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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.
Haiti is at the forefront of one of the most important developments in global health.
On Saturday, this beautiful country – devastated by earthquake and hurricane – will become the 14th GAVI-supported country to introduce lifesaving rotavirus vaccines into its national immunisation programme joining four other GAVI countries in the Americas region: Bolivia, Guyana, Honduras and Nicaragua.
The introduction of rotavirus vaccine is a tangible symbol of Haiti’s effort to rebuild and protect its children. It is a remarkable achievement just three years after a 7.0 magnitude earthquake demolished the Ministry of Health, destroyed or seriously damaged 30 hospitals, and took the lives of 230,000 people, including some 300 health workers.
I am honoured to represent the GAVI Alliance at the launch, in partnership with the Haitian Ministry of Health, the Pan American Health Organization (PAHO), UNICEF and the World Health Organization (WHO).
Rotavirus, which causes severe diarrhoea, takes the lives of more than 2,200 Haitian children every year, accounting for nearly half of all under-five diarrhoea-related deaths in Haiti. Globally, more than 1,200 children each day will die as a result of rotavirus.
The introduction of this new vaccine – the capstone to PAHO’s Vaccination Week in the Americas and WHO’s World Immunization Week (WIW) – puts the government of Haiti at the forefront of developing countries, demonstrating significant leadership.
I applaud Haiti’s leaders for making child health a top-priority. Their commitment to routine immunisation services will create a backbone that supports the rest of society as Haiti rebuilds.
Rotavirus is highly contagious and resilient. Typical interventions that stop many bacteria and parasites that cause diarrhoea, including cholera – improvements in hygiene, sanitation and drinking water – do not adequately prevent the spread of rotavirus. Rotavirus disease cannot be treated with antibiotics or other drugs. Vaccination is the best way to prevent severe rotavirus disease and reduce its burden.
The good work of PAHO and WHO to highlight the critical need for immunisation is admirable. In its second year, World Immunization Week builds on a decade of Vaccination Week regional campaigns that have helped vaccinate more than 411 million people in Central America, South America and the Caribbean, led by PAHO.
Last year, in conjunction with Vaccination Week and World Immunization Week, Haiti introduced pentavalent vaccines in partnership with GAVI. Its target: protect more than 200,000 children against five deadline diseases: diphtheria, tetanus, pertussis (also known as whooping cough), Haemophilus influenzae type B and hepatitis B.
GAVI has been a partner with Haiti for twelve years, with over US$ 24 million committed through 2015 to support its immunisation programs. It is an honour that GAVI can play a role in the rebirth of Haiti’s public health system. When I see the faces of its children at ceremonies this Saturday, I will see the future of Haiti and appreciate the lasting difference that immunisation makes.
This blog post is also featured on One.org.
I am looking forward to participating in the 2012 World Cancer Leaders’ Summit, to be held in Montreal, Canada on 27 August. This will be an opportunity to take stock of where the world is with regards to cancer prevention and treatment and to learn more about action to address the existing challenges to eliminating cancer as a life-threatening disease for future generations.
Leaders from the health, government, philanthropic and corporate sectors will come together to discuss innovative ways of reversing the global cancer epidemic and I am excited to be part of this.
Since 2000, the GAVI Alliance has made great strides in supporting low-income countries in tackling leading child killers, such as pneumonia and diarrhoea, by accelerating the roll-out of new and under-used vaccines.
When it comes to cancer prevention, I am happy to say that GAVI is also making a difference on this front. By accelerating the introduction of hepatitis B vaccines in developing countries since 2000, GAVI has helped prevent an estimated 3.7 million deaths from liver cancer (caused by hepatitis B).
GAVI’s success in rolling out the hepatitis B vaccine, the first anti-cancer vaccine, can now be potentially replicated with vaccines against the human papillomavirus (HPV), the leading cause of cervical cancer.
Women in developing countries often have little or no access to screening or treatment for cervical cancer so a vaccine that prevents HPV is even more important.
GAVI’s support for HPV vaccines will help protect tens of millions of girls from cervical cancer, which is the leading cause of cancer deaths among women in poor countries. What is most disturbing about this cancer is that it hits women in their forties and fifties when their contribution to families and childrearing is most important. And the children left behind are not only robbed of their mother but all too often have a lower chance of getting a good education and receiving adequate healthcare.
As long as GAVI can secure affordable prices from manufacturers, we expect to begin providing the vaccines to GAVI-eligible countries ready to roll them out nationally as early as 2013. Countries applying for GAVI support to run a more focused HVP demonstration project also need to show that their HPV roll-out strategy to vaccinate girls aged 9 to 13 is integrated as part of a national cancer prevention and screening plan.
With the growing focus on cervical cancer prevention, I am very hopeful that the GAVI Alliance will contribute by preventing millions of cervical cancer deaths through vaccination and ensuring that all women, wherever they are born, can be protected from this horrible cancer.
This blog post is also featured on ONE.org.
Helen Evans and Andrea GayDeputy CEO, GAVI
We have a chance to make history in the fight against rubella and measles. The human and economic toll of these diseases is huge and preventable.
In some places, rubella -- often referred to as German measles -- is no longer the threat it used to be. During the last large-scale epidemic in the United States, in the mid-1960s, about 12.5 million people were infected and more than 20,000 infants were born with related birth defects. Thanks to widespread vaccination in almost 50 years since the epidemic, rubella has disappeared from the Americas.
But for millions of mothers and children in poorer countries with limited access to vaccines, rubella poses an on-going danger. Pregnant women who contract rubella in the first 10 weeks risk a miscarriage or stillbirth and there's a 90% chance their child will be born with serious birth defects -- such as blindness, deafness, or heart disease -- known as Congenital Rubella Syndrome, or CRS. With at least 110,000 babies born with CRS every year, the consequences can be staggering.
The GAVI Alliance, the Measles Initiative, and our partners are committed to creating a dramatically different scenario by building on the success of accelerated measles control efforts. This year, GAVI will begin to fund catch-up campaigns to provide a combined Measles-Rubella (MR) vaccine. Following guidelines from WHO, the campaigns will target children aged 9 months to 14 years inclusive and ensure the impact is lasting by embedding MR vaccine into continuing immunisation programmes. In response to country demand, we anticipate introducing MR vaccine into 30 countries by the end of 2015 and by 2018 we expect to support at least a further 20 developing countries.
In 2000, measles killed more than 700,000 children. A global drive led by the Measles Initiative to increase access to measles vaccine has protected more than 1 billion children, raised measles routine coverage to 85% and reduced measles deaths by 78%. This has contributed to about a quarter of the reduction of child mortality globally since 1990 as we strive to reach the Millennium Development Goals.
Investments in measles control have also led to tens of thousands of trained health workers, detailed plans and mapping, community demand and logistics systems to reach children with vaccines no matter how remote their village. Now to combat rubella, countries can use the sameplatform and deliver MR vaccine.
The Measles Initiative, which has already mobilised and invested US $875 million for measles control including generous support from GAVI, will continue to raise funds for immunisation, surveillance, and research, and provide technical support to countries to ensure childrenhave opportunities to receive MR vaccine.
Developing countries supported by GAVI and the Measles Initiative will play their part by continuing to fully fund and provide MR after the catch-up campaigns.
While GAVI and the Measles Initiative rightly focus resources in developing countries, industrialised countries must alsostep-up efforts as outbreaks have led to measles importation across borders. More than 33,000 people in Europe suffered measles last year due primarily to a failure to vaccinate, according to WHO. A recent meeting of health experts in Rome on progress toward eliminating rubella and CRS in Europe underscores the need to address both diseases simultaneously and globally through partnership, political commitment and funding. There's no better time to seize this opportunity.
A young woman receives immunisation against measles and rubella during an immunisation campaign in Laos, November 2011. The rubella virus can lead to miscarriage, still births, or birth defects when passed from mother to child during pregnancy. An estimated 90,000 birth defects, known collectively as congenital rubella syndrome (CRS), happen every year in the world’s poorest countries. Photo credit: The Measles Initiative/C. McNab/2011.
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