Haemophilus influenzae type b vaccine support

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Large numbers of poor countries have made Haemophilus influenzae type b vaccines part of their national immunisation programmes

Routine use of the vaccine has led to virtual eradication of Hib disease in many sub-Saharan countries

Hib Nicaragua

Nearly all low-income countries introduce Hib vaccines

In 2008, some 10 years after high-income countries crossed the 50 percent coverage line, Haemophilus influenzae type b (Hib) vaccines had been introduced in half of all low-income countries.
 

By 2011,  nearly all Gavi-eligible countries had introduced Hib vaccines with Gavi support, immunising a cumulative 124 million children and preventing an estimated 697,000 future deaths.

Shift in market conditions after slow start

The average number of country introductions per year increased by more than 10-fold post-Gavi.

Second Gavi Evaluation 2011

According to Gavi's Second Evaluation report, the Vaccine Alliance played a critical role in facilitating the shift in market conditions to create today's ever-growing demand for Hib vaccine.

First, the Hib Initiative allowed health ministries in developing countries to establish the exact disease burden of Hib and make evidence-based arguments in favour of introducing a suitable vaccine.
 

Critically, it also secured a global recommendation from WHO for the introduction of Hib vaccines into national immunisation programmes.

Graph: Hib vaccine introduction in high- and low-income countries

Hib vaccine introduction in high- and 
low-income countries 

Subsidisation of pentavalent

Second, Gavi's subsidisation of pentavalent for countries interested in introducing vaccines against Hib has encouraged manufacturers to invest in developing new versions of the conjugate vaccine.

It is no coincidence that the number of WHO prequalified pentavalent vaccines has risen since 2005 - the year when both developing countries and manufacturers were reassured that Gavi's initial five-year life cycle would be extended.

The long-term predictability and large-scale nature of Gavi support for pentavalent, coupled with the guaranteed supply at a slowly diminishing price, has given low-income countries confidence to include Hib in their long-term plans. 

Haemophilus influenzae type b is the third vaccine-preventable cause of death in under-fives

By 1999, 10 years after being licensed, Hib vaccine only available in one low-income country

Disease burden

Spread through sneezing and coughing, in the pre-vaccine era Haemophilus influenzae type b (Hib) was the leading cause of childhood meningitis - inflammation of the membranes covering the brain and spinal cord. Many survivors suffer paralysis, deafness, mental retardation and learning disabilities.

Even today, almost 20 years since safe and effective Hib conjugate vaccines were first licensed in the early 1990s, Hib remains the second most common cause of bacterial pneumonia deaths in children aged under five and the third vaccine-preventable cause of death in children aged under five.
 

Globally, the disease accounts for about eight million serious illnesses each year, resulting in nearly 400,000 child deaths, most of them in low-income countries. Ten countries in Asia and Africa account for 61 percent of all Hib-related deaths.

Hib can be treated with antibiotics, but lack of access to adequate medical facilities and increasing levels of antibiotic resistance lead to high mortality rates.

Vaccine fails to take-off in low-income countries

After Canada became the first country to introduce Hib vaccines in 1986, uptake was fast and, by 1998, 50% of high income countries had introduced the vaccine into their immunisation programmes leading to dramatic declines in the incidence of Hib disease.

However, high costs meant low-income countries could not afford the vaccine. The Gambia was the lone exception, becoming the only developing country to introduce Hib vaccine thanks to a manufacturer's donation in 1997.

In 2006, WHO issued a powerful recommendation for Hib vaccines, urging that it be included in all routine immunisation programmes around the world.

Map of the global burden of Hib disease

Hib - disease burden 

In 2000, Gavi offers routine immunisation support for Hib vaccines

Gavi-funded Hib Initiative aims to raise profile of Hib vaccine among developing countries and donors

Hib, one of Gavi's first priorities

When Gavi set-out to catalyse the adoption of new vaccines in poor countries in 2000, Haemophilus influenzae type b (Hib) was top of its priority list. The vaccine had existed since the early 1990s but by 2000, only one low-income country had introduced the vaccine into its national immunisation programme.

As a result, subsidisation for routine immunisation against Hib was immediately made available through Gavi's new and underused vaccine (NVS) programme.

The Vaccine Alliance encouraged the administration of Hib through the combination pentavalent vaccine. This five-in-one multivalent vaccine, administered in a three-dose schedule, offered low-income countries the opportunity to provide protection from Hib at the same time as protecting their children against four other diseases: diphtheria, tetanus, pertussis (DTP) and hepatitis B.

Map of countries approved for Gavi's Hib vaccine support

Map of countries approved for Hib support 

Role of the Hib Initiative

Initially, Gavi-eligible countries were slow to take-up the offer of support for Hib vaccine, both because of a poor understanding of Hib's disease burden and concerns about the cost.  By 2004, four years after the Hib vaccine had become part of Gavi's vaccine portfolio, only 15 countries had been approved for Hib vaccine support out of the 74 eligible.

In response, in July 2004, the Gavi Board established the Hib Task Force to explore how the Vaccine Alliance could fill the knowledge gap and lay the political foundations for large-scale Hib vaccine introduction. Following the 2005 recommendation of the Task Force, the Board allocated a four-year US$ 37 million grant to set up the Hib Initiative.

By bringing together the knowledge of the Johns Hopkins Bloomberg School of Public Health, the London School of Hygiene & Tropical Medicine, and the Centers for Disease Control and Prevention (CDC), the Hib Initiative used a combination of collecting and disseminating existing data, research and advocacy to help countries build a case for adopting the Hib vaccine.

+ 150 million

By the end of 2013, 11 countries in the African meningitis belt had collectively immunised 153 million people against meningitis A with support from the Vaccine Alliance.

WHO/UNICEF

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