GAVI blogs

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Tuesday

14 May

2013

Cervical cancer vaccine success brings hope to millions of women

Cervical cancer is a scourge of women the world over, but particularly so in the poorest parts of the world, where it kills nearly a quarter of a million women every year, or roughly one every two minutes. From Mombasa to Mumbai women who have been infected with the human papillomavirus (HPV) could be developing life-threatening cervical cancer and are unaware or unable to do anything about it.

Every year an estimated 275,000 women lose their lives to cervical cancer. More than 85% of those who die from the disease live in developing countries where access to screening and treatment is limited – and often non-existent – so they simply do not receive the treatment they require.

But this is about to change.

From this week, the GAVI Alliance, a public-private partnership that supports vaccination in developing countries, will help countries to introduce the HPV vaccine. By 2020, we estimate that countries will have immunised more than 30 million girls in 40 countries against this silent killer.

Making HPV vaccine available to girls in developing countries marks a huge step for GAVI too. For the first time we will help countries offer vaccination to girls of school age. Previously GAVI’s routine immunisation support has been focused on protecting babies from the major killers of children under five, such as pneumococcal disease and rotavirus diarrhoea.

Our second major challenge was to secure agreements with vaccine manufacturers to enable us to purchase HPV vaccines at prices that are both affordable for GAVI and sustainable for countries once their economies grow beyond the threshold for GAVI support. When we made our decision to include HPV in our portfolio at the GAVI Board meeting in Dhaka in November 2011, we did it on the condition that affordable prices would be accessible. As chair of the GAVI board I was delighted when GAVI’s CEO, Dr Seth Berkley, was able to report to me that he had secured a record low price for HPV vaccine of $4.50 per dose.

The whole case of HPV not only shows that the GAVI model makes sense when it comes to market innovation, but it is also a compelling case for equity: most of the disease burden is in the poorest countries yet most of the vaccine has so far been used in the richest countries. Just three years ago the need for HPV vaccine in the developing world existed, but no vaccination programs did. But now thanks to GAVI’s model, that need is being filled.

This week, Kenya became the first country to introduce HPV vaccines with GAVI funding as part of a demonstration project, where countries are given the opportunity to explore ways to deliver HPV vaccines and to make informed decisions if they then choose to apply for national introduction. We expect Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and United Republic of Tanzania to follow suit over the next year. From 2014, a further set of countries will begin national HPV vaccine introductions giving, extending the reach of this life-saving vaccination.

Prevention is usually better than treatment. This is never more true than when the opportunity to prevent comes in the form of a simple vaccination while the diagnosis and treatment is, in many cases, simply not accessible.

It fills me with pride to know that the GAVI Alliance is at the forefront of ensuring that women in developing countries have access to the same vaccines as their counterparts in the industrialised world.

Vanessa Mdee
MTV Africa VJ from Tanzania, singer and activist

Thursday

9 May

2013

Giving my younger African sisters a chance

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 interaction. 

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.

Helen Evans
Deputy CEO, GAVI

Thursday

25 April

2013

Haiti rebuilds with a foundation of vaccines

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.

Mercy Ahun
GAVI’s Special Representative to GAVI Eligible Countries

Wednesday

24 April

2013

Photo credit: GAVI/2012/Olivier Asselin

I accompanied GAVI CEO, Dr Seth Berkley, on a joint country visit with Bill Gates to Ghana two weeks ago. This was Mr Gates' first visit to the Ghana Health Service.

We spent our first morning in the field, visiting the Community-based Health Planning & Services initiative’s compound, which is part of the strategy for changing primary health care from a focus on clinical care at district and sub-district levels to a new focus on high quality services at community and doorstep locations.

The Community Health Officers were working at an outreach clinic, under a shady tree providing some cover from the hot sun. They showed us their child registers and 'Well Baby Clinic' cards with records of vaccinations, weight and other relevant child health records. This particular district is also using mobile phone technology to register pregnant women. Regular messages, including vaccination appointments are sent in the local language to mothers.

The Community Health Officers use this mobile technology to generate a list of expected clients and defaulters for follow up. They also use paper systems of child health cards and registers as well as logbooks in clinics to track a child’s progress with vaccinations. 

Mr Gates witnessed real progress in using the paper system and the culture of data that it supports. For example, the district holds regular monthly meetings to validate data before it is shared with higher levels.

At the end of the day, the health workers were happy with Mr Gates summary of the visit: "The system is not perfect but it works."

I was reminded of his words in subsequent conversations I had with family and friends the following week. My cousin, a dermatologist, praised the Community Health Officers for the way they keep and use immunisation data. Monthly inter-district review meetings were opportunities to share best practices and validate data on reproductive and child health including immunisation. She wished clinical services were as organised as the preventive services organised by the Community Health Officers.

At a subsequent dinner organised by some retired public health colleagues, one of them described how medical students he examined could not remember the last time they saw a case of clinical measles. He spoke eloquently about the dedication of Community Health Officers at peripheral levels of the health care system in bringing services including immunisation to communities. Countries unhampered by the scourge of vaccine preventable diseases can rise to their full developmental potential, he said. 

More should be done by the Ghana Health Service and development organisations to publicise how we are contributing to national prosperity. Strong primary health care systems are the bedrock of successful immunisation programmes, which ultimately contributes to saving lives.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Monday

22 April

2013

New vaccine introductions mark World Immunization Week

Dagfinn Høybråten vaccinating a child in Haiti during World Immunization Week,2012

World Immunization Week, which is being celebrated around the globe this week, is an important opportunity to highlight the power of immunisation in protecting children against life-threatening diseases, including rotavirus diarrhoea and pneumococcal disease, two of the leading child killers.

It is impressive and encouraging to see how governments, development partners, international organisations, manufacturers, health experts and civil society are all uniting around one important goal – universal immunisation coverage. Every child, everywhere deserves a healthy start in life. There is no reason why children in poor countries should die from vaccine-preventable diseases in the 21st century.

Although vaccines are widely available in high-income countries, the unacceptable reality is that 22 million children under five in developing countries are missing out on basic vaccines. For this reason, the GAVI Alliance is committed to working closely with countries to reach the hard to reach with vaccines – including children in remote areas and marginalised populations, and improve communities’ understanding about the health benefits of immunisation.

The good news is that, this week alone, four countries – Haiti, Somalia, Uganda and Zambia - will introduce new vaccines with GAVI support. 

Over the past year, Haiti has really stepped up to the plate in making immunisation a priority after the devastations caused by the earthquake that hit its capital, Port au Prince, in January 2010.

This time last year during World Immunization Week, I was in Haiti representing GAVI at a vaccination campaign against measles, rubella and polio organized by Haiti’s Ministry of Health. It is inspiring to see that one year on the country has made great strides in rolling out the pentavalent vaccine and is now introducing the rotavirus vaccine, protecting infants from the leading cause of severe diarrhoea, which is often fatal for children under five. To date, GAVI has supported 14 countries to introduce the rotavirus vaccine and plans to reach five million children with the vaccine.

During World Immunization Week this year, political leaders and global health experts will gather in Abu Dhabi for the Global Vaccine Summit to celebrate immunisation successes, including the unrelenting efforts of the polio eradication partners over the past few years. This global push around polio eradication underscores the true power of immunisation – the idea that diseases can be literally wiped off the face of the earth.

GAVI is committed to supporting the polio “endgame” by strengthening routine immunisation services. These services are essential to complete eradication and ensure that countries remain polio free. Investing in routine immunisation programmes will not only help us deliver the full package of vaccines to children, but eradicate polio once and for all.

I am delighted to see that President Barroso and Commissioner Piebalgs of the European Commission will take part in the Summit, demonstrating the EC’s strong commitment to support immunisation. I was very pleased to meet with Bono and Commissioner Piebalgs last year in October and to discuss with the Commissioner the power of immunisation.

Scaling up immunisation programmes in poor countries would not be possible without continued support from GAVI’s generous donors, including 10 European Union member states and the European Institutions. Since 2003, the European Institutions have committed EUR 82.5 million to support GAVI’s mission of ensuring that children of the African, Caribbean and Pacific (ACP) Group receive the basic package of vaccines, including EUR 10 million for pneumococcal vaccines in ACP countries, pledged in June 2011.

We are grateful that most of GAVI’s donors provide long-term predictable funding, thereby ensuring that routine immunisation programmes are sustained with a reliable supply of quality, low-cost vaccines.

World Immunization Week is a chance to celebrate global achievements in vaccination, but also an opportunity to acknowledge how much we still need to do.

This blog post is also featured on Euractiv.

Bill Gates
Co-chair and trustee of the Bill & Melinda Gates Foundation

Monday

25 March

2013

What I'm Learning About Ghana

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 Whetham
GAVI Country Responsible Officer

Friday

22 March

2013

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

Friday

15 March

2013

Why I am a Red Nose Day supporter

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.

Kicking off the GAVI Partners’ Forum with simple reminders of simple solutions

"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:

• Malaria
• Pneumonia
• Diarrhea
• Low-birth rate
• Pre-term birth

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 Moore
Country Programmes, GAVI

Friday

16 November

2012

Watched by Benin President, Dr. Thomas Boni Yayi, Health Minister Dr. Dorothée K.Gazard, administers the MenAfriVac. 

Something to write home about from Benin: meningitis vaccination campaign to protect young people

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.

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.

Freezing cold in Pakistan, with a heart-warming story to tell

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.

Dan Thomas
Head, Media and Communications, GAVI Alliance

Tuesday

12 June

2012

The Great, the Good, the Glamorous ... and Ghana

The Great, the Good and the Glamorous are gathering in Washington DC this week to talk about some really big issues affecting the world’s poorest and most vulnerable children and adults.

Anyone who is anyone in Global Health and Development is in town.

Nobel prize winner President Ellen Johnson Sirleaf of Liberia and Malawi’s President Joyce Banda top the bill at the Frontiers in Development Conference from 11-13 June and Hillary Clinton will kick things off at the Child Survival Call to Action from 14-15 June.

Mandy Moore, Christy Turlington Burns and Ben Affleck will add a little glamour but also a ton of heartfelt commitment. And, only slightly less exciting if you are a “development insider”, members of the GAVI Alliance Board will meet at the Capitol Hilton from 12-13 June to review progress since the historic GAVI Pledging Conference one year ago when generous donors made unprecedented commitments to childhood immunisation.

Of course, everyone is wondering if President Obama might even make an appearance? Now that would really help focus attention on important subjects like child and maternal mortality in the world’s poorest countries.

To raise awareness about the huge number of children who die before they reach the age of five (7.6 million in 2010) (and because they are good sports), many of these global health advocates have sent photographs of themselves taken when they were five to USAID’s excellent new website.

Even the media are getting in on the act with the likes of Judy Woodruff and Ray Suarez from PBS, Femi Oke of WNYC and CNN’s Kaj Larsen bringing professional TV-style moderation in order to keep the debates focussed and strategic.

And as they sit in their various sessions at the Hilton and Georgetown University, The Great, the Good and the Glamorous will no doubt all be discussing and wondering “What does success really look like?”

It’s a big question. But fortunately I know where they can find one answer at least.

It’s in this short film produced by GAVI about Ghana’s ambitious and unprecedented introduction of two vaccines at once – vaccines that have the power to help protect against the two diseases that kill more of the world’s children before they reach their fifth birthday than any others.

So if, like so many people, you occasionally feel overwhelmed by the problems facing children and parents in the world’s poorest countries, I encourage you to watch this film. It’s guaranteed to vaccinate you against despair and give you some hope.

Dan's blog also appears around the web at: ONE.org | Population Services International | Global Poverty Project

Bill Roedy
Former Chairman and CEO of MTV Networks International, GAVI Envoy

Wednesday

28 March

2012

Sport Relief's Push for Immunisation

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

Thursday

8 March

2012

Liberia calls for HPV vaccines against top cause of cancer deaths among women

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 Nimatallah
Senior Programme Officer, Advocacy, GAVI

Wednesday

8 Feb

2012

GAVI reflects on Honduras and gears up for Shot@Life launch

“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 Summers
Senior Specialist Advocacy and Public Policy, GAVI Alliance

Friday

3 Feb

2012

World Cancer Day 2012: Together it is possible

In many countries, cancer is no longer considered a death sentence. But for the world’s poorest people it remains a stark reality.

A 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.

Two 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.

Cervical 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.

HPV 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 cancers.

No one should die because of where they are born.

David Ferreira
Managing Director, Innovative Finance, GAVI Alliance

Thursday

26 Jan

2012

A breakfast of champions for public health

I have long believed that a group of committed people can accomplish almost anything.

I saw it in my native South Africa.  I have seen it in my work for the GAVI Alliance, which in just over a decade has helped immunise 326 million children and save more than 5.5 million lives.  And, in Davos, Switzerland, I was privileged to have breakfast with a group of very committed people.

In the past year, a handful of visionary government and business leaders have stepped forward to create an unusual partnership that could save millions of lives over the next few years.  That partnership is the GAVI Matching Fund.

Under the GAVI Matching Fund, the British government and the Bill & Melinda Gates Foundation have pledged about US$ 130 million combined (GBP 50 million and US$ 50 million, respectively) to match contributions to GAVI from corporations, foundations and other organizations, as well as from their customers, employees and business partners.

The goal – including the match – is to raise US$ 260 million for immunisation by the end of 2015, bringing us much closer to ensuring that GAVI can help immunise 225 million children and save 3.9 million lives over that period.

This programme has shone a light on an increasing number of private sector champions for global health.  They range from financial services firms such as JP Morgan and the Spanish bank “la Caixa” (through its foundation), to prominent global enterprises such as Anglo American and nimble, creative foundations such as Comic Relief, Absolute Return for Kids (ARK) and the Children’s Investment Fund Foundation (CIFF).

Collectively, these champions are contributing their voices, skills and financial resources to the fight for child immunisation in the world’s poorest countries.  This is a model that works.  The GAVI Matching Fund was launched in June 2011 and in just a few months has already raised around US$ 40 million for immunisation.

This new model was an important theme that at the breakfast I attended in Davos, where the World Economic Forum is holding its annual meeting.  The gathering literally was a “breakfast of champions.”  There, several GAVI Matching Fund partners and other global business leaders met with Andrew Mitchell, the British Secretary of State for International Development and Bill Gates.

They spoke convincingly of how a public-private partnership can succeed, whether through Comic Relief raising funds from the general public for global health, “la Caixa” organising business partners to help fund the roll-out of vaccines in Central America, or companies offering their technologies and core business skills to save lives.

For instance, the same know-how that gets soft drinks to remote areas of Africa could help the countries that GAVI supports deliver vaccines to those areas.  Or cellphone technology could be used to efficiently monitor the use of vaccines.

Even a US$ 3 million donation – matched by the British Government or the Gates Foundation – would buy enough vaccine to immunise more than 500,000 children this year against pneumococcal disease, one of the main causes of death from pneumonia.  Or nearly a million children against potentially fatal diarrhoea caused by rotavirus.

The GAVI Matching Fund is an example of what can be achieved when governments, corporations, foundations and the general public work together to solve difficult problems, such as the inequity in the availability of vaccines for children living in poor countries.  It represents a rare chance to be part of something guaranteed to change the lives of millions of people for the better.

It represents a new era of champions for public health.

Raj Kumar
GAVI senior program manager

Friday

21 Oct

2011

To mark World Polio Day, Raj Kumar, GAVI’s Senior Programme Manager, reflects on a 2003 experience of polio in India

A volunteer checks the little finger of a child to see whether it has been immunised against polio, and administers a drop of oral polio vaccine while the child is still sitting in the traffic during an April 2008 immunization effort in India. Source: Rotary International/2008.

When the news came through in Andhra Pradesh that we had our first polio case for seven years, I was advising the state government on introducing hepatitis B and Japanese encephalitis vaccines.

Mainly affecting children under five, polio can lead to irreversible paralysis for about one in 200 infections. It can also lead to death if the paralysis interrupts the breathing.

Those who have lived and worked in less-developed countries are all too familiar with the terrible disability and deformation that polio leaves in its wake.

But, as with smallpox, polio is one of a handful of diseases that cannot survive for long outside the human body. And eradication is a real possibility.

When we have such effective vaccines, the single biggest obstacle to polio eradication is the strength of our immunisation systems. If the routine immunisation system is working, polio will not spread.

So while the child’s parents were willing him to survive and adjusting to the likelihood that survival would also mean permanent disability, I was fretting about our system. The next 30 cases highlighted weaknesses, but a well-aimed immunisation campaign finished off the outbreak.

A social health activist administers drops of the oral polio vaccine to a child in April 2008 during a door-to-door immunisation effort in India. Source: Rotary International/2008.

Around the world, high immunisation coverage with four doses of oral poliovirus (OPV) vaccine for infants has been key to polio eradication efforts. Indeed, enormous synergies exist between polio eradication and routine immunisation, because routine immunisation systems are still the most efficient and effective way of getting polio vaccination to where it’s needed most.

Persistent transmission in Pakistan and major outbreaks in Chad and the Democratic Republic of Congo reflect ongoing weaknesses in immunisation systems.

My country, India, is one of four countries in the world where polio is endemic, but since January 2011, it has not seen a single case of polio. This shows that eradication is possible.

Eradicating polio will be a tremendous demonstration of immunisation’s power, allowing countries like my own to focus on other life-saving vaccines.

Victory against polio will be triumph for us all.

Dr Raj Kumar is an Indian national. Between 2002 and 2006, he advised the state of Andhra Pradesh, population 75 million, on immunisation. Now as a Senior Programme Manager for GAVI, he manages GAVI’s portfolio in 13 countries across the Middle East and East Asia.

Daniel Thornton
Chief of Staff, GAVI Alliance

Sunday

16 Oct

2011

Excerpt from Daniel's speech to mark the launch of the pneumococcal vaccine in Ethiopia

A woman and her child waits alongside many other parents for their children to receive the pneumococcal vaccine for the first time in Ethiopia. Source: Daniel Thornton/GAVI/2011.

Thank you President of the Southern Nation, Nationalities and People Region, and Minister Tedros, Ministers, Officials, esteemed international guests, doctors, health workers, fathers, mothers, grandfathers – I was talking to a grandfather yesterday who was excited that his five month old granddaughter would receive this new vaccine, he is here today – and grandmothers.

I am proud to represent the Global Alliance for Vaccines and Immunisation, or GAVI.  We are here today to launch our most powerful vaccine – the pneumococcal vaccine.  And we are launching in the biggest country so far – this beautiful country of Ethiopia.

I represent a small secretariat based in Geneva. But a big Alliance. I am pleased that there are so many other representatives of that Alliance here today.

The most important members of our Alliance are the countries. I visited Ethiopia once before, twenty years ago, as a young diplomat. The country has made a lot of progress. A few weeks ago I met Minister Tedros in New York at an event hosted by Raj Shah of USAID and Andrew Mitchell of DFID to celebrate examples of successful progress towards meeting the Millennium Development Goals. GAVI and Ethiopia were both presented as examples of that success.

A decade ago in this country two hundred children for every 1000 died before their fifth birthday. That rate has fallen by more than half now, and as Minister Tedros said earlier, there has been dramatic recent progress. That is because Ethiopia has been building its health system. As Minister Tedros was saying - a few years ago, 300 trainee doctors entered medical school, this year 3000 will enter school. Yesterday I met some health extension workers who were committed to introducing this new vaccine. Ethiopia has successfully spread the benefits of immunisation. That includes pentavalent vaccine, which protects against five diseases, including a form of pneumonia, which is funded by GAVI. It also includes measles, and polio vaccine, which has helped to keep Ethiopia free of polio.

But as the figure I have quoted indicates, and as we will be discussing during this annual review meeting, there is a lot more to do. 100,000 children die each year from pneumonia in Ethiopia. Pneumococcal disease accounts for more than half of those deaths, as well as causing meningitis and sepsis. With the vaccine that we are launching today we can protect children against these terrible diseases.

And what we are doing here today in Ethiopia is part of a global story. Every twenty seconds a child dies of pneumonia somewhere in the world. Pneumonia is the biggest killer of children before their fifth birthday. Building upon what Ethiopia is doing here today, we are planning to introduce this vaccine in forty countries up to 2015, which can save 700,000 children’s lives every year.

Now, this small secretariat in Geneva can’t do this on its own. We need a big Alliance. And I am pleased that today we have a representative from UNICEF, which buys the vaccine and supports its introduction in countries. And WHO which provides scientific expertise and advice here in countries. These partners have been working with the government to strengthen treatment of pneumonia, which needs to go hand in hand with the introduction of the vaccine. Civil society organisations are represented here today who work in communities that could not otherwise be reached. And the vaccine companies, without which there would be no vaccines.

GAVI is a funding mechanism; without funds it has no purpose. So I am not going to forget GAVI’s generous donors. The pneumococcal vaccine has been funded under a special mechanism called the Advance Market Commitment. Italy, the UK, Canada, Russia, Norway and the Gates Foundation have provided $1.5bn so that vaccines companies have the confidence to invest in large scale production for developing countries. In London in June the Big Alliance met – with PMs David Cameron and Jens Stoltenberg and also with Bill Gates, who together with our other donors raised an additional $4.3bn. We are grateful to all of them and all of GAVI’s donors, all of them part of the big Alliance. Their generosity has meant that Ethiopia is receiving the vaccine very soon after children in rich countries receive it.

The scale of the numbers I have mentioned today are hard to imagine. More than 50,000 children dying each year here in this country – deaths which can be prevented by this new vaccine. But the mothers, and fathers, and grandparents here today know what these figures mean.

My children benefited from the vaccines they needed. I think children everywhere should get the vaccines they need. Together in this Big Alliance, starting today in this hospital this great work has begun to save children’s lives.

Dr. Clarisse Loe Loumou, paediatrician and member of the Steering Committee of the GAVI Civil Society Organisation (CSO) Constituency

Tuesday

27 Sept

2011

Protect children against severe diarrhoea: here is the long awaited vaccine!

During my years of practice in the largest paediatric hospital of Cameroon in Yaoundé, I remember that the 300 beds were rarely empty. I was in charge of the gastroenterology and paediatric nutrition ward, where 28 beds were occupied more than 90% of the time by infants who were dehydrated and suffering from severe diarrhoea.

Our problem was not the diarrhoea itself - its treatment protocols are well known; oral re-hydration salts, adequate re-nutrition, zinc supplementation, intravenous (IV) fluids for the most severe cases - but in making real the possibility of preventing severe diarrhoea.

The roll out of rotavirus vaccines in Africa has begun. In this five-minute film, immunisation experts, health workers and mothers from Sudan and Tanzania talk about the need for the vaccines and their hope for the future. Source: Ryan Youngblood, Doune Porter/GAVI/2011.

It was and still is common for children in Cameroon and other parts of Africa who are suffering from severe diarrhoea to die due to limited access to oral re-hydration salts, IVs, clean drinking water, or even the inability to reach a hospital in time.

Rotavirus is the leading cause of severe diarrhoea in children under five years of age worldwide, killing more than half a million children each year and hospitalising millions more. Nearly 50%, or 230,000 of thoserotavirus deaths, happen in Africa. Worldwide, more than one third of the 1.34 million diarrhoea deaths in children under five years of age, and 40% of the 9 million diarrhoea-related hospitalisations are due to rotavirus disease. In Africa, the percentage of rotavirus-related hospitalisations is even a bit higher at 41%. These facts may be little-known, yet diarrhoea remains the primary cause of child mortality in Africa.

In Cameroon, diarrhoea is the third highest cause of death in children under five years old. 30% of those diarrhoeal deaths are due to rotavirus.

We need to draw attention to the devastating role of rotavirus in causing death to millions of young children. My hopes of delivering a rotavirus vaccine across all of Africa must one day become a reality, not only to prevent hundreds of thousands of unnecessary deaths, but to boost our fight against poverty.

And let’s not forget the economic costs of diarrhoea; of hospitalisation, of medications, of parents or caregivers who must stop work, and of young lives lost. This leads to a vicious circle, where diarrhoea that is inadequately treated can cause malnutrition, which can decrease immunity and lead to further re-infection with diarrhoea or other diseases. Vaccination offers the best hope for preventing severe rotavirus disease and the deadly dehydrating diarrhoea that it causes.

I am proud that in July 2011, with the support of the GAVI Alliance, Cameroon introduced a vaccine against pneumococcal disease, the leading cause of pneumonia, and aims to introduce the rotavirus vaccine in 2013. None of this would be possible without political will, the active contribution of donors, and the efforts of the Government of Cameroon and its Immunisation Programme, which have made the environment conducive to helping these life-saving vaccines reach the children who need them most.

I am delighted that our children are finally going to be protected against the main causes of diarrhoea and pneumonia, the world’s two biggest killers of children under five and the leading killers here in Cameroon. There is no reason for such unjust deaths, and we now eagerly await the rotavirus vaccine to reach us in 2013.

Version français.

This post also appears on the ONE International site.

John Wecker
Ph.D., director of Vaccine Access and Delivery, PATH

Friday

23 Spt

2011

Rotavirus Vaccines: A Compelling Case for Their Use in Africa and the World.

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 Aydogan
Senior Programme Manager, Programme Delivery, GAVI Alliance

Friday

8 July

2011

Nilgun reports from a recent field visit to Sri Lanka, where despite multiple challenges immunisation coverage has remained near 100% due to the people's steadfast commitment.

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!

This blog post is also featured on the Bill & Melinda Gates Foundation website.