pneumococcal vaccines into their national immunization programs have done so with GAVI support. 18 other countries—17 in Africa—have been approved by GAVI for rotavirus vaccines support and another 18 countries—9 in Africa—have been approved for pneumococcal vaccines support. We sincerely hope that donors will continue to support the GAVI Alliance so that we can continue to benefit from their support for the introduction of new vaccines in our country as well as reduce the deaths caused by these vaccine-preventable diseases.
The Burkina Faso Pediatric Society (SO.B.PED) has been waiting for many years for this new victory for our children’s survival. Blowing out its 24th candle this year, the SO.B.PED is one of the oldest academic societies of Burkina Faso. It was founded in 1989 by ten pediatricians and now has over 70 active members scattered in 45 provinces. One of the first objectives mentioned in the statutes of our Society is to support the development of maternal and child health policies at national and regional levels. It is in this frame that we focus our advocacy efforts towards the introduction of new vaccines against the most deadly childhood diseases. When the haemophilus influenza b vaccine was introduced in the routine immunization program in 2006, SO.B.PED leveraged this opportunity to multiply advocacy efforts towards decision-makers and partners. We did this during World Pneumonia Day in December 2010, and again at the UNAPSA Pan African Pediatric Congress in December 2011 in Ouagadougou. Today, our advocacy efforts are finally paying off!
We must thank not only our leaders but also our numerous partners, donor countries and other donors, and especially the GAVI Alliance and its financial support, without which none of this would have been possible. I would also like to take this opportunity to thank our colleagues at PATH and IVAC/Johns Hopkins University for their assistance and support in our advocacy efforts.
As of October 31, 2013—the “D-Day” of the dual new vaccine launch under the patronage of the First Lady of Burkina Faso—our children will finally be protected against the two biggest killers of children under five: pneumonia and diarrhoea. Now, it is up to us to ensure that the introduction and implementation of these vaccines are effective, successful, and sustainable.
Mathias Bonk Program Director of the World Health Summit at the Charité, Berlin
As a first-year medical student I travelled to India to work as a volunteer with the Missionaries of Charity in Calcutta. I was extremely fortunate to have had the opportunity to meet Mother Teresa. She told me I should work hard to help the poorest of the poor. Since then her children´s orphanage, Shishu Bhavan, has become something like a safe haven and a source of great inspiration for me. Here I have learnt a lot about health-care and how medicine is practiced in resource-poor settings, and about the various, often preventable, infectious diseases. To me it seemed to be unbelievable that so many children are still suffering and dying from diseases like diarrhoea, pneumonia and polio.
A few years later I returned to India for an internship in a hospital in Bangalore, Karnataka. During my rotation on the Emergency Intensive Care Unit, I met a 14-year-old boy, suffering from polio. He was not able to breathe by himself anymore and was being kept alive by a ventilator – a very costly procedure for his poor family already deeply in debt. His 12-year-old brother was taking care of him day and night, knowing that his brother’s death might be near. Still, he was full of compassion and hope. When I returned to the ward after the next weekend, the boy had passed away. His family had taken the critical decision order to save the livelihood of the other siblings.
After returning to Germany, I graduated from medical school and became a paediatrician. Vaccinations became part of my daily routine and nothing seemed to be more natural than to provide all children with the chance of a healthy start in life. The last polio case in Germany was seen in 1990 but it has taken decades and a multi-sectoral approach to reach this state. Today we are close to eradicate polio once and for all. The polio story is an impressive success story about the power of vaccination.
The GAVI Alliance has proved that a multi-sector partnership can achieve excellent results in a relatively short time. Its mission is to save children’s lives and protect people’s health by increasing access to immunisation in developing countries. The Alliance includes governments of developing and donor countries, WHO, UNICEF, the World Bank, Civil Society organizations, research institutions and vaccine producers. Each partner chips in, and working together the Alliance can reach goals none of the organisations could reach alone. 370 million additional children vaccinated since 2000, 5,5 million future deaths averted. Working together obviously pays off.
As the programme manager of the World Health Summit I am delighted that GAVI, a key player in global health and especially in the fight against child mortality, participated actively in the event ever since it was established in 2009 in Berlin. The World Health Summit pursues a similar goal: It brings people together to improve health all over the world. The annual World Health Summit is held under the high patronage of Germany’s Chancellor Angela Merkel, the French President François Hollande and the President of the European Commission, José Manuel Barroso. An academic network based on the M8 Alliance of Academic Health Centers, Universities and National Academies underpins its work.
In 2013, the World Health Summit will focus on the interplay between health and development, research and education, and on the role of health in many aspects of foreign policy. These interconnections are even more important in light of new and emerging health threats arising from increasing global mobility, demographic change and environmental pollution. A special focus will also be placed on global activities to eradicate preventable diseases such as polio.
On February 25, 2012, only about 10 years after my experience with the two brothers in India, the World Health Organization (WHO) eventually struck India off its list of polio-endemic countries. India hadn’t reported a single case of wild poliovirus for more than a year. This at least gives hope that other families will not have to suffer like the family I met in the hospital in Bangalore.
# # #
Dr. Mathias Bonk, a paediatrician with working experience in Germany, India and the United Kingdom and trained in Tropical Medicine and International Health, is the Program Director of the World Health Summit at the Charité in Berlin. In addition he is the Coordinator of the M8 Alliance of Academic Health Centers, Universities and National Academies, a collaboration of academic institutions of educational and research excellence that recognizes its responsibility to improve global health.
The World Health Summit 2013 takes place from October 20-22 in Berlin, Germany. GAVI’s Managing Director for Policy & Performance Nina Schwalbe will speak at two symposia at this year’s summit:
Helen EvansDeputy CEO, GAVI
An Indonesian child becomes among the first in the country to receive pentavalent vaccine with GAVI support.GAVI/2013/Dian Estey
As Indonesia celebrated the introduction of a new pentavalent vaccine last week there was an extra dose of good news: The vaccine that will benefit children across the country was manufactured in Indonesia.
The pentavalent roll out will mean big progress towards ensuring that all children in Indonesia have a healthy start to life. Children will now be immunised against five vaccine preventable killers: diphtheria, tetanus, whooping cough, hepatitis b and haemophilus influenza type B. Between now and the end of next year, the five in one shot will be delivered to over four million children across the 6,000 inhabited islands that make up the Indonesian archipelago.
In and of itself, this is a critical advance. As I joined the Indonesian Minister of Health, Dr. Nafsiah Mboi, for the vaccine launch in a tent clinic in Karawang, I could see how keen mothers and fathers were to get their children vaccinated. They knew just how important it was to get that protection for their kids.
But last week's announcement was significant for several other reasons – all of which point to an encouraging future for vaccination programmes in Indonesia.
Indonesia has a growing economy and will graduate away from GAVI support by 2016. There will be a gradual increase in the portion funded by Indonesia over the years to 2016, at which point GAVI funding will cease and the programme will be funded entirely by the Indonesian Government.
Helen Evans and Indonesian Minister of Health, Dr Nafsiah Mboi, meet mothers and children at the launch of pentavalent vaccine in Karawang.GAVI/2013/Dian Estey
Indonesia’s move to self-sufficiency isn't just fiscal - it's industrial and scientific too.
The pentavalent vaccine that will be used for Indonesian children is manufactured in Indonesia by Bio Farma, a parastatal company based in Bandung, West Java. I had the pleasure of touring the Bio Farma facility along with a delegation of Japanese and Korean MPs during my recent visit.
After we finished visiting the impressive facilities we were shown a tree that was planted to recognise the contribution of Japanese scientists to Indonesian vaccine production. By happy coincidence, one of the Japanese MPs on our trip, Motoyuki Fuji, was the health attaché at the Japanese embassy in Indonesia when that collaboration first began.
While the tree had taken root and flourished in the time since Motoyuki Fuji left Indonesia, Bio Farma has also grown into a highly sophisticated organisation with the capacity to deliver a range of vaccines including most recently the pentavalent vaccine to millions of children.
It’s a story that complements GAVI’s experience in Indonesia. Just as Indonesian is now manufacturing its own pentavalent vaccine, so too is the country shifting to the point where it will entirely finance its own immunisation programmes, from the purchase of vaccines to the cold storage and delivery networks which are vital to ensuring all children are reached.
And that is the goal of the GAVI Alliance – to support governments, communities and individuals to save children’s lives and protect people’s health by increasing access to immunisation ultimately through using their own resources. Indonesia is well on the road to self-sufficiency in immunisation and I look forward to hearing about the successes that surely await in this bustling, vibrant country.
GAVI senior program manager
GAVI makes waves in the Pacific
A typical vaccination outreach session at a village maneaba. Kiribati is the smallest and most remote country to receive GAVI support. 103,000 people live across three islands. On May the 6, 2013, Kiribati launched the pneumococcal vaccine.Photo credit: GAVI/2013/Raj Kumar
With 103,000 people living across three islands, Kiribati is the smallest and most remote country to receive GAVI support. Its position close to the international dateline and the equator make the group of islands, spread across 3.5 million square kilometres, one of the most difficult to access by people or vaccines.
I was honoured to be the first GAVI staff member ever to visit this mesmerising country to participate in the launch of the pneumococcal vaccine for the children of Kiribati.
More than half the population resides in the capital, Tarawa, which boasts just one road. There is no television or a regular newspaper – although a vernacular bulletin comes out once a month. Telephone and internet connectivity are challenging. Kiribati exists almost in a world of its own, unworried and untroubled by global security and economic issues.
The commitment to maternal and child health services in the country is amazing. Every child receives pentavalent vaccine and vaccinators do not know of any child who has not received the vaccine. They can be sure because they know everyone, communities are like large families and everyone is on their minds. The society is egalitarian and hierarchy is not important.
The pneumococcal vaccine launch event on 6 May was an impressive, traditional spectacle. Anybody and everybody who matters in the health sector were there. What was more impressive was that next day the vaccination was being done in three facilities I visited. The approach was simple. At Santo Ioane health centre, after vaccinating many children, two nurses Utinia Dennis and Lavender Tineon assisted by a Nurse aide Terengaoiti Toteri went to an outreach site two kilometres away and immunised more children, followed by house visits to ones who did not turn up.
The outreach sites are located at ‘maneabas’ (or meeting sites) which are the largest buildings in the villages and centre of village life, and the basis of island and national governance. Through this system, pneumococcal vaccine was effectively rolled out all over Kiribati in just one week!
Next day we took a one hour boat ride to go to Abaokoro on other end of L-shaped island of Tarawa. The School Health Nurse Miriaa had completed the vaccination in the centre and had plans for rest of the week to cover four other locations to get to 57 children in her area. Every child had taken BCG and Hepatitis B vaccine at birth.
Equally interesting was that each of three centres we visited had new child cards and registers to record pneumococcal vaccination. There were brand new posters with new schedule; all provided by LDS Charities, a faith based organization in Kiribati with a significant following. LDS is working closely with the Government to create an enabling environment and demand for vaccines across Kiribati - a good example of Government and CSO working together.
Does this mean Kiribati faces no challenges? No. The vaccine store is far from ideal. In the stores were three boxes of 1 ml. auto disable syringes and no one knew why they had been delivered to Kiribati. Also, according to GAVI’s eligibility threshold, Kiribati is no longer eligible for any new support as its per capita income is $2,030. However, the cost of living is high. So if one looks at PPP income, Kiribati drops more than ten places in the international economic rankings, below many other countries still eligible for GAVI support. This is a difficult situation. The Government can certainly sustain pentavalent and pneumococcal vaccines but other new vaccines would be a challenge, both in terms of financial resources and in-country technical expertise.
Towards end of my visit I felt in love with this new world, the like of which I never before encountered. For me, the smallest GAVI-eligible country is also one of the most fascinating. I am proud that the children of Kiribati are not being forgotten and will benefit from the power of vaccines.
Raj Kumar is a Senior Country Responsible Officer at the GAVI Alliance. AusAid is a major supporter of GAVI and its mission to immunise an additional 250 million children in developing countries by 2015, saving an estimated four million lives.
Cary AdamsCEO of the Union For International Cancer Control
Seth BerkleyCEO of the GAVI Alliance
Around 16% of all cancer cases in the world are caused by known infectious agents. In sub-Saharan Africa, that proportion rises to one in three cancer cases. Today around 10% of all cancer cases can be prevented with vaccines. Prevention offers the most cost-effective long-term strategy for the control of cancer.
On 27 May, the World Health Assembly in Geneva adopted a key strategy to accelerate progress on cancer and other non-communicable diseases (NCDs). The new WHO Global Action Plan and Monitoring Framework for the Prevention and Control of NCDs will create a robust global architecture and firmly position vaccines as a key pillar in the fight against NCDs.
NCDs are the world’s number one killer, accounting for 63% of all global deaths. The highest death toll is in low- and middle-income countries. In 2010, for example, cancer accounted for eight million deaths. In September 2011, a High-Level Meeting at the United Nations (UN) acknowledged NCDs as a global priority. Since then, the UN has agreed an ambitious global target to reduce premature deaths from NCDs by 25% by 2025.
Vaccines can help avert millions of premature deaths by preventing the infections Hepatitis B and Human Papilloma Virus, that cause two leading cancers in developing countries – liver and cervical cancer - and are an essential element of the effort to reach this “25 by 25” target.
The introduction of hepB vaccine into the routine immunisation programmes of developing countries was a turning point in the fight against liver cancer in countries where the burden was highest. In the past 10 years, GAVI has supported the immunisation of 267 million infants against hepB in developing countries and prevented an estimated 3.8 million premature deaths from liver cancer.
Today, HPV vaccines to prevent cervical cancer in women offer similar potential.
Cervical cancer is a leading cause of cancer deaths among women in sub-Saharan Africa. In Latin America and Asia, more women die from cervical cancer than in childbirth. Global cervical cancer mortality highlights some of the great injustices of our time—inequities in wealth, gender and access to health services. Women worldwide are exposed to HPV, yet women in developing countries have little or no access to early cancer detection and treatment and many die as a result of this infection.
When the hepB vaccine was first developed, it was seen as too expensive for introduction into developing countries. As a result, low-income countries did not have access to the vaccine despite the high burden of disease. GAVI support has encouraged new manufacturers to enter the market, helping to stimulate healthy competition and lower prices. The price of the pentavalent vaccine (which includes hepB) has dropped by 37% in 10 years.
GAVI has been working with vaccine manufacturers on strategies to lower vaccine prices to make them more affordable for developing countries. Two weeks ago, GAVI announced a new record low price for HPV vaccines to help protect millions of girls in developing countries against cervical cancer.
Last week, Kenya became the first country to protect girls against cervical cancer with GAVI-supported HPV vaccines. The moment is coming when those who need protection most from infections that cause cancer will get the vaccines they need.
Cervical cancer survivor and model
Genevieve SambhiPhoto credit: Her World Magazine
If it is one thing that I have learnt, it’s that there is a huge misconception about cancer. Cancer can affect anyone but it is not necessarily a death sentence, it can be beaten! I was diagnosed with cervical cancer at the age of 35. And as I went through the hardest 7 months of my life, I vowed that if I came out the other side, I would do what I could to educate and build awareness about this dreadful disease.
I remember the day my life came tumbling down so clearly. I was feeding my children dinner (Isabella was 4 and Alexander 15 months). My father rang (He is a gynaecologist and I had been for my annual pap smear 2 days earlier). He explained that the results weren’t normal and more tests were needed. I was in a state of shock, was I going to die? I had cancer?
I had to go in for a cone biopsy a few days later, and had hardly recovered from that when I was dealt the worst blow. The cancer had spread and a hysterectomy was needed. This is when I sat and cried. I was going to die and who would look after my babies? They were so young and they needed me.
Then I realised how lucky I actually was. I had a girl and a boy and a husband who loved me, and that was all I needed. I needed to be here for them and that was all that was important.
My next blow came 10 days after my hysterectomy, when the results showed that I would need chemotherapy and radiation treatments. It was like I was in a nightmare, how much more could I take?
What I couldn’t understand was how I had got to this stage. I went annually for my pap smear, so how in 1 year had I gone from all clear to stage 2b and chemotherapy? The aggressiveness of the cancer shocked my doctors; this was a disease that took 5-10 years to get to the stage that I was at after less than 1 year.
On paper I am probably the last person who should have got cancer. I am young, have been with my husband since I was 20, have 2 young kids, don’t smoke or drink, and exercise regularly - yet I still got cancer. So if it could happen to me, it could happen to you!
So I try and make it my mission to build awareness about pap smears and vaccinations. If I had not gone for my pap smear I would not be here today. Cervical cancer is a treatable cancer if caught early, and the only way to do this is through a pap smear. Safe and effective vaccines protect against two types of human papillomavirus (HPV), which cause about 70% of cervical cancer cases. And I am very glad to hear that many poor countries in Africa and Asia will soon be able to protect young girls with the HPV vaccine thanks to support from the GAVI Alliance.
So why would you not want to protect yourself and your loved ones? My daughter, when she is old enough, will definitely be vaccinated. She will be protected so that she never has to go through what I did. No woman should have to go through what I did.
I have decided to put up with the nasty and hurtful things people say as to why I got cervical cancer because there is always one who will listen. And if I can save one person, then that is 1 person saved, and I have done my job!
Vanessa MdeeMTV Africa VJ from Tanzania, singer and activist
I’m trying to think of the first time my
mother had ‘THE TALK’ (yes the birds and the bees talk) with me. THE TALK that
I’d heard my friends refer to as the most embarrassing moment of their lives,
the talk that officially indicted you into teen-hood, THE TALK that signified
your maturity – your parents decided you were old enough to speak of natural
human interaction between a man and a woman. I’m still eagerly awaiting this
‘TALK’. Now don’t be fooled, my mother knows all too well that I’m well aware
of physical interaction. Not because I told her but because she’s got that
sixth sense like all mothers do besides I am of age and slightly adventurous (for lack of a better word). I gather I never put my parents in a place where
they felt the need to have this conversation with me. I did after all grow up
in a Muslim turned every Sunday church-going Roman Catholic home - where I
obviously wasn’t having sex. My parents were right – not because I was holier
than the next but the mere thought of them finding out crippled me. You see, growing
up in an African home as exposed and worldly as my upbringing was, certain
things were NOT discussed. This remains the case to date. My line of work has
allowed me to converse intimately with young African women and girls, and their
stories are similar. SEX TALK! Is a no go.
When I started DynamitesMission - my awareness
blog sponsored by the UNAIDS and MTV’s Staying Alive - I wanted to lend my
voice and extend my ear to the streets. I was learning about grassroots
organizations and their efforts to educate their communities. I was moved and
in turn spoke from my perspective – pretty layman but CLEAR to other laymen. A
year in, I get a BBM from one of my best friends Michelle, it read ‘ You’re
trying to tell me that above all the heartache we take from these men, they
also pass HPV (the virus that causes cervical cancer) to us ‘ – I chuckled
and said ‘ Yes Elle, they do – talk about short end of the stick’. Many women are unaware of cervical cancer and
HPV, MOSTLY about how exposed we are to the virus through our everyday
My first personal encounter with cervical cancer
was in my early teens. My aunt was diagnosed with cervical cancer at a very
late stage and when her health deteriorated I remember wondering what she had
done to deserve this and why the meds weren’t working. I kept asking my father
– why she wasn’t getting better. Only to properly understand the severity as
she passed away after being bed ridden for 2 weeks. When a woman is diagnosed
with cervical cancer in Tanzania there is a 70% chance she will survive. Experts
agree that the low survival rate is due to late diagnosis and treatment by a
healthcare provider. It wasn’t until I was approached by GAVI that I found out
that there now is a vaccine and that if administered early (before young women
become sexually active) then we can ensure a brighter future for our women and
decrease the numbers of cervical cancer cases. Young women need to be aware of
these opportunities that can be availed but most importantly the knowledge of
HPV and cervical cancer – I truly believe these formative years will define
their sexual reproductive health and nurture a generation of healthier women.
It starts with open communication about sex and sexual reproductive health.
2013 is the beginning of a dramatic shift in women’s
health. A record low price for a HPV vaccine has been negotiated by GAVI for the 50+ countries eligible for GAVI support ( including my home country,
Tanzania), opening the door for millions of girls in the world’s poorest
countries to be immunized against a devastating women’s cancer. This not only
is the beginning of a shift in the overall eradication of cervical cancer but a
new dawn for young African women around the continent. An opportunity that
myself and many other young African women did not have.
It breaks my heart to see
lives cut short due to ailments. In Africa these losses happen often
and deprive our societies. It's about time
proper healthcare is administered for all, especially the future generation.
GAVI is making this possible by pioneering the administration of the HPV
vaccine. Giving my younger sisters a chance - that's ONE less
killer to worry about.
Bill Gates Co-chair and trustee of the Bill & Melinda Gates Foundation
I arrive in Ghana today to see firsthand why the country’s immunization system is working so well and meet the people involved.
For some people, health delivery systems might not seem like the most intriguing topic, but I am really interested in understanding how they’ve done so much of this right. Strong immunization systems are crucial for protecting our gains against polio and helping us reach mothers and children with new vaccines and other life-saving health services. In Ghana, for example, polio was eliminated a decade ago and an outbreak in 2008 was quickly controlled. No child there has died from measles since 2002. And Ghana was the first country to launch two new vaccines last April, against rotavirus, which causes severe diarrhea, and pneumococcal pneumonia.
Ghana’s approach works so well for a few key reasons: Rigorous data gathering and analysis, accountability at the district level, and community outreach. Just as importantly, the vaccination program is fully integrated into the health system. But there’s really no substitute for seeing it on the ground.
Tomorrow we’re going to visit a director of health services in a district in central Ghana, then a nearby clinic. We’re then going to visit a community health center where the nurses also go out to find mothers who missed appointments or children due for immunizations to make the program as thorough as possible. As I wrote in my annual letter this year, measurement is crucial for improving health care, so at every stop I want to understand how the data is collected and used for planning and decision making–and meet the people who are making this success possible.
I plan to share my experience in Ghana at the Global Vaccine Summit in Abu Dhabi April 24-25, where global health leaders will celebrate progress in immunization and demonstrate how the world is united to give all children a healthy start to life.
Of course, no system is perfect, so I want to learn about the obstacles and challenges in Ghana as well. I’ll speak with many of the leaders who are working so hard to reach every child with vaccines, including Dr K.O. Antwi-Agyei, who manages the national immunization program. I’m also excited to talk to some of the well-trained community health nurses and meet some of their local clients. In my next post I’ll tell you about the people I’m meeting and some of the lessons we can learn from Ghana’s success.
This blog post is also featured on the Impatient Optimists.
Charlie WhethamGAVI Country Responsible Officer
Community interest in the campaign: one of four marquees this size.
Rwanda’s 2012 Olympics wasn’t noteworthy, with the highlight an odds-defying 14th by Robert Kajuga in the men’s 10,000m.
It’s a very different story in immunisation. Rwanda leads the way amongst the poorest countries in Africa, with the first introduction of pneumococcal vaccine (for pneumonia and similar infections) in 2009; the first national introduction of human papillomavirus (HPV) vaccine in 2011; over 95% coverage for the vaccines they have introduced and now the first introduction of measles-rubella (MR) vaccine.
Vaccine introduction is no competition, but this list well illustrates the ambition of the leadership in Rwanda. And it is producing results, with under five mortality reduced from 250/1000 in 1995, immediately post-genocide to 177 in 2000 and to 91 in 2010.
Campaign preparations, with typical Rwandan thoroughness.
Last week I was in Rwanda for that first MR campaign. Rwanda has been carrying out measles campaigns every three years, supplementing their routine immunisation, which has reduced confirmed measles cases from 3500 in 2006 to fewer than 100 in subsequent years (Rwanda EPI reports). The measles surveillance system now identifies a higher proportion of rubella than measles cases.
Rubella vaccine is therefore a natural next step. Although rubella is usually a mild disease affecting children, when a pregnant woman becomes infected serious consequences can occur with Congenital Rubella Syndrome (CRS) causing hearing loss, blindness or heart defects in the baby, and still-birth also endangering the mother’s life. WHO (2011) estimate that 112,000 children a year (300 each day) are born with birth defects from CRS, placing heavy human and economic tolls on these children and their families.
Leveraging the wide reach of immunisation programmes to reach children with other life-saving interventions.
Now thanks to the technical advice of the Measles and Rubella Initiative and GAVI’s financial support, over 700 million children under the age of 15 in 49 countries will be protected against measles and rubella by 2020.
Over four days last week, Rwandan health workers vaccinated close to five million children between the ages of nine months and 14 years with the MR vaccine. Rwanda used the opportunity of the campaign to also provide a third national cohort of 12 year-old girls with their first dose of HPV, donated by Merck – GAVI will support the national programme from 2014. The selection by the Government of the Minister of Gender and Family Promotion, Hon. Oda Gasinzigwa, to be guest of honour at the campaign launch highlighted that the primary victims of both CRS and cervical cancer are women.
GAVI in partnership with the Government of Rwanda and the UN family
This campaign well illustrated how the wide reach of immunisation programmes can be leveraged to reach children with other life-saving interventions – with Rwanda providing vitamin A droplets, educating children on malaria-avoidance and testing, and providing a wide range of contraception.
GAVI describes our support for MR as catalytic: we meet the costs of the campaign almost entirely. In Rwanda, these totalled nearly US$ 7 million, with half paying for the vaccines, syringes and safe-disposal boxes and the other half for the daunting operational logistics. The key condition for this support is that the country itself then introduces MR into its routine immunisation programme, including paying itself for the vaccine from that point on, with only a small (US$ 300,000) further grant from GAVI. Rwanda will do this in January 2014.
GAVI: trackside coach in Africa’s race to immunise its children against vaccine-preventable diseases.
Charlie manages GAVI’s partnerships with the countries of East and Southern Africa to increase their use of new and underused vaccines which significantly reduce childhood mortality. His interest in athletics – an 800m (half-mile) personal best of 1 min 52 – doubtless influenced this article…
Photo credit: © UNICEF Rwanda/2013/Rusanganwa
Rt Hon Stephen O’Brien, MP
Prime Minister’s Envoy and Special Representative to the Sahel
Rt Hon Stephen O’Brien MP seeing the impact funding from Comic Relief has on millions of children
I firmly believe that it is in the British character to try to help those whose lives are blighted by disease, poverty and violence. Red Nose Day, supported by Comic Relief, gives millions of people across the country the opportunity to do just that.
This Friday night we will all be reminded of the desperate situations that persist in many countries around the world. The support that Comic Relief is able to provide to scores of organisations working in the most difficult of circumstances really does make a difference.
Like everyone, I am keen to know that the money raised by Comic Relief will be well-spent on tackling extreme poverty. Thanks to my work as the Prime Minister’s Envoy to the Sahel region, and previously as a Minister for International Development, I am in the privileged position of being able to see the impact funding from Comic Relief has on millions of children.
Access to vaccines is a critical issue in developing countries. Healthy children lead to healthy and self-sufficient societies but in many places a simple injection or some oral drops that will prevent children from succumbing to potentially fatal diseases are simply not available or, if they are, they are too expensive for most families.
Thankfully in the UK our children are vaccinated as a matter of course but the situation in many developing countries could not be more different. That’s why I’m an avid, unapologetic supporter of the work of the GAVI Alliance, funded by, amongst others, the UK Government and Comic Relief.
In all my experience in Sub-Saharan Africa, my current and former roles include helping tackle humanitarian challenges at their root – including access to immunisation – that are facing the people in countries such as Chad, Eritrea, Mali, Burkina Faso, Mauritania, Niger, Senegal, South Sudan and Sudan.
These are among the poorest countries on earth, and yet each is a contributing partner of the GAVI Alliance. GAVI is a public-private partnership which aims to increase access to lifesaving vaccines – both old and new – for children in the world’s poorest countries. This is not charity. GAVI is clear that countries must help finance their vaccine programmes through a co-payment arrangement.
Working with other partners such as Comic Relief, GAVI has helped immunise 370 million children in more than 70 countries since 2000, saving more than 5.5 million lives. This includes children in Tanzania, a country with a special resonance for me as it was where I was born.
GAVI is making progress but there is still a great deal to do. Every year, 1.7 million children die from vaccine-preventable diseases. The vast majority of these deaths occur in developing countries, where one out of every five children remains unvaccinated.
Comic Relief is playing its part by supporting the GAVI Matching Fund which sees a donation matched by the Bill & Melinda Gates Foundation. This funding pays for lifesaving vaccines – one of the most cost-effective health investments around.
Consider Tanzania, a country of 46 million people that has a plan to transform itself into a middle-income economy by 2025.
To succeed, the government recognised it must ensure good health for its people. By working closely with GAVI and its partners, Tanzania has increased its routine vaccine coverage rates to above 90%, while co-financing about 10 % of the cost of the vaccines. In parallel, the country’s GDP growth has risen to about £16 billion from £6.8 billion in 2001.
Immunisation should be a right for all children, no matter where they live and GAVI, through its work with Comic Relief and the UK Government, is helping to turn that basic right into a reality.
Rt Hon Stephen O’Brien, MP, is the Prime Minister’s Envoy and Special Representative to the Sahel, a part of Africa just south of the Sahara. He previously served as Parliamentary Under-Secretary of State for International Development from May 2010 to September 2012. He chaired the global charity, Malaria Consortium and is about to resume his trusteeship of the Liverpool School of Tropical Medicine. He is the Conservative MP for Eddisbury.
Maggie CarterDeputy Director, Shot@Life Campaign
"Immunizations are how we can give all children a fair start at a healthy life," said GAVI Board Chair Dagfinn Hoybraten this morning. As we gather in Dar es Salaam for the GAVI Partners' Forum, we are reminded in the simplest way why we have come together and our work is reaffirmed.
Over the past several days, I have participated in gatherings of Civil Society Organizations and traveled several hours outside of Dar es Salaam to the Morogoro region for a field visit. In Morogoro, our delegation met with Dr. Mtey at the Morogoro Regional Medical Office who oversees health activities in this region. He provided us with a landscape of their work at the country, region, district and local level. What struck me was how high the immunization rates are in this region – above 90 percent – even with insufficient health systems. Yet, the largest killers of children under 5 in Morogoro are:
The Tanzanian government has committed one million insecticide treated bed nets to protect against malaria. And there is a significant need for the pneumococcal and rotavirus vaccines to protect these children from pneumonia and diarrhea.
Morogoro is the second largest region in Tanzania with six districts, 181 wards and 613 villages. The region covers more than 73,000 kilometers. However, there are only three hospitals, 48 health centers and 358 dispensaries. Ideally, they would have one hospital per district, one health center per ward and one dispensary per village.
Dr. Mtey then took us to a district health center and a village dispensary in Malera and Doma. We witnessed children receiving routine immunizations like the oral polio vaccine, Vitamin A and deworming tablets. At one site we visited, health days are provided in a "hut" where there is no electricity so immunizations and supplies have to be transported from the nearest dispensary. As these families don't have access to regular health care or emergency services, regular immunizations provide these children with the first line of defense – protecting them from disease and potential death.
As we transition today to the GAVI Partners’ Forum, we come together to discuss creative and effective ways we can assist families like the ones we just met in Morogoro, as well as millions of others across developing countries, to give them access to the health care they need and ensure that all of their children get a shot at a healthy life.
This blog post also appears on shotatlife.org.
Katherine MooreCountry Programmes, GAVI
Watched by Benin President, Dr. Thomas Boni Yayi, Health Minister Dr. Dorothée K.Gazard, administers the MenAfriVac.
GAVI and partners, the World Health Organization (WHO), UNICEF and PATH, gathered in Cotonou this week to mark an upcoming milestone in public health – later this year the 100th million person will be vaccinated with MenAfriVac, less than two years after the start of our mass campaign programme.
While the Alliance will not reach the number until December, Benin President Dr. Thomas Yayi Boni, senior government representatives, 2,000 Beninois and international guests held a major party on 15 November complete with traditional poetry, Guedele dancing and singing.
We all have reasons to celebrate the success of the meningitis A vaccine. Just 17 years ago, Meningitis, an inflammation of the protective membranes covering the brain and spinal cord, ravaged a broad swath of Africa, extending from Senegal in the West to Ethiopia, commonly known as the ‘meningitis belt’.
With a mortality rate of 50 percent for those unable to seek immediate treatment, it robbed many countries of the very young, children and adults aged less than 30. In 1996, the region’s worst epidemic infected a quarter of a million and killed 25,000.
Responding to pressure from African Ministers of Health, the Meningitis Vaccine Project, a collaboration between the WHO and PATH funded by the Bill & Melinda Gates Foundation, worked on the development of a vaccine specifically tackling the strain of meningitis in the region. Together with the Serum Institute of India, they have brought to the market an affordable vaccine easily accessible to countries that most need it.
GAVI has funded the campaigns, providing more than US$162 million for vaccine support and preparations for the 10 countries that have launched to date. GAVI’s plans include continued support for preventive campaigns in the additional meningitis A belt countries as well as help with epidemic response, surveillance and routine immunisation going forward.
Benin President Dr. Thomas Boni Yayi shows-off a child's vaccine card freshly stamped with MenAfriVac.
It is fitting that all partners in this extraordinary collaboration paused for one day to applaud the collective efforts.
Burkina Faso, Niger and Mali, the first African nations to conduct campaigns, sent representatives to the festivities to tell their stories. Burkina Faso reported 40,000 meningitis cases in 2006 and 2007. In 2010, the country vaccinated 12 million people aged one to 29. Since then, there have been no new cases of meningitis A reported among vaccinated populations.
Ouagadougou’s Eric Nabyoure, the project’s first vaccinee, was only 20 months when he received MenAfriVac. He is now a pre-schooler and thriving.
In the small country of Benin, two million children and young people will receive MenAfriVac in an efficient 10 day sweep of the central and northern part of the country that starts tomorrow. They will join neighbours in Ghana, Cameroon, Chad, Sudan, Nigeria and Senegal, countries that have or will launch mass campaigns in 2012 to beat back the epidemic.
Thursday’s ceremony included many official speeches, awards, declarations, felicitations, hand shaking and back slapping. However, the finale was the most meaningful. President Boni Yayi, healthcare workers, and the Minister of Health participated in the immunisation of another toddler, the first to be vaccinated with MenAfriVac in Benin. To her obvious surprise, the event included not only a large needle, but 4,000 eyes, loud band music, the blinding lights of dozens of television cameras and soothing pats from many important-looking strangers.
From Eric Nabyoure to another toddler on a stage at the Palais de Congres in Cotonou we have jumped from one to approximately 90 million protected against the devastating disease of meningitis. Now that is really something to write home about.
Rob KellyGAVI spokesperson
EPI officials, GAVI's Deputy CEO Helen Evans and Mir Hazar Khan Bijaroni, Minister of the Inter-Provincial Committee, talk about Pakistan's rollout of the pneumococcal vaccine.
I never expected to be so cold in Pakistan in October that I wished I’d brought my fleece. But as I stood in the sub-zero temperatures of Islamabad’s vaccine storage room, surrounded by hundreds of thousands, if not millions, of doses of pneumococcal conjugate vaccines (PCV), I wouldn’t have wanted to be anywhere else.
The introduction of pneumococcal vaccines has the potential to save many thousands of lives, drastically reducing Pakistan’s under-five mortality rate. Today I was privileged enough to have an inside view as the process of vaccinating Pakistani children with PCV started in the national capital.
The PCV vaccine is a complex, conjugate vaccine that has, until now, proved prohibitively expensive to the average Pakistani family, many of whom have seen firsthand the terrible effect of pneumonia on babies and small children. Now, with GAVI support, Pakistan aims to introduce pneumococcal vaccine across the country, hopefully vaccinating the country’s entire annual birth cohort of 4.8 million each year from 2015.
As I walked out of the cold room into the stifling heat, I was reminded of the challenges the Government and its partners face in meeting this objective.
Because of its complexity, PCV must be handled with care. It must be stored at a low temperature, between two and eight degrees centigrade, and used within six hours of opening.
These practical issues underline why GAVI has funded an overhaul of Pakistan’s cold chain, to ensure vaccines are stored and transported at the correct temperature, and paid for training for 100,000 female health workers who will vaccinate children in urban and rural communities.
It is hard to comprehend the sense of relief that parents across Pakistan will feel when their children are vaccinated against pneumococcal disease as a result of this work.
Sadly, more than 400,000 children in Pakistan die before their fifth birthday each year. Pneumonia, which is often caused by pneumococcal disease, accounts for one fifth of these deaths. By choosing to work with GAVI through co-financing (paying a proportion of the cost of each dose of PCV) and vaccinate millions of its children against pneumococcal disease, Pakistan is making an investment in its future.
An ambitious target? Yes. One worth pursuing? Absolutely.
Former Chairman and CEO of MTV Networks International, GAVI Envoy
People throughout the UK have come together in an extraordinary way in recent weeks for a cause greater than themselves. They literally are helping to repair the world through an extraordinary charity, Comic Relief, and its inspiring Sport Relief fundraising campaign.
The efforts of hundreds of thousands in the UK, from stars such as Miranda Hart and John Bishop to everyday people, are making a huge difference.
One of the issues Sport Relief is focusing on this year is child immunisation. I personally have seen in health clinics and villages throughout Africa the impact of these efforts. For just a few pounds, vaccines not only provide protection and save lives, but they also cut healthcare and treatment costs, help reduce poverty, boost local economies and contribute to political stability.
It's a small investment that reaps huge benefits as children grow to be healthy and live a productive life. Yet one in five children still don't have access to this life-saving protection and sadly every 20 seconds a child dies from a disease that could have been prevented with a vaccine.
This is why the funds raised through Sport Relief are so important. Another critical player in this effort is the private sector. Increasingly we are seeing that global health also means economic health and that vaccines produce a huge return on investment.
One of the recipients of this year's Sport Relief campaign is the GAVI Alliance, a cutting-edge international non-profit that has helped immunise 326 million children in more than 70 countries since it was founded in 2000. The support of GAVI and its partners has helped save more than 5.5 million lives.
GAVI has recently launched an innovative private sector programme that will make the Sport Relief campaign even more impactful. The Gavi Matching Fund welcomes contributions from companies, foundations, their customers, employees and business partners which are than 100% matched by the UK Government and the Bill & Melinda Gates Foundation - a longstanding partner of Comic Relief.
This means that Comic Relief is able to make a £5 million grant toward child immunisation through GAVI, with £2.5 million raised through Sport Relief and £2.5 million matched by the Gates Foundation.
This combination of non-profit and private sector support led by the British public's extraordinary support to Comic Relief and the GAVI Matching Fund is quite an impactful way of addressing global health challenges.
The expansion of public and private efforts - especially in wealthy countries like the U.S - would mean that critical goals are reachable, such as GAVI's goal of immunising an additional 225 million children and saving 4 million lives by 2015. But it also would mean that entire villages, communities and nations can begin to engage more profitably in the global economy, standing strong thanks to a handful of effective and affordable vaccines.
Many private sector champions already have joined the efforts of U.K. charities such as Comic Relief, the ARK Foundation and the Children's Investment Fund Foundation as well as global multinationals - J.P. Morgan, Anglo American and "la Caixa". I look forward for others to do also.
They are proving that doing social good is also good business.
This blog features on the Huffington Post.
Honourable Walter T. Gwenigale
Minister of Health and Social Welfare of the Republic of Liberia
Women in poor countries are at risk of many deadly diseases – such as HIV, malaria and TB - in part because there are no vaccines available yet to protect them. But there is a vaccine that can prevent the most deadly form of cancer.
Cervical cancer is the number one cancer-killer of women in my country, Liberia.
Cervical cancer is overwhelmingly a problem of the developing world. Almost 90% of the 275,000 women who die from it every year live in developing countries. These numbers are growing, and if the problem isn’t tackled right now, by 2030 cervical cancer could kill 430,000 women every year.
Yet though women in the world’s poorest nations are at the highest risk of the disease, they have no defence. Unlike in the West, women here often don’t have access to screening and treatment. And what people might not realise is that though the virus is spread through sexual contact, using condoms doesn’t necessarily protect against it. This is why the vaccines are so important to us – to protect girls before they are infected with the virus.
Those vaccines are available to girls and young women in the developed world. Yet, they are not available yet in my country. The high price of HPV vaccines has kept it out of reach of poor women. But thanks to GAVI, vaccine prices for developing countries are falling.
I am delighted that the GAVI Alliance is supporting HPV vaccines in developing nations. A staggering 28 million girls and young women will be immunised by 2020. With these vaccines, the GAVI Alliance is opening the door for women in developing countries to enjoy equal access to these life-saving vaccines as our sisters in rich countries.
We are happy that GAVI has answered our call for HPV vaccines. Now, we must get ready to show we can deliver them. The World Health Organisation recommends giving the vaccine to girls aged between 9 and 13; with three doses within six months. This means coordination between schools and health clinics and the girls’ families – so each country will have to work out how to best reach the girls.
The importance of this vaccine cannot be overestimated. Like many African countries, Liberia’s economy has gone through enormous difficulties, but we are rebuilding our country and making progress in improving healthcare. We need this vaccine. The health of our economy depends entirely on the health of our people. When you save women and girls, you save the very fabric of society.
Leila NimatallahSenior Programme Officer, Advocacy, GAVI
“I always bring my children in on time for their vaccines. I know how important that is for keeping them healthy,” said Misael Amador as he sat in the waiting room at a public hospital in Tegucigalpa, Honduras, holding his four-year-old daughter, Karen Maria on his lap. “I am proud that I am never late to bring them in.”
This sense of pride in ensuring children’s health could be felt everywhere we went in Honduras last week—from the Minister of Health to the health monitors who regularly travel out to rural communities (without pay) to check that children are up to date on their immunisations.
Somehow, this small nation, burdened with deep poverty and violent crime, has achieved what most others (including the United States) have not: a near-perfect vaccination coverage rate. This means fewer child deaths because immunisations have saved the lives of more children than any other medical intervention in the last 50 years.
I had the honour of accompanying members of the United Nations Foundation’s Shot@Life Campaign and six congressional staffers to view Honduras’ national immunisation programme, and I learned that the public health success story of Honduras is directly related to the deep commitment and strong teamwork of everyone involved in the programme.
Back in 2009, my organisation, the GAVI Alliance, paid for immunisations in Honduras to prevent the leading cause of diarrhoea, which is one of the two biggest killers of children worldwide. Two years after the rotavirus vaccine was rolled out, GAVI financed Honduras’ rollout of pneumococcal vaccine as well, taking aim at the other major cause of death for children under five, pneumonia. But buying vaccines at an affordable and sustainable price is only part of the story.
Delivering vaccines, which must be refrigerated from the moment they are developed until the time they are administered, is an incredibly complex task—especially in a place like Honduras, where 45 percent of the rural population lacks reliable electricity. It takes all stakeholders— PAHO, the CDC, the US Agency for International Development, the Honduran Expanded Program on Immunization, doctors, nurses, volunteers, civil society, teachers and parents—working in concert to achieve this incredible success.
Here in the US, advocates of the Shot@Life Campaign are bringing this inspirational story to American citizens and leaders to make the case for why our country should continue its investment and leadership in global health, vaccines and organiSations like GAVI.
In April 2012, Shot@Life will roll out nationally. Everyday citizens, who have been inspired by success stories like Honduras’ and who have been trained to take action to make a difference, will be reaching out to engage their families, their communities and their leaders to educate them and raise awareness about the power of vaccines.
To prepare for this launch, the campaign will be gathering a powerful group of committed Americans together this week in Washington, D.C., to strategiSe and design their efforts to bring the story of vaccines’ impact to the masses. Once Americans learn more about what vaccines can do, they will want to be a child’s shot at life.
Diane SummersSenior Specialist Advocacy and Public Policy, GAVI Alliance
In many countries, cancer is no longer considered a death sentence.
But for the world’s poorest people it remains a stark reality.
startling statistic underpins this situation. Of the more than seven
million people who die from cancer every year, about 70% lived in low-
and middle-income countries. Preventive technology like vaccines, and
effective screening and treatment programmes that we take for granted in
industrialised countries, are simply unavailable to the poor.
This year’s World Cancer Day
calls on everyone to do their part to reduce cancer deaths. GAVI is a
member of the Union for International Cancer Control and supporter of
World Cancer Day. On this day, I want to highlight how GAVI contributes
to the fight against cancer through accelerating the reach of vaccines
that prevent cancer-causing infections.
One in five cancers is
caused by chronic infections. For example, viral hepatitis infections
contribute to liver cancer, one of the top three causes of cancer deaths
worldwide. Cervical cancer, the third most common cause of cancer
deaths among women, is primarily caused by human papillomavirus (HPV). The bacterium Helicobacter pylori contributes to stomach cancer.
vaccines now exist that prevent the viruses that are the primary causes
of liver and cervical cancers. GAVI works to accelerate the reach of
those vaccines to people living in low-income countries.
Hepatitis B vaccine
was the world’s first anti-cancer vaccine. The vaccine prevents
infection with hepatitis B virus, a primary cause of liver cancer and
cirrhosis. When the vaccine became first available in 1981 it was too
expensive for low-income countries to introduce, despite their high
burden of disease.
However, price reductions achieved with GAVI
support spurred a spectacular acceleration of hepatitis B vaccine
introduction in low-income countries. Between 2000 and 2010, the vaccine price dropped by 68% from US $ 0.59 cents to US $0.18 cents.
Consequently, by 2006 more low-income countries than high-income
countries had introduced the vaccine into routine immunisation.
GAVI’s support to developing countries for hepatitis B vaccine has now prevented over three million deaths.
China is a well-documented success story.
Following the introduction of hepatitis B vaccines into national
routine immunisation programme, the percentage of immunised newborns has
risen to 90% and the prevalence of hepatitis B virus carriers is
markedly reduced. Less than 1% of children under five are now chronic
carriers of hepatitis B.
Now, the World Health Organization identifies hepatitis B vaccines as a ‘best buy’
on a population-wide basis – that is, an immediate action that can
accelerate lives saved, diseases prevented and heavy costs avoided.
Vaccines against the human papillomavirus infection that causes cervical cancer in women offer a similar potential.
cancer kills 275,000 women every year. Over 85% of those deaths are in
developing countries. Safe and effective human papillomavirus (HPV)
vaccines can prevent around 70% of cervical cancer cases.
vaccines have been available since 2007. Although HPV vaccines quickly
became part of routine immunisation of girls and young women in many
industrialised countries, they are still largely unavailable in
low-income countries. The high price of the new vaccines remains a
barrier to introduction.
GAVI is working with the two
WHO-prequalified vaccine manufacturers on strategies to lower the price
of the vaccines to make them more affordable. A milestone was reached in
June 2011 when one manufacturer offered to provide its HPV vaccine at
$US 5 per dose to GAVI-eligible countries, a 67% reduction in the
current lowest public price. This was the first-ever public offer of an indicative price for HPV vaccines for low-income countries.
A second milestone was achieved in November 2011, when GAVI took first steps towards introducing HPV vaccines in GAVI-eligible countries.
GAVI will invite countries to apply for funding for HPV vaccines
provided that further price reductions from manufacturers can be secured
to ensure affordability. Funding proposals will have to demonstrate
country’s ability to deliver the vaccines successfully or deploy pilot
projects. By 2015, nine countries are expected to apply and an estimated
1.6 million young women and girls immunised.
The power of
vaccines to prevent the infections that cause cancers has yet to be
fully harnessed. Research continues to better understand the role of
infections in cancer. With this work comes the promise of dramatic new
developments of vaccines to reduce cancer deaths, and the need to roll
out these vaccines in low-income countries.
GAVI is committed to
accelerating the reach of life-saving vaccines, a mission aligned with
the UN General Assembly’s declaration to increase access to
cost-effective vaccinations to prevent infections associated with
No one should die because of where they are born.
15 NovPneumonia: No friend of mine - Seth Berkley, CEO of the GAVI Alliance
12 NovPneumococcal vaccine is saving lives already - Mwai Kibaki, President of the republic of Kenya
12 NovShot in arm breathes hope into lives of world's most vulnerable (The Age) - Sir Gus Nossal, former President of International Union of Immunological Societies, former Chair of WHO's expert advisory group on vaccines
12 NovFighting pneumonia in Bangladesh (ONE.org) - UK Parliamentarian Jim Dobbin, MP
9 NovThe WPD Generation: Moving the needle to fight childhood disease (ONE.org) - Bill Roedy, former CEO of MTV, GAVI Envoy
9 NovRwanda is Proud to Pioneer the Pneumococcal Vaccine (ONE.org) - Agnes Binagwaho, Rwanda’s minister of health
8 Nov'No child should die of a disease we can prevent' (ONE.org) - Joseph Yieleh Chireh, Ghana’s minister of health
8 Nov Pour lutter contre la pneumonie – vaccinez vos enfants ! - Guy Aho Tete Benissan Coordinateur régional du REPAOC, membre du Comité de pilotage du Forum des OSC partenaires de GAVI Alliance
Dr. Amani Abdelmoniem MustafaManager, Expanded Programme on Immunisation, Sudan
This is a guest blog by Dr. Amani Abdelmoniem Mustafa, Manager of the Expanded Programme on Immunisation for Sudan. In August, she wrote about the launch of the rotavirus vaccine in Sudan in the blog: We started! The first child in Sudan to receive a rotavirus vaccine. Here she updates readers about the country’s progress.
KHARTOUM, Sudan — Two months ago, a 42-day-old infant named Jasir Tarig was vaccinated against rotavirus at a ceremony here in Khartoum. He was the very first child in Sudan to be vaccinated against a disease that kills more than a quarter million African children each year. Almost every child in Sudan suffers terribly from diarrhea, especially during the first year of their life, and rotavirus is the leading cause of severe diarrhea. So it was very exciting to watch as Jasir—and hundreds of other infants—were finally given a chance at a future free from the misery of this disease and its possible death sentence.
My immunization team was determined that the vaccine would reach infants not only in the cities, but throughout the country. We can now say we achieved this goal, but it wasn’t easy. Sudan is an immense country with geographical
challenges, isolated villages without health facilities, and security issues. If there was flooding, we used boats or rafts. If roads were blocked, we used tractors. Sometimes vaccines were transported on camels. Sudan has waited so
long for this vaccine that we will not let these challenges get in our way. We will not miss any child.
We also worked hard to get the word out to communities that
the new vaccine would help prevent severe diarrhea and save children’s lives.
We shared the message in schools, and students then shared it with their
mothers who shared it with their neighbors. We placed announcements and
information in newspapers and SMS, on radio and TV, at health centers and on
road signs. If you were walking down the road, you got the message. If you
watched TV, you got the message.
Because the rotavirus vaccine is new to us we’ve monitored
the introduction of the vaccine closely. Recently I returned to the health
clinic where Jasir received his vaccine. I had been especially touched by Jasir
and his mother, who had waited ten years for a child. When I learned that
he—and all the other children vaccinated that day—had come in for their second doses
on schedule and were well, I felt I could finally relax.
Sudan is the first country in Africa to introduce the
rotavirus vaccine with the support of the GAVI Alliance. We hope our experience
will encourage other African countries to apply for support from GAVI, so our
continent no longer carries the staggering burden of a quarter million deaths
due to rotavirus.
All children deserve to be vaccinated and live healthy lives.
Vaccination is a human right. The rotavirus vaccine must reach every child by
any means, irrespective of their situation. We should all work to make this a
Today, GAVI announced that rotavirus vaccines will soon be rolled out in other African countries. Watch a short film in which immunization experts, health workers, and mothers from Sudan
and Tanzania talk about the need for the vaccines and their hope for the future.
John WeckerPh.D., director of Vaccine Access and Delivery, PATH
Last month, I visited the pediatric ward of a district hospital in Dar es Salaam, Tanzania, and found it relatively empty. Relative, that is, to what I would expect to find in the rainy season, when three to four children typically fill each bed. Children hospitalized during the rainy season mainly suffer from respiratory disease or severe diarrhea. Of the children with severe diarrhea in that ward in Dar es Salaam, as throughout hospitals in Africa, the majority will be infected with rotavirus.
Rotavirus is the leading cause of severe diarrhea in children under five years of age, killing as many as half a million each year. A staggering 50 percent of these deaths occur in Africa; six of the seven countries with the highest child death rates from rotavirus are located on the continent.
While these statistics are disturbing, there is hope. Rotavirus vaccines are already saving children’s lives today in countries where children have access to them—and could be saving millions more in Africa and around the world if they were more widely used.
Three recent scientific studies strengthen the case that rotavirus vaccines reduce the risk of disease, decrease deaths and hospitalizations, and save health care costs. Prior to the introduction of the vaccines in Mexico in 2006, 50 percent of deaths due to childhood diarrhea were caused by rotavirus. The country has since seen an impressive 56-percent reduction in the number of children under age five dying from diarrhea.
In the US, a study by the Centers for Disease Control and Prevention (CDC) found that vaccinating infants against rotavirus led to a significant reduction in the number of older children hospitalized with severe diarrhea. The authors conclude that very young children transmit much of the rotavirus disease in communities and, by vaccinating them, severe forms of the disease can be prevented even in those who have not been vaccinated. Another CDC study reported dramatic decreases in health care visits and costs for diarrhea-related illnesses in children under age five following the introduction of rotavirus vaccines.
The evidence supporting the use of rotavirus vaccines around the world is compelling, and African countries are beginning to demand this lifesaving tool. In July of this year, Sudan became the first country in Africa to introduce rotavirus vaccines nationwide with the support of the GAVI Alliance. This is the first step in a coming wave of introductions sweeping across Africa. By rapidly introducing rotavirus vaccines across the continent, we look forward to the day when pediatric wards in places such as Tanzania are nearly empty of children with severe diarrhea throughout the year.
Dr. Wecker directs PATH’s activities in vaccine access and delivery, which focus on developing and advancing strategies, technologies, and interventions that help move research achievements in immunization into routine use in the field.
This blog post is also featured on the Bill & Melinda Gates Foundation website.
Nilgun AydoganSenior Programme Manager, Programme Delivery, GAVI Alliance
I’ve just come back from a field visit to Sri Lanka, still recovering from a 25 year civil war.
Despite this and a tsunami in 2004, the tropical island has maintained its immunisation coverage at consistently close to 100%. (footnote ref: UNICEF/WHO country estimate for 2009 is 97%).
Sri Lanka’s government and 20 million population are extremely committed to immunisation. And, even without the stunning beaches and coconut tree, mountain scenery, it’s a pleasure to be assisting.
GAVI’s health system strengthening support (HSS) programme is helping rebuild clinics in the island’s north-east regions, where entire communities are returning to their villages since the war ended two years ago.
Not that the war dented Sri Lankan desire for immunisation.
Fleeing the fighting, Sri Lankans would leave their money and possessions but never their immunisation records. Even when crossing rivers and other barriers to run away, they wrapped their immunisation cards in plastic.
GAVI’s money is helping to train medical staff in a wide range of primary health care issues, as well as renovate the health centres.
There’s no shortage of commitment from the communities, where mountains of paperwork follow every child’s nutrition status, growth, as well as immunisation.
And in one village that I visited, a landlord had donated a room in a house for public health midwife so that so his community could have access to primary care.
Another village, the community built their own health center so that government can staff the clinic for MCH services.
With an average annual income per person of more than US$ 1,500, Sri Lanka will soon graduate from GAVI support, wealthy enough to be needing no more GAVI support.
One day, we can hope, the civil war will be a distant memory. Immunisation, I’m sure, will be present for many years to come!
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