Yellow fever vaccine support

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Gavi-supported yellow fever vaccine campaigns in 14 African countries have protected 98 million people

Yellow fever vaccine introduced in routine immunisation systems in 17 countries in Africa

Over 30 million doses from the emergency stockpile have reached Gavi-supported countries experiencing yellow fever outbreaks 

Yellow fever Nigeria

Nigeria, where yellow fever is highly endemic, has introduced yellow fever vaccine into the routine system and conducted vaccination campaigns with support from Gavi. Credit: Gavi/2013/Adrian Brooks.

Yellow fever vaccine is highly effective: a single dose leads to long-term, probably even lifelong, immunity in 99% of people vaccinated.

Gavi has invested more than US$ 264 million in yellow fever control since 2001, focusing on African countries where the vast majority of yellow fever deaths occur. The Vaccine Alliance funds routine vaccine introductions, an emergency stockpile and preventive vaccination campaigns.

Gavi’s support is closely aligned with the Yellow Fever Initiative, a partnership led by WHO and UNICEF to coordinate yellow fever control at the global level.

LIFE-SAVING PREVENTIVE CAMPAIGNS

Since 2011, Gavi-supported prevention campaigns have been organised in 14 countries in Africa, protecting more than 98 million people in Benin, Burkina Faso, Cameroon, the Central African Republic, Côte d’Ivoire, Ghana, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone, the Sudan and Togo.

In 2015 alone, 10 million people were vaccinated through Gavi-supported immunisation campaigns. Since 2010, yellow fever campaigns together with routine immunisation programmes supported by Gavi have averted an estimated 200,000 yellow fever-related deaths. The campaigns have significantly reduced the risk of yellow fever outbreaks in Africa, lowering the disease burden by an average 27% among 12 “high-risk” countries.

No yellow fever outbreaks were registered in 2015 in countries in West Africa where campaigns had been conducted. However, rapid urbanisation and environmental changes are shifting the geography of yellow fever, and the virus is now affecting areas previously considered non-endemic. Recent yellow fever epidemics, which have also spread outside of Africa, underline the continued global threat posed by yellow fever. 

ROUTINE IMMUNISATION IN 17 COUNTRIES – BUT COVERAGE REMAINS LOW

Despite the success of mass campaigns, challenges remain. Although the Vaccine Alliance has helped 17 countries introduce yellow fever vaccine through routine immunisation, only 3 of these countries reported routine coverage rates of 80% or above in 2015, and 5 countries reported less than 60% coverage.

For example, in Nigeria, where yellow fever is highly endemic, routine immunisation coverage stood at just 54% in 2015.

EMERGENCY STOCKPILE RESPONDS TO OUTBREAKS

Between 2006 and 2015, and with support from Gavi, the International Coordination Group (ICG) deployed over 25 million doses of the yellow fever vaccine worldwide in response to outbreaks. The ICG includes representatives from WHO, UNICEF, Médecins sans Frontières and the International Federation of Red Cross and Red Crescent Societies.

Countries can receive financial support to cover emergency vaccination campaigns that draw on the stockpile. For more details, visit: www.who.int/csr/disease/yellowfev/global_partnership/en/  

Outbreaks of yellow fever continue to erupt despite availability of an effective vaccine since the 1930s

Geographic focus of the disease shifting from West to Central and East Africa

UP TO 60,000 YELLOW FEVER DEATHS EVERY YEAR

Before the development of a life-saving vaccine in the 1930s, the yellow fever virus was responsible for devastating epidemics in large cities in Africa, the Americas and Europe.

In the last 20 years, a combination of declining population immunity, rapid urban migration, climate change, deforestation and an increase in mosquito vectors has led to a resurgence of yellow fever. Forty-seven countries in Africa (34) and Central and South America (13) are endemic, or have regions that are endemic, for yellow fever. A recent modelling study estimated that yellow fever infects between 840,000 and 1.7 million people in Africa each year, resulting in 84,000–170,000 cases and 29,000–60,000 deaths.1 

Rapid urbanisation has exacerbated the issue by concentrating people who have not been immunised in settings where the yellow fever virus thrives. City areas provide fertile breeding grounds for mosquito larvae, as stagnant water collects in water containers, cans and tyres. Overcrowded housing further accelerates the spread of the virus.

DISEASE BURDEN

An acute viral haemorrhagic disease transmitted by mosquitoes, yellow fever causes devastating epidemics in areas where infected mosquitoes can come in contact with people who are not vaccinated. Death rates can be as high as 50% among those severely affected.

Yellow fever can be prevented by a safe, affordable and highly effective vaccine. One injection protects an individual for at least 35 years, and possibly for life.

Yellow fever cannot be eliminated. However, the risk of outbreaks can be substantially reduced by immunising at least 70% of the at-risk population. In order to achieve this high coverage and maintain immunity for life in the 34 endemic countries in Africa, Gavi supports routine immunisation and preventive campaigns in eligible countries.

AFRICA RISK

The recent resurgence of yellow fever is especially pronounced in West and Central Africa, where mass vaccination campaigns in the period 1933–61 effectively meant the virus had disappeared.

This alarming trend started in equatorial Africa with a 1990 epidemic in Cameroon, and then spread across the region. By 2005, failure to immunise successive birth cohorts through routine immunisation had led to approximately 200,000 yellow fever cases and more than 50,000 deaths in West Africa's 12 highest-risk countries.

Today, the virus poses the greatest threat to 900 million people in more than 47 endemic countries – 34 in Africa and 13 in Central and South America. Shifts in migration patterns and environmental changes are affecting the geography of yellow fever, with outbreaks now occurring in areas historically considered non-endemic.

In 2015, two “low-risk” central African countries reported yellow fever cases – Equatorial Guinea and Gabon. In December, the initial cases of an urban outbreak were detected in Luanda, Angola – the beginning of an outbreak that subsequently spread throughout the community as well as outside of Africa.

Faced with an increasing risk of large urban yellow fever outbreaks, WHO has revised its long-term yellow fever control strategy. This emphasises the importance of international health regulations in preventing cross-border spread of the virus, and the need to enhance surveillance to detect, confirm and respond to yellow fever cases in a timely way. The strategy is closely aligned with previous Gavi-funded yellow fever immunisation strategies.

SHORTAGE OF SUPPLY

Even though four companies manufacture the yellow fever vaccine, the demands of mass preventive campaigns and outbreak response have severely depleted supplies. Doses intended for preventive campaigns are frequently diverted to treat outbreaks, leaving emergency stocks dangerously low and delaying preventive campaigns. In both Nigeria and the Sudan, for example, campaigns are three–four years overdue. In response, Gavi has worked with WHO to revise its yellow fever control strategy.


1 http://www.who.int/csr/disease/yellowfev/YellowFeverBurdenEstimation_Summary2013.pdf

Gavi provides yellow fever support for routine immunisation, campaigns in high-risk countries and emergency stockpiles in case of outbreaks

Yellow fever vaccine is one of the priority vaccines that Gavi has supported since its foundation in 2000, both to protect populations at risk and to reduce the need for emergency response.

GAVI FUNDING SUPPORT

Preventive campaigns

Eligible countries can receive support for preventive campaigns on a one-dose vaccination schedule, as well as associated supplies. Countries receiving support for preventative campaigns do not get a vaccine introduction grant. However, Gavi provides US$ 0.65 per individual in the target population of the campaign to help cover operational costs (expected to cover approximately 80% of the total estimated cost). Countries must meet the remaining operational expenses.

Countries approved for Gavi yellow fever vaccine support

 

Introduction into the routine immunisation system

WHO recommends that all countries at risk incorporate the vaccine into their national routine immunisation programme.

Gavi provides support for a one-dose vaccination schedule, as well as associated injection supplies. Countries that are using the vaccine for the first time can also apply for a one-time cash vaccine introduction grant. It is expected that the government or partners cover the remaining costs associated with the vaccine introduction.

Global stockpile for emergencies

Countries eligible for Gavi support can rely on the global stockpile of yellow fever vaccine for use in emergency outbreaks. The stockpile is managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control. Countries can receive funding to cover emergency vaccination campaigns that draw on the stockpile.

In 2011, following a shortage of yellow fever vaccine during an outbreak in Guinea, a global reserve of two million doses was created to ensure a rapid response to future epidemics.

5 -> 16

From 5 to 16 vaccine manufacturers supplying Gavi – over half based in emerging markets.

2001: 5 vaccine manufacturers producing prequalified, appropriate Gavi vaccines – 1 based in an emerging market;
2015: 16 vaccine manufacturers producing prequalified, appropriate Gavi vaccines – 9 based in emerging markets.

Gavi 2016

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