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Director, Media and Communications, GAVI Alliance
At the end of January we were taught a lesson in the power of social media in global health, as a striking interactive map of vaccine preventable outbreaks since 2008 went, well, viral on Twitter.
By the middle of the week more than 500,000 people had visited the map, and in an intriguing piece of research the trail of tweets led all the way back to a post by our own CEO, Dr Seth Berkley, a few weeks earlier.
As gratifying as the origins of this post’s spread may be, the unusual success of this map begs an important question about the important potential of using social media for communicating challenging global health issues like immunisation. Are we making the most of its responsive potential and huge reach?
With the social media platforms like Twitter constantly overflowing with a tangle of questions, concerns and misinformation surrounding vaccines, the rise of infographics and interactive visuals provides a unique opportunity for those with the data to back vaccine effectiveness to more effectively communicate the evidence that can save lives, as well as presenting the dangers of the anti-vaccine stance.
And that online communities can respond so positively to this exercise in data sharing should give us hope for the future of communication surrounding public health measures. The digital world of social media is primed and ready to share and interact with meaningful and engaging data sets and case studies, the challenge now is to ensure that those with the evidence grant social media enough importance to translate it engagingly to digital platforms, thereby making the most of social media as a public information tool.
To get our take on global health and immunisation on social media, like us on Facebook, follow us on Twitter, or join the conversation using #vaccineswork.
See you online!
Below are some popular posts to get you up to speed with global health on social media over the past couple of months.
Bill Gates & Jimmy Fallon make a viral video
Bill Gates and Jimmy Fallon’s clip, confidently named “viral video”, was created to drive traffic to Gates’ Annual letter on global poverty and health– and it looks like the silly headwear did the job!
#Endpolio now in India
The official announcement of India’s “polio-free” status created quite a storm online, but Rotary’s simple infographic was one of the most shared pieces of content.
Weeks after the post started its life as viral content, CFR’s map of preventable disease outbreaks is still going strong.
Vaccine introductions in 2013
GAVI’s own graph of vaccine introductions last year reached 90,000 people on Facebook at the end of 2013 – it didn’t quite go viral, but who knows who might share it in future?
Each of us has had the privilege of serving for many years as minister of state. Although we come from different parts of the world – one from Senegal, the other from Norway – we share the experience that good government can accomplish great things.
Good government can lift whole populations. It can support those in desperate need. It can help protect the innocent. It can enable amazing technological breakthroughs. What no government can do is single-handedly solve the world’s problems. It needs to work with others.
In particular, government needs to work with the private sector. Businesses have the ability to rally the public by providing solutions and applying know-how to problems of any size.
As business leaders gather in Davos, Switzerland, for the World Economic Forum Annual Meeting, we hope to engage them in thinking more creatively about how their work can be applied to global health.
We each serve as volunteer board members for the GAVI Alliance, a public-private partnership whose mission is to save children’s lives and protect people’s health by increasing access to immunization in developing countries. Since the year 2000, the GAVI Alliance has helped immunize more than 440 million children, saving six million lives.
We strongly support private sector contributions to this cause and urge other business leaders to join us. In fact, we are keenly impressed by the growing corporate awareness that the world’s biggest health challenges – including how to reach the 22 million children who go unvaccinated each year – also have profound economic implications.
Vaccine-preventable diseases such as pneumonia, measles and deadly diarrhea take an enormous toll on people in developing countries. We have both seen this first-hand. Companies recognize that their competitiveness and the health of the communities where they do business are mutually dependent. Global health means economic health. We all are stakeholders.
This is why it is imperative that both the public and private sectors work together. Businesses have invested in GAVI because they know that one of the strongest ways to promote global health is through immunization. Vaccines provide a strong return on investment (ROI). Among GAVI’s private sector partners:
Companies are expanding beyond traditional philanthropy and instead favour initiatives that make a measurable and long-term impact on individual lives and entire economies. Funding and supporting the delivery of life-saving vaccines is one proven way that the private sector can obtain measurable, long-term and extremely cost-effective results.
The GAVI model is designed as a sustainable approach that puts countries on track to self-sufficiency. If we – the public and private sectors – collectively seize the moment, we can accelerate progress toward a world in which every child, everywhere, is fully immunized. And we all will be better for it.
This blog was originally posted on the World Economic Forum.
Dr. Kathy Neuzil
Program Leader Vaccine Access and Delivery, PATH
Dr. Kathy Neuzil, Program Leader Vaccine Access and Delivery, PATH, is in Mali this week as the country introduces a vaccine against rotavirus, the most common cause of severe and fatal diarrhea in young children worldwide. Her report follows.
Credit: UNICEF Mali/2014/Cao.
As I watched the historic launch of rotavirus vaccines in Bamako, Mali, yesterday, I was reminded of an anxious time in my life more than a decade ago. I sat between two small beds in a hospital room in Seattle, Washington USA, where my daughter, 1, and my son, 6, were both receiving intravenous (IV) fluid for serious diarrhea. As a physician, I knew that rehydration with IV fluids is a simple and potentially lifesaving intervention. As a mother, I was worried.
Fortunately, my children were able to return home with me the following day, fully recovered. I was grateful that the hospital was an easy 15-minute drive from my home, and that advanced medical care was readily available.
Had I been a mother in Mali, I may not have been so fortunate—one or both of my children could have died from diarrhea. Mali is one of the poorest countries in the world. Mothers, fathers, and other caregivers often have to travel great distances over difficult terrain to reach health facilities. Depending on the location, IV therapy may not be available for their children. Lack of access to care is one reason more than 90 percent of diarrhea-related deaths occur in young children in countries with few resources.
Rotavirus is the most common cause of severe and fatal diarrhea in young children worldwide. In Mali, it kills more than 7,200 children each year and hospitalizes many more. Vaccination against rotavirus as part of a comprehensive approach to prevent and control diarrheal disease is the best way to protect infants from rotavirus disease and reduce its burden. In many countries that have introduced rotavirus vaccines, scientific studies have shown swift and significant declines in hospitalization and deaths due to diarrhea, as these tables on our rotavirus vaccine access and delivery website show.
While this is not my first visit to Mali, it is certainly my most gratifying. Yesterday’s momentous occasion is the culmination of more than seven years of hard work by a dedicated Malian team, my colleagues at PATH, and many other partners who paved the way for distribution of these lifesaving vaccines in Mali and in other low-resource countries.
In 2005, I joined PATH’s Rotavirus Vaccine Program, a partnership with the World Health Organization (WHO) and the US Centers for Disease Control and Prevention that was funded by the GAVI Alliance. We worked with rotavirus vaccine manufacturers and in-country partners to design and execute clinical trials of rotavirus vaccines in Africa and Asia, including here in Mali. The strong evidence generated from these trials was pivotal to the 2009 WHO recommendation that all countries introduce rotavirus vaccines into their childhood immunization programs.
Mali is the 20th GAVI-eligible country and the 53rd worldwide to introduce rotavirus vaccines into its national immunization program. While this is cause for celebration, there is a lot more work to be done. Many children still do not have access to the lifesaving benefits of rotavirus vaccines. While 14 countries—13 of them in Africa—plan to introduce rotavirus vaccines with GAVI support in the next two years, more than 15 other GAVI-eligible countries have yet to apply for rotavirus vaccine support. In addition, numerous middle-income countries, where childhood diarrhea is a huge problem, have yet to include rotavirus vaccines in their national immunization programs.
The incredible, positive health effects and related reduction in health costs due to the introduction of rotavirus vaccines is one of the most remarkable public health achievements of the past decade. Mali’s decision to proceed with rotavirus vaccine introduction despite recent devastating political and social turmoil underscores the country’s commitment to the health and lives of its children. Mali’s leadership should inspire other countries to take action in the fight against rotavirus and help ensure that all children worldwide have access to these lifesaving vaccines.
This blog was originally posted on the Path Blog.
GAVI’s Special Representative to GAVI Eligible Countries
I am delighted to participate to the European Development Days (EDD), Europe’s premier forum on international affairs and development cooperation organised by the European Commission.
It is a landmark event in the development calendar and an important opportunity to share knowledge and experiences with European development practitioners and partners worldwide. It is also a major opportunity to discuss what works and what does not work on the ground without losing sight of the fact that millions of mothers, kids and families rely on our work to have a better life. Together with all stakeholders, we will examine solutions to shared problems in order to achieve a Decent Life for all by 2030, as this year's EDD sheds light on the post-2015 development agenda.
One of the next decade’s challenges will be non-communicable diseases and, more specifically, cancer. Vaccines play a critical role in preventing the infections that cause certain cancers like liver and cervical cancers. The prevention of the infectious causes of cancer through hepatitis B and human papillomavirus (HPV) vaccines can help fight the rising global burden of cancer deaths.
Since 2001, the GAVI Alliance has supported the immunisation of 360 million infants against hepatitis B in the poorest countries of the world. Ghana, my country, recently started to protect girls against cervical cancer with GAVI-supported HPV vaccines.
When I was in charge of the Expanded Program on Immunization in Ghana, I saw the urgent need to make girls and women’s health a priority. Cervical cancer now kills as many women as childbirth, claiming a life every two minutes in some countries. More than 85% of them happen in low-income countries, where infections are higher and fewer women have access to screening and treatment. Without changes in prevention and control, cervical cancer deaths are expected to increase to 430,000 each year by 2030, virtually all in developing countries.
Sweden hosted GAVI’s Mid-Term Review a few weeks ago where key results were highlighted: the Alliance is on course to reach its mission target of immunising an additional 243 million children between 2011 and 2015. By 2014, all 73 GAVI-supported countries will have introduced the 5-in-1 pentavalent vaccine, including Haiti, Myanmar, Somalia and South Sudan.
It would not have been possible without The European Union. The GAVI Alliance and the European Institutions have worked hand in hand to ensure leadership in global health issues and help achieve MDG 4. From 2003 to 2012, the European Institutions have contributed to financing vaccines introductions in GAVI-eligible African Caribbean Pacific (ACP) states with other donors. Moreover, 10 European Union member states are GAVI donors, seven of which are among the top 10 GAVI donors. Most of them provide long-term predictable funding, thereby enabling effective market-shaping and sustainable routine immunisation programmes in the ACP states and beyond.
I would like to thank the European Union at large for its major contribution and I am pleased to see the impact on the ground of taxpayers’ euros. I was recently in Nigeria for the launch of the National Routine Immunisation Strategic Plan and in Cambodia to attend the very important meeting of the GAVI Board. My visits and discussions showed the importance of country ownership in ensuring the sustainability of programmes.
Vaccines offer a giant step forward in the prevention of cancer caused by infectious agents. As research accelerates and technology evolves, new vaccines are on the horizon against other infections associated with cancer bringing the promise of a quiet revolution in cancer prevention. A new development agenda cannot be built without immunisation that leads to a healthy future for all nations.
Dr. Antwi-Agyei is a disease control unit programme manager for the Ghana Health Service. To read more of his interview with GAVI about immunisation in Ghana, click here. Photo credit: Olivier Asselin, 2012.
Back in 2011, the GAVI Alliance was challenged with ambitious goals. Partners and donors tasked the Alliance with immunising 370 million children in the poorest countries in the world and averting 4 million future deaths by 2015.
Halfway through the 2011-2015 period, the same partners and donors gathered in Stockholm, in Sweden, on 30 October to review the progress made to date. Thanks to an unprecedented scale up in activities, our stakeholders were able to conclude that the Alliance is well on its way to meeting its bold targets.
But we were also facing a different challenge. As we started to tell partners about our progress, many commented that while we were "delivering together" on the promises made in 2011, we were also not doing quite enough to let the world know about these successes. So we reached out.
In the months leading to the Stockholm meeting, a number of partners such as One.org, the Bill & Melinda Gates Foundation, the World Bank, UN Foundation, and World Vision lent their digital platforms to carry the immunisation success stories of this daily fight against childhood diseases. And many news media in the US, UK, France, Sweden and in implementing countries such as Ghana, added context and a critical view to these successes.
Médecins Sans Frontières (MSF) reminded us that more has to be done to reach the 20 million children that currently don't have access to the most basic vaccines, Save the Children issued its own report reviewing GAVI’s progress, and Action produced a scorecard to analyse our achievements and pledges. These joint efforts to inform and review deserve our gratitude, and they will also serve as inspiration in the time to come.
As we look at completing the 2015 objective of saving four million lives while setting new and more ambitious goals for 2020, more creative ideas will be needed from GAVI Alliance partners to keep our audiences moved, challenged, interested and engaged.
The word is out, it’s now our task to continue this year’s momentum by sharing more inspiring immunisation stories than ever before. This way, by 2015 we’ll have presented a clear picture of the demands, necessity and incredible impact of large-scale immunisation, and of why slowing down now is unacceptable.
If we can do this, we will also never lose sight of what lies at the heart of GAVI’s achievements so far: the amazing work conducted with vaccines in the world’s poorest countries every day, where healthcare providers are saving lives, one child and one village at a time.
This blog post is also featured on ONE.org.
Board Chair of the GAVI Alliance
Dagfinn Hoybraten, Chair of the GAVI Board, with three and a half month old boy Phum Seyha at the Koh Dach health centre outside Phnom Penh, Cambodia. Credit: GAVI/2013/Luc Forsyth.
From the busiest city clinic to the smallest rural health centre, the privilege of seeing a child vaccinated and the reassurance it brings to a family never fails to stir strong feelings in me.
As the GAVI Alliance Board gathered in Cambodia for a meeting that will shape our mission to 2020, I had the opportunity to meet the children and families who directly benefit from the outcomes of our Board decisions.
In the small Koh Dach village clinic, about 30 minutes from the bustling capital Phnom Penh, I met two-and-a-half-month-old Phum Seyha and his mother Chum Thy.
Thanks to the support of GAVI Alliance partners and the work of dedicated health workers at the Koh Dach centre, Phum Seyha received the pentavalent vaccine. This gives protection against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B.
Phum Seyha left the clinic under the morning sunshine in the arms of his mother having become one of the 243 million additional children who will be immunised with vaccines funded by the GAVI Alliance between 2011 and 2015.
It is important that we keep the faces behind these numbers at the front of our minds.
Dagfinn with Phum Seyha and his mother Chum Thy at the Koh Dach health centre outside Phnom Penh, Cambodia. Credit: GAVI/2013/Luc Forsyth.
Immunising nearly a quarter of a billion children in a five year period, as GAVI partners are on track to do, is an impressive feat. Yet it is only by meeting the individual children who are benefitting from vaccines – and the parents and grandparents who are reassured by the knowledge their child or grandchild is receiving protection – that the achievement becomes real.
I firmly believe that health is a fundamental human right for all people and vaccines are one of the most effective ways of protecting people’s health. GAVI’s mission is to ensure that children benefit from the power of vaccines no matter where they live. Ultimately, we want each baby to become a healthy child, teenager and eventually an adult who will lead a productive life while contributing to their country’s growth.
I am pleased that we are on track to meet the ambitious targets we set ourselves in 2011, but the privilege of meeting Phum Seyha and Chum Thy brings the additional pleasure of seeing first-hand the wonderful effect vaccines have on children and parents alike.
Yesterday Bill Gates and Ali Dangote, two billionaires with a passion for immunisation, joined Nigeria's Federal Minister of Health, Prof Onyebuchi Chukwu, in the nation's capital Abuja to launch Nigeria's National Routine Immunisation Strategic Plan.
The ceremony was also attended by dignitaries including His Eminence, the Sultan of Sokoto, the spiritual head of Muslims in Nigeria, the Chairs of the Senate and House Committees on Health, as well as staff from government, faith-based groups, development partners, civil society organisations and the private sector. But amidst the VIPs, children from Bema Home, a local orphanage, were there to remind all those present why we were there and of the need to invest in immunisation - to secure the future for our children.
I was there representing GAVI's CEO, Dr Seth Berkley, and to give a short address on GAVI’s total US$ 700 million commitment to Nigeria since 2001 and the prospects for future support. GAVI has worked with Nigeria for 12 years, supporting the introduction of new and underused vaccines – pentavalent, yellow fever, Meningitis A and measles - and the strengthening of health systems.
Over this period, I have followed the twists and turns, highs and lows in its programme performance. Small peaks in coverage have been interspersed with vaccine shortages, cold chain breakdowns and outbreaks of vaccine preventable diseases. Last December the country held a ‘Get back on track’ meeting, following a prolonged vaccine shortage earlier that year and in 2011, where the bottlenecks facing the programme were outlined and seven strategies for a programme turnaround were agreed upon. By the end of 2012, I was pleased to inform my colleagues in Geneva that 2013 was looking positive for Nigeria’s routine immunisation programme.
The resolve of the leadership and commitment of the National Primary Health Care Development Agency is indeed bearing fruit. As is the use of terms like ‘100% bundling of vaccines and syringes’ and its monthly monitoring of coverage data. In terms of data quality we are not yet there, but all partners around the table agree that 2013 coverage is much better than the two previous years and GAVI-supported pentavalent introduction has contributed to the positive turnaround. Health workers who have not been trained for years have had a new lease of knowledge on injection safety and adverse events, supply chain issues have been highlighted and are being addressed, and improvement of data quality is now on everyone’s agenda.
I’m certainly coming back in December, to see the last group of states introduce penta and follow-up on how states and Local Government Areas are translating the National Routine Immunisation Strategic Plan into work plans for 2014 and 2015.
We teach our children about the importance of keeping promises, but the best way to communicate this is by keeping our promises to them. In 2011 my organisation the GAVI Alliance held its first ever pledging conference in London, an historic meeting where we committed to help developing countries immunise an additional quarter of a billion children by 2015, and prevent four million future deaths in the process. As Chair of the GAVI Alliance Board I’m proud to say that midway through GAVI is on track to keep those promises.
Dagfinn Hoybraten, Chair of the GAVI Board, at the Usa River Health Centre, Arusha, Tanzania. Credit: GAVI/2012/Robert Beechey.
While we may not be there yet, it is nevertheless a huge accomplishment and one that is not just measured in lives saved. Since 2011, GAVI has funded a total of 67 new vaccine introductions and campaigns. By 2014 all 73 GAVI-supported countries will have introduced 5-in-1 pentavalent vaccines, including introductions in a number of fragile states, such as Democratic Republic of Congo, Haiti, Myanmar, Somalia and South Sudan. The cost of new, priority vaccines, such as pneumococcal and rotavirus, has also fallen significantly thanks to GAVI, and this is speeding up the time it takes for new vaccines to reach those children most in need. When taken together all this shows that, in terms of their access to vaccines, the historic gap between low- and high-income countries is starting to close.
This was made possible because at the pledging conference donors committed further funds towards GAVI’s work, bringing its total funds to 2015 up to US$ 7.4 billion. They were willing to do this because they had seen what GAVI had already achieved and they believed in GAVI’s ambitious goals and its ability to realise them. At the end of the month these donors will come together again at GAVI’s Mid-Term Review, in Stockholm, where they will discuss the progress made and the challenges that lie ahead, as laid out in GAVI’s Mid-Term Review report.
But now with two years to go, there is indeed much left to do if we are to fulfil our promises. Some countries have had to postpone introductions of new vaccines because of global supply constraints or local capacity issues. Many regions also still need better systems for monitoring immunisation data, and for transporting and storing vaccines. But we are getting there. In Ethiopia, in 2011, I got to see first-hand the difference that GAVI is making. And by meeting with parents, supply chain managers and health workers, I was deeply moved by their stories and the dedication I saw.
Such accounts have now been captured in a series of impact stories showing the extraordinary efforts being made by implementing countries and GAVI partners to ensure that vaccines reach the children who need them, wherever they are. These stories are about the people on the ground, the people who are the heart of what GAVI is doing. I invite you to take a look and share in their personal stories and learn about the inspirational work they are doing to make a difference, so that we may all deliver on our promises.
Prof. François H. Tall
President of Burkina Faso Pediatric Society (SO.B.PED)
Madame Chantal Compaoré, First Lady of Burkina Faso, holds the baby given the first dose of rotavirus vaccine at the official launch ceremony of pneumococcal and rotavirus vaccines, which took place in the rural community of Tanghin Dassouri. Credit: WHO Burkina Faso/2013/Barry.
October 31st is a big day for my country, Burkina Faso, because we are finally going to introduce vaccines against rotavirus and pneumococcal disease in our routine vaccination program! Thanks to these new vaccines, we will be able to save thousands of children’s lives.
As a pediatrician, not a single day goes by where I do not see children suffering from vaccine-preventable diseases, and specifically from pneumonia or diarrhoea. Currently, thousands of children less than five years of age die each year from pneumonia and diarrhoea in Burkina Faso, as well as in most countries in sub-Saharan Africa. In 2010, 21,764 child deaths were caused by pneumonia and 14,648 were caused by diarrhoea in Burkina Faso. Today we know that prevention through vaccination is the most effective way to guard against these diseases.
As President of the Burkina Faso Pediatric Society (SO.B.PED), I would like to congratulate my Government on this major advancement that allows us to fight these two diseases, which are the most deadly among our children who are less than five years of age, and a true blight in our country. By introducing these vaccines together, Burkina Faso is taking a step forward in promoting the approach of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), which advocates for the introduction of both vaccines as part of a comprehensive and integrated strategy to combat these two diseases.
I rejoice that my country will finally introduce these long-awaited vaccines. Burkina Faso has just joined several other countries in the sub region that have already introduced these two vaccines, thanks to the support of the GAVI Alliance. Globally, 16 of the 48 countries that have introduced rotavirus vaccines into their national immunization programs, and 33 of the 72 countries that have introduced pneumococcal vaccines into their national immunization programs have done so with GAVI support. 18 other countries—17 in Africa—have been approved by GAVI for rotavirus vaccines support and another 18 countries—9 in Africa—have been approved for pneumococcal vaccines support. We sincerely hope that donors will continue to support the GAVI Alliance so that we can continue to benefit from their support for the introduction of new vaccines in our country as well as reduce the deaths caused by these vaccine-preventable diseases.
The Burkina Faso Pediatric Society (SO.B.PED) has been waiting for many years for this new victory for our children’s survival. Blowing out its 24th candle this year, the SO.B.PED is one of the oldest academic societies of Burkina Faso. It was founded in 1989 by ten pediatricians and now has over 70 active members scattered in 45 provinces. One of the first objectives mentioned in the statutes of our Society is to support the development of maternal and child health policies at national and regional levels. It is in this frame that we focus our advocacy efforts towards the introduction of new vaccines against the most deadly childhood diseases. When the haemophilus influenza b vaccine was introduced in the routine immunization program in 2006, SO.B.PED leveraged this opportunity to multiply advocacy efforts towards decision-makers and partners. We did this during World Pneumonia Day in December 2010, and again at the UNAPSA Pan African Pediatric Congress in December 2011 in Ouagadougou. Today, our advocacy efforts are finally paying off!
We must thank not only our leaders but also our numerous partners, donor countries and other donors, and especially the GAVI Alliance and its financial support, without which none of this would have been possible. I would also like to take this opportunity to thank our colleagues at PATH and IVAC/Johns Hopkins University for their assistance and support in our advocacy efforts.
As of October 31, 2013—the “D-Day” of the dual new vaccine launch under the patronage of the First Lady of Burkina Faso—our children will finally be protected against the two biggest killers of children under five: pneumonia and diarrhoea. Now, it is up to us to ensure that the introduction and implementation of these vaccines are effective, successful, and sustainable.
Mathias Bonk Program Director of the World Health Summit at the Charité, Berlin
As a first-year medical student I travelled to India to work as a volunteer with the Missionaries of Charity in Calcutta. I was extremely fortunate to have had the opportunity to meet Mother Teresa. She told me I should work hard to help the poorest of the poor. Since then her children´s orphanage, Shishu Bhavan, has become something like a safe haven and a source of great inspiration for me. Here I have learnt a lot about health-care and how medicine is practiced in resource-poor settings, and about the various, often preventable, infectious diseases. To me it seemed to be unbelievable that so many children are still suffering and dying from diseases like diarrhoea, pneumonia and polio.
A few years later I returned to India for an internship in a hospital in Bangalore, Karnataka. During my rotation on the Emergency Intensive Care Unit, I met a 14-year-old boy, suffering from polio. He was not able to breathe by himself anymore and was being kept alive by a ventilator – a very costly procedure for his poor family already deeply in debt. His 12-year-old brother was taking care of him day and night, knowing that his brother’s death might be near. Still, he was full of compassion and hope. When I returned to the ward after the next weekend, the boy had passed away. His family had taken the critical decision order to save the livelihood of the other siblings.
After returning to Germany, I graduated from medical school and became a paediatrician. Vaccinations became part of my daily routine and nothing seemed to be more natural than to provide all children with the chance of a healthy start in life. The last polio case in Germany was seen in 1990 but it has taken decades and a multi-sectoral approach to reach this state. Today we are close to eradicate polio once and for all. The polio story is an impressive success story about the power of vaccination.
The GAVI Alliance has proved that a multi-sector partnership can achieve excellent results in a relatively short time. Its mission is to save children’s lives and protect people’s health by increasing access to immunisation in developing countries. The Alliance includes governments of developing and donor countries, WHO, UNICEF, the World Bank, Civil Society organizations, research institutions and vaccine producers. Each partner chips in, and working together the Alliance can reach goals none of the organisations could reach alone. 370 million additional children vaccinated since 2000, 5,5 million future deaths averted. Working together obviously pays off.
As the programme manager of the World Health Summit I am delighted that GAVI, a key player in global health and especially in the fight against child mortality, participated actively in the event ever since it was established in 2009 in Berlin. The World Health Summit pursues a similar goal: It brings people together to improve health all over the world. The annual World Health Summit is held under the high patronage of Germany’s Chancellor Angela Merkel, the French President François Hollande and the President of the European Commission, José Manuel Barroso. An academic network based on the M8 Alliance of Academic Health Centers, Universities and National Academies underpins its work.
In 2013, the World Health Summit will focus on the interplay between health and development, research and education, and on the role of health in many aspects of foreign policy. These interconnections are even more important in light of new and emerging health threats arising from increasing global mobility, demographic change and environmental pollution. A special focus will also be placed on global activities to eradicate preventable diseases such as polio.
On February 25, 2012, only about 10 years after my experience with the two brothers in India, the World Health Organization (WHO) eventually struck India off its list of polio-endemic countries. India hadn’t reported a single case of wild poliovirus for more than a year. This at least gives hope that other families will not have to suffer like the family I met in the hospital in Bangalore.
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Dr. Mathias Bonk, a paediatrician with working experience in Germany, India and the United Kingdom and trained in Tropical Medicine and International Health, is the Program Director of the World Health Summit at the Charité in Berlin. In addition he is the Coordinator of the M8 Alliance of Academic Health Centers, Universities and National Academies, a collaboration of academic institutions of educational and research excellence that recognizes its responsibility to improve global health.
The World Health Summit 2013 takes place from October 20-22 in Berlin, Germany. GAVI’s Managing Director for Policy & Performance Nina Schwalbe will speak at two symposia at this year’s summit:
Helen EvansDeputy CEO, GAVI
An Indonesian child becomes among the first in the country to receive pentavalent vaccine with GAVI support.GAVI/2013/Dian Estey
As Indonesia celebrated the introduction of a new pentavalent vaccine last week there was an extra dose of good news: The vaccine that will benefit children across the country was manufactured in Indonesia.
The pentavalent roll out will mean big progress towards ensuring that all children in Indonesia have a healthy start to life. Children will now be immunised against five vaccine preventable killers: diphtheria, tetanus, whooping cough, hepatitis b and haemophilus influenza type B. Between now and the end of next year, the five in one shot will be delivered to over four million children across the 6,000 inhabited islands that make up the Indonesian archipelago.
In and of itself, this is a critical advance. As I joined the Indonesian Minister of Health, Dr. Nafsiah Mboi, for the vaccine launch in a tent clinic in Karawang, I could see how keen mothers and fathers were to get their children vaccinated. They knew just how important it was to get that protection for their kids.
But last week's announcement was significant for several other reasons – all of which point to an encouraging future for vaccination programmes in Indonesia.
Indonesia has a growing economy and will graduate away from GAVI support by 2016. There will be a gradual increase in the portion funded by Indonesia over the years to 2016, at which point GAVI funding will cease and the programme will be funded entirely by the Indonesian Government.
Helen Evans and Indonesian Minister of Health, Dr Nafsiah Mboi, meet mothers and children at the launch of pentavalent vaccine in Karawang.GAVI/2013/Dian Estey
Indonesia’s move to self-sufficiency isn't just fiscal - it's industrial and scientific too.
The pentavalent vaccine that will be used for Indonesian children is manufactured in Indonesia by Bio Farma, a parastatal company based in Bandung, West Java. I had the pleasure of touring the Bio Farma facility along with a delegation of Japanese and Korean MPs during my recent visit.
After we finished visiting the impressive facilities we were shown a tree that was planted to recognise the contribution of Japanese scientists to Indonesian vaccine production. By happy coincidence, one of the Japanese MPs on our trip, Motoyuki Fuji, was the health attaché at the Japanese embassy in Indonesia when that collaboration first began.
While the tree had taken root and flourished in the time since Motoyuki Fuji left Indonesia, Bio Farma has also grown into a highly sophisticated organisation with the capacity to deliver a range of vaccines including most recently the pentavalent vaccine to millions of children.
It’s a story that complements GAVI’s experience in Indonesia. Just as Indonesian is now manufacturing its own pentavalent vaccine, so too is the country shifting to the point where it will entirely finance its own immunisation programmes, from the purchase of vaccines to the cold storage and delivery networks which are vital to ensuring all children are reached.
And that is the goal of the GAVI Alliance – to support governments, communities and individuals to save children’s lives and protect people’s health by increasing access to immunisation ultimately through using their own resources. Indonesia is well on the road to self-sufficiency in immunisation and I look forward to hearing about the successes that surely await in this bustling, vibrant country.
In a previous life when I was a National Immunisation Programme Manager in Ghana, I saw firsthand the challenges that many African states face in delivering healthcare. Last week, while attending the Ministerial Forum on China-Africa Health Development, representing the GAVI Alliance, I was struck by the common legacy that China and countries across Africa share in overcoming such obstacles, and the important gains that have been made.
China and African countries also share a vision for the future: one where all citizens have a chance to lead healthy and productive lives. Our governments understand the African proverb that if you want to go fast, go alone, if you want to go far, go together.
To forge the path ahead, dozens of health ministers from across Africa and high-level Chinese government officials met at the Ministerial Forum on China-Africa Health Development in Beijing, China last week. Along with representatives of international organisations including the United Nations, they explored ways to strengthen their partnership towards greater health gains across the continent.
Ministers at the Forum also signed the Beijing Declaration of the Ministerial Forum on China-Africa Health Development, which sets a vision for a continued partnership to address a number of pressing health issues that affect Nigeria and other African countries disproportionately. Among these are HIV, malaria, schistosomiasis, reproductive health, immunisation and vaccine-preventable diseases. The declaration also highlights efforts to address the shortage of healthcare workers and increase joint research efforts. Moving forward, China-African cooperation will aim to align with African countries’ priorities as well as national and regional development plans.
These new actions at the forum build on the long-standing health partnership between China and African countries, which began when China first sent medical teams to the continent 50 years ago. Since then, China has worked with countries to establish hospitals, clinics and malaria control centers in many African countries as well as sharing technical expertise to help address health issues.
Recognising these past efforts, officials at the forum emphasised that they are entering a “new era” of Sino-African health cooperation that will meet the health needs and priorities of African countries more effectively, including Nigeria.
By working together as partners from the Global South, China and African countries can help develop sustainable, local solutions to health challenges. Addressing shortages of doctors, nurses and health technicians and improving health facilities are just some of the ways that the partnership can drive greater health impacts across the continent. Additionally, China and African countries are exploring ways to increase access to high-quality, low-cost health technologies produced in China that can make a public health impact.
China’s partnership with Africa draws on the lessons it has learned from improving the health of its own citizens, and is generating solutions to many health issues, issues which continue to affect millions of Africans.
Although many countries on the continent have made progress in increasing access to vaccines, many children still remain unimmunised. Through advances in disease surveillance, service delivery and research and development, China has reduced childhood deaths and illness from diseases such as polio, which was once widespread.
Another example is China’s partnership with the GAVI Alliance to increase access to immunisation against hepatitis B, a disease that can cause chronic liver infection and cancer. Just a decade ago hepatitis B infected one in 10 Chinese children. Today, less than one percent of children under five are chronic carriers. Such an improvement shows the dramatic gains that can be achieved by expanding access to immunisation. Through sharing best practices, technical expertise and innovations, China and Africa’s partnership can work towards addressing other health priorities across the continent.
Chinese and African leaders at the forum further pledged to develop a strategy that is responsive to the needs and priorities of African countries, and which invests in country-led development. The Nigerian government, like many of its counterparts across Africa, aims to create a health agenda that is led by African leaders and health professionals and which puts the country on a path toward sustainable progress. In May, when I joined African and Chinese officials at the International Roundtable on China-Africa Health Collaboration in Botswana, we engaged in similar consultations to help inform policies and initiatives for the partnership moving forward.
Chinese and African partners will work closely with multilateral and international organisations to help strengthen and scale-up joint efforts. The GAVI Alliance is committed to supporting China-Africa health cooperation to drive even greater impact.
Health plays a key role in reducing poverty and helping the world’s poorest communities build self-sufficiency and accelerate their own development. When people are healthy, they can reach their fullest potential. Through collaboration on health, China, Nigeria and other African countries will help advance the well-being and prosperity of all of their citizens. China and African countries have built a strong partnership over the past 50 years and, together, they can achieve even more in the decades to come.
As economies grow in The South, countries hit by financial crisis in The North, including European countries, are rethinking their strategies for development cooperation.
Rather than merely cutting back on their official development assistance (ODA) or retreating to programmes that merely serve their self-interest, donor countries should renew their thinking as well as their models for fighting poverty and enhancing social and economic development.
The new thinking of what could be called smart development” needs to rid itself of any old paternalistic patterns where donors know best, or aim to promote their own ways. Sovereign countries need to be in the drivers seat, their plans must be the foundation; their ambition must fuel the process. Smart development is about growth that can be sustained and gradually make developing countries independent of the elements of aid.
The rather impressive growth in The South poses new questions of development for poor people who are not necessary living in poor countries anymore. This has caused a revival of attention to the universality of health and social rights. Smart development models are those linking these rights with more robust taxation systems that will secure a level of fulfilment of these rights in the new economic era. Countries like Ghana and Rwanda are examples of how this may be done.
Over the last decade, the GAVI Alliance (Global Alliance for Vaccines and Immunisation) has demonstrated a way of smart development well fitted for the 21st Century challenges. Through a unique partnership between governments, multilateral organisations and the private sector programmes for scaling up vaccination of children and introducing new life saving vaccines, more than 5.5 million unnecessary and premature deaths have been prevented in the poorest parts of the world.
GAVI’s mission is about granting all children their human right to basic protection against deadly diseases.
Countries are eligible for support based on their level of per capita Gross National Income (GNI) below or equal to US$ 1,550, but they all co-pay for vaccines through their national immunisation programme. As their economies grow, their co-payment increases until they reach the threshold for graduation where they may still benefit from reasonable GAVI prices for vaccines, but without GAVI support.
China is a good example of a country that received GAVI support for their nationwide introduction of hepatitis B vaccine between 2002 and 2006. Since then China has graduated from GAVI and is now considering how to contribute to GAVI.
As the European Union leads the world in seeking to build strong foundations for sustainable development, I believe the GAVI model offers an example of smart development well suited the economic dynamic of our times.
Multilateral development reviews by the UK, Sweden and Australia among others have praised this model for being cost-efficient and results-focused. I think the GAVI way offers a direction for countries reconsidering a model which is not only smart, but also right and just.
This blog post is also featured on Euractiv.
GAVI senior program manager
A typical vaccination outreach session at a village maneaba. Kiribati is the smallest and most remote country to receive GAVI support. 103,000 people live across three islands. On May the 6, 2013, Kiribati launched the pneumococcal vaccine.Photo credit: GAVI/2013/Raj Kumar
With 103,000 people living across three islands, Kiribati is the smallest and most remote country to receive GAVI support. Its position close to the international dateline and the equator make the group of islands, spread across 3.5 million square kilometres, one of the most difficult to access by people or vaccines.
I was honoured to be the first GAVI staff member ever to visit this mesmerising country to participate in the launch of the Pneumococcal vaccine for the children of Kiribati.
More than half the population resides in the capital, Tarawa, which boasts just one road. There is no television or a regular newspaper – although a vernacular bulletin comes out once a month. Telephone and internet connectivity are challenging. Kiribati exists almost in a world of its own, unworried and untroubled by global security and economic issues.
The commitment to maternal and child health services in the country is amazing. Every child receives Pentavalent vaccine and vaccinators do not know of any child who has not received the vaccine. They can be sure because they know everyone, communities are like large families and everyone is on their minds. The society is egalitarian and hierarchy is not important.
The Pneumococcal vaccine launch event on 6 May was an impressive, traditional spectacle. Anybody and everybody who matters in the health sector were there. What was more impressive was that next day the vaccination was being done in three facilities I visited. The approach was simple. At Santo Ioane health centre, after vaccinating many children, two nurses Utinia Dennis and Lavender Tineon assisted by a Nurse aide Terengaoiti Toteri went to an outreach site two kilometres away and immunised more children, followed by house visits to ones who did not turn up.
The outreach sites are located at ‘maneabas’ (or meeting sites) which are the largest buildings in the villages and centre of village life, and the basis of island and national governance. Through this system, Pneumococcal vaccine was effectively rolled out all over Kiribati in just one week!
Next day we took a one hour boat ride to go to Abaokoro on other end of L-shaped island of Tarawa. The School Health Nurse Miriaa had completed the vaccination in the centre and had plans for rest of the week to cover four other locations to get to 57 children in her area. Every child had taken BCG and Hepatitis B vaccine at birth.
Equally interesting was that each of three centres we visited had new child cards and registers to record Pneumococcal vaccination. There were brand new posters with new schedule; all provided by LDS Charities, a faith based organization in Kiribati with a significant following. LDS is working closely with the Government to create an enabling environment and demand for vaccines across Kiribati - a good example of Government and CSO working together.
Does this mean Kiribati faces no challenges? No. The vaccine store is far from ideal. In the stores were three boxes of 1 ml. auto disable syringes and no one knew why they had been delivered to Kiribati. Also, according to GAVI’s eligibility threshold, Kiribati is no longer eligible for any new support as its per capita income is $2,030. However, the cost of living is high. So if one looks at PPP income, Kiribati drops more than ten places in the international economic rankings, below many other countries still eligible for GAVI support. This is a difficult situation. The Government can certainly sustain Pentavalent and Pneumococcal vaccines but other new vaccines would be a challenge, both in terms of financial resources and in-country technical expertise.
Towards end of my visit I felt in love with this new world, the like of which I never before encountered. For me, the smallest GAVI-eligible country is also one of the most fascinating. I am proud that the children of Kiribati are not being forgotten and will benefit from the power of vaccines.
Raj Kumar is a Senior Country Responsible Officer at the GAVI Alliance. AusAid is a major supporter of GAVI and its mission to immunise an additional 250 million children in developing countries by 2015, saving an estimated four million lives.
Cary AdamsCEO of the Union For International Cancer Control
Seth BerkleyCEO of the GAVI Alliance
Around 16% of all cancer cases in the world are caused by known infectious agents. In sub-Saharan Africa, that proportion rises to one in three cancer cases. Today around 10% of all cancer cases can be prevented with vaccines. Prevention offers the most cost-effective long-term strategy for the control of cancer.
On 27 May, the World Health Assembly in Geneva adopted a key strategy to accelerate progress on cancer and other non-communicable diseases (NCDs). The new WHO Global Action Plan and Monitoring Framework for the Prevention and Control of NCDs will create a robust global architecture and firmly position vaccines as a key pillar in the fight against NCDs.
NCDs are the world’s number one killer, accounting for 63% of all global deaths. The highest death toll is in low- and middle-income countries. In 2010, for example, cancer accounted for eight million deaths. In September 2011, a High-Level Meeting at the United Nations (UN) acknowledged NCDs as a global priority. Since then, the UN has agreed an ambitious global target to reduce premature deaths from NCDs by 25% by 2025.
Vaccines can help avert millions of premature deaths by preventing the infections Hepatitis B and Human Papilloma Virus, that cause two leading cancers in developing countries – liver and cervical cancer - and are an essential element of the effort to reach this “25 by 25” target.
The introduction of hepB vaccine into the routine immunisation programmes of developing countries was a turning point in the fight against liver cancer in countries where the burden was highest. In the past 10 years, GAVI has supported the immunisation of 267 million infants against hepB in developing countries and prevented an estimated 3.8 million premature deaths from liver cancer.
Today, HPV vaccines to prevent cervical cancer in women offer similar potential.
Cervical cancer is a leading cause of cancer deaths among women in sub-Saharan Africa. In Latin America and Asia, more women die from cervical cancer than in childbirth. Global cervical cancer mortality highlights some of the great injustices of our time—inequities in wealth, gender and access to health services. Women worldwide are exposed to HPV, yet women in developing countries have little or no access to early cancer detection and treatment and many die as a result of this infection.
When the hepB vaccine was first developed, it was seen as too expensive for introduction into developing countries. As a result, low-income countries did not have access to the vaccine despite the high burden of disease. GAVI support has encouraged new manufacturers to enter the market, helping to stimulate healthy competition and lower prices. The price of the pentavalent vaccine (which includes hepB) has dropped by 37% in 10 years.
GAVI has been working with vaccine manufacturers on strategies to lower vaccine prices to make them more affordable for developing countries. Two weeks ago, GAVI announced a new record low price for HPV vaccines to help protect millions of girls in developing countries against cervical cancer.
Last week, Kenya became the first country to protect girls against cervical cancer with GAVI-supported HPV vaccines. The moment is coming when those who need protection most from infections that cause cancer will get the vaccines they need.
Cervical cancer survivor and model
Genevieve SambhiPhoto credit: Her World Magazine
If it is one thing that I have learnt, it’s that there is a huge misconception about cancer. Cancer can affect anyone but it is not necessarily a death sentence, it can be beaten! I was diagnosed with cervical cancer at the age of 35. And as I went through the hardest 7 months of my life, I vowed that if I came out the other side, I would do what I could to educate and build awareness about this dreadful disease.
I remember the day my life came tumbling down so clearly. I was feeding my children dinner (Isabella was 4 and Alexander 15 months). My father rang (He is a gynaecologist and I had been for my annual pap smear 2 days earlier). He explained that the results weren’t normal and more tests were needed. I was in a state of shock, was I going to die? I had cancer?
I had to go in for a cone biopsy a few days later, and had hardly recovered from that when I was dealt the worst blow. The cancer had spread and a hysterectomy was needed. This is when I sat and cried. I was going to die and who would look after my babies? They were so young and they needed me.
Then I realised how lucky I actually was. I had a girl and a boy and a husband who loved me, and that was all I needed. I needed to be here for them and that was all that was important.
My next blow came 10 days after my hysterectomy, when the results showed that I would need chemotherapy and radiation treatments. It was like I was in a nightmare, how much more could I take?
What I couldn’t understand was how I had got to this stage. I went annually for my pap smear, so how in 1 year had I gone from all clear to stage 2b and chemotherapy? The aggressiveness of the cancer shocked my doctors; this was a disease that took 5-10 years to get to the stage that I was at after less than 1 year.
On paper I am probably the last person who should have got cancer. I am young, have been with my husband since I was 20, have 2 young kids, don’t smoke or drink, and exercise regularly - yet I still got cancer. So if it could happen to me, it could happen to you!
So I try and make it my mission to build awareness about pap smears and vaccinations. If I had not gone for my pap smear I would not be here today. Cervical cancer is a treatable cancer if caught early, and the only way to do this is through a pap smear. Safe and effective vaccines protect against two types of human papillomavirus (HPV), which cause about 70% of cervical cancer cases. And I am very glad to hear that many poor countries in Africa and Asia will soon be able to protect young girls with the HPV vaccine thanks to support from the GAVI Alliance.
So why would you not want to protect yourself and your loved ones? My daughter, when she is old enough, will definitely be vaccinated. She will be protected so that she never has to go through what I did. No woman should have to go through what I did.
I have decided to put up with the nasty and hurtful things people say as to why I got cervical cancer because there is always one who will listen. And if I can save one person, then that is 1 person saved, and I have done my job!
Vanessa MdeeMTV Africa VJ from Tanzania, singer and activist
I’m trying to think of the first time my
mother had ‘THE TALK’ (yes the birds and the bees talk) with me. THE TALK that
I’d heard my friends refer to as the most embarrassing moment of their lives,
the talk that officially indicted you into teen-hood, THE TALK that signified
your maturity – your parents decided you were old enough to speak of natural
human interaction between a man and a woman. I’m still eagerly awaiting this
‘TALK’. Now don’t be fooled, my mother knows all too well that I’m well aware
of physical interaction. Not because I told her but because she’s got that
sixth sense like all mothers do besides I am of age and slightly adventurous (for lack of a better word). I gather I never put my parents in a place where
they felt the need to have this conversation with me. I did after all grow up
in a Muslim turned every Sunday church-going Roman Catholic home - where I
obviously wasn’t having sex. My parents were right – not because I was holier
than the next but the mere thought of them finding out crippled me. You see, growing
up in an African home as exposed and worldly as my upbringing was, certain
things were NOT discussed. This remains the case to date. My line of work has
allowed me to converse intimately with young African women and girls, and their
stories are similar. SEX TALK! Is a no go.
When I started DynamitesMission - my awareness
blog sponsored by the UNAIDS and MTV’s Staying Alive - I wanted to lend my
voice and extend my ear to the streets. I was learning about grassroots
organizations and their efforts to educate their communities. I was moved and
in turn spoke from my perspective – pretty layman but CLEAR to other laymen. A
year in, I get a BBM from one of my best friends Michelle, it read ‘ You’re
trying to tell me that above all the heartache we take from these men, they
also pass HPV (the virus that causes cervical cancer) to us ‘ – I chuckled
and said ‘ Yes Elle, they do – talk about short end of the stick’. Many women are unaware of cervical cancer and
HPV, MOSTLY about how exposed we are to the virus through our everyday
My first personal encounter with cervical cancer
was in my early teens. My aunt was diagnosed with cervical cancer at a very
late stage and when her health deteriorated I remember wondering what she had
done to deserve this and why the meds weren’t working. I kept asking my father
– why she wasn’t getting better. Only to properly understand the severity as
she passed away after being bed ridden for 2 weeks. When a woman is diagnosed
with cervical cancer in Tanzania there is a 70% chance she will survive. Experts
agree that the low survival rate is due to late diagnosis and treatment by a
healthcare provider. It wasn’t until I was approached by GAVI that I found out
that there now is a vaccine and that if administered early (before young women
become sexually active) then we can ensure a brighter future for our women and
decrease the numbers of cervical cancer cases. Young women need to be aware of
these opportunities that can be availed but most importantly the knowledge of
HPV and cervical cancer – I truly believe these formative years will define
their sexual reproductive health and nurture a generation of healthier women.
It starts with open communication about sex and sexual reproductive health.
2013 is the beginning of a dramatic shift in women’s
health. A record low price for a HPV vaccine has been negotiated by GAVI for the 50+ countries eligible for GAVI support ( including my home country,
Tanzania), opening the door for millions of girls in the world’s poorest
countries to be immunized against a devastating women’s cancer. This not only
is the beginning of a shift in the overall eradication of cervical cancer but a
new dawn for young African women around the continent. An opportunity that
myself and many other young African women did not have.
It breaks my heart to see
lives cut short due to ailments. In Africa these losses happen often
and deprive our societies. It's about time
proper healthcare is administered for all, especially the future generation.
GAVI is making this possible by pioneering the administration of the HPV
vaccine. Giving my younger sisters a chance - that's ONE less
killer to worry about.
Bill Gates Co-chair and trustee of the Bill & Melinda Gates Foundation
I arrive in Ghana today to see firsthand why the country’s immunization system is working so well and meet the people involved.
For some people, health delivery systems might not seem like the most intriguing topic, but I am really interested in understanding how they’ve done so much of this right. Strong immunization systems are crucial for protecting our gains against polio and helping us reach mothers and children with new vaccines and other life-saving health services. In Ghana, for example, polio was eliminated a decade ago and an outbreak in 2008 was quickly controlled. No child there has died from measles since 2002. And Ghana was the first country to launch two new vaccines last April, against rotavirus, which causes severe diarrhea, and pneumococcal pneumonia.
Ghana’s approach works so well for a few key reasons: Rigorous data gathering and analysis, accountability at the district level, and community outreach. Just as importantly, the vaccination program is fully integrated into the health system. But there’s really no substitute for seeing it on the ground.
Tomorrow we’re going to visit a director of health services in a district in central Ghana, then a nearby clinic. We’re then going to visit a community health center where the nurses also go out to find mothers who missed appointments or children due for immunizations to make the program as thorough as possible. As I wrote in my annual letter this year, measurement is crucial for improving health care, so at every stop I want to understand how the data is collected and used for planning and decision making–and meet the people who are making this success possible.
I plan to share my experience in Ghana at the Global Vaccine Summit in Abu Dhabi April 24-25, where global health leaders will celebrate progress in immunization and demonstrate how the world is united to give all children a healthy start to life.
Of course, no system is perfect, so I want to learn about the obstacles and challenges in Ghana as well. I’ll speak with many of the leaders who are working so hard to reach every child with vaccines, including Dr K.O. Antwi-Agyei, who manages the national immunization program. I’m also excited to talk to some of the well-trained community health nurses and meet some of their local clients. In my next post I’ll tell you about the people I’m meeting and some of the lessons we can learn from Ghana’s success.
This blog post is also featured on the Impatient Optimists.
Charlie WhethamGAVI Country Responsible Officer
Community interest in the campaign: one of four marquees this size.
Rwanda’s 2012 Olympics wasn’t noteworthy, with the highlight an odds-defying 14th by Robert Kajuga in the men’s 10,000m.
It’s a very different story in immunisation. Rwanda leads the way amongst the poorest countries in Africa, with the first introduction of pneumococcal vaccine (for pneumonia and similar infections) in 2009; the first national introduction of human papillomavirus (HPV) vaccine in 2011; over 95% coverage for the vaccines they have introduced and now the first introduction of measles-rubella (MR) vaccine.
Vaccine introduction is no competition, but this list well illustrates the ambition of the leadership in Rwanda. And it is producing results, with under five mortality reduced from 250/1000 in 1995, immediately post-genocide to 177 in 2000 and to 91 in 2010.
Campaign preparations, with typical Rwandan thoroughness.
Last week I was in Rwanda for that first MR campaign. Rwanda has been carrying out measles campaigns every three years, supplementing their routine immunisation, which has reduced confirmed measles cases from 3500 in 2006 to fewer than 100 in subsequent years (Rwanda EPI reports). The measles surveillance system now identifies a higher proportion of rubella than measles cases.
Rubella vaccine is therefore a natural next step. Although rubella is usually a mild disease affecting children, when a pregnant woman becomes infected serious consequences can occur with Congenital Rubella Syndrome (CRS) causing hearing loss, blindness or heart defects in the baby, and still-birth also endangering the mother’s life. WHO (2011) estimate that 112,000 children a year (300 each day) are born with birth defects from CRS, placing heavy human and economic tolls on these children and their families.
Leveraging the wide reach of immunisation programmes to reach children with other life-saving interventions.
Now thanks to the technical advice of the Measles and Rubella Initiative and GAVI’s financial support, over 700 million children under the age of 15 in 49 countries will be protected against measles and rubella by 2020.
Over four days last week, Rwandan health workers vaccinated close to five million children between the ages of nine months and 14 years with the MR vaccine. Rwanda used the opportunity of the campaign to also provide a third national cohort of 12 year-old girls with their first dose of HPV, donated by Merck – GAVI will support the national programme from 2014. The selection by the Government of the Minister of Gender and Family Promotion, Hon. Oda Gasinzigwa, to be guest of honour at the campaign launch highlighted that the primary victims of both CRS and cervical cancer are women.
GAVI in partnership with the Government of Rwanda and the UN family
This campaign well illustrated how the wide reach of immunisation programmes can be leveraged to reach children with other life-saving interventions – with Rwanda providing vitamin A droplets, educating children on malaria-avoidance and testing, and providing a wide range of contraception.
GAVI describes our support for MR as catalytic: we meet the costs of the campaign almost entirely. In Rwanda, these totalled nearly US$ 7 million, with half paying for the vaccines, syringes and safe-disposal boxes and the other half for the daunting operational logistics. The key condition for this support is that the country itself then introduces MR into its routine immunisation programme, including paying itself for the vaccine from that point on, with only a small (US$ 300,000) further grant from GAVI. Rwanda will do this in January 2014.
GAVI: trackside coach in Africa’s race to immunise its children against vaccine-preventable diseases.
Charlie manages GAVI’s partnerships with the countries of East and Southern Africa to increase their use of new and underused vaccines which significantly reduce childhood mortality. His interest in athletics – an 800m (half-mile) personal best of 1 min 52 – doubtless influenced this article…
Photo credit: © UNICEF Rwanda/2013/Rusanganwa
Rt Hon Stephen O’Brien, MP
Prime Minister’s Envoy and Special Representative to the Sahel
Rt Hon Stephen O’Brien MP seeing the impact funding from Comic Relief has on millions of children
I firmly believe that it is in the British character to try to help those whose lives are blighted by disease, poverty and violence. Red Nose Day, supported by Comic Relief, gives millions of people across the country the opportunity to do just that.
This Friday night we will all be reminded of the desperate situations that persist in many countries around the world. The support that Comic Relief is able to provide to scores of organisations working in the most difficult of circumstances really does make a difference.
Like everyone, I am keen to know that the money raised by Comic Relief will be well-spent on tackling extreme poverty. Thanks to my work as the Prime Minister’s Envoy to the Sahel region, and previously as a Minister for International Development, I am in the privileged position of being able to see the impact funding from Comic Relief has on millions of children.
Access to vaccines is a critical issue in developing countries. Healthy children lead to healthy and self-sufficient societies but in many places a simple injection or some oral drops that will prevent children from succumbing to potentially fatal diseases are simply not available or, if they are, they are too expensive for most families.
Thankfully in the UK our children are vaccinated as a matter of course but the situation in many developing countries could not be more different. That’s why I’m an avid, unapologetic supporter of the work of the GAVI Alliance, funded by, amongst others, the UK Government and Comic Relief.
In all my experience in Sub-Saharan Africa, my current and former roles include helping tackle humanitarian challenges at their root – including access to immunisation – that are facing the people in countries such as Chad, Eritrea, Mali, Burkina Faso, Mauritania, Niger, Senegal, South Sudan and Sudan.
These are among the poorest countries on earth, and yet each is a contributing partner of the GAVI Alliance. GAVI is a public-private partnership which aims to increase access to lifesaving vaccines – both old and new – for children in the world’s poorest countries. This is not charity. GAVI is clear that countries must help finance their vaccine programmes through a co-payment arrangement.
Working with other partners such as Comic Relief, GAVI has helped immunise 370 million children in more than 70 countries since 2000, saving more than 5.5 million lives. This includes children in Tanzania, a country with a special resonance for me as it was where I was born.
GAVI is making progress but there is still a great deal to do. Every year, 1.7 million children die from vaccine-preventable diseases. The vast majority of these deaths occur in developing countries, where one out of every five children remains unvaccinated.
Comic Relief is playing its part by supporting the GAVI Matching Fund which sees a donation matched by the Bill & Melinda Gates Foundation. This funding pays for lifesaving vaccines – one of the most cost-effective health investments around.
Consider Tanzania, a country of 46 million people that has a plan to transform itself into a middle-income economy by 2025.
To succeed, the government recognised it must ensure good health for its people. By working closely with GAVI and its partners, Tanzania has increased its routine vaccine coverage rates to above 90%, while co-financing about 10 % of the cost of the vaccines. In parallel, the country’s GDP growth has risen to about £16 billion from £6.8 billion in 2001.
Immunisation should be a right for all children, no matter where they live and GAVI, through its work with Comic Relief and the UK Government, is helping to turn that basic right into a reality.
Rt Hon Stephen O’Brien, MP, is the Prime Minister’s Envoy and Special Representative to the Sahel, a part of Africa just south of the Sahara. He previously served as Parliamentary Under-Secretary of State for International Development from May 2010 to September 2012. He chaired the global charity, Malaria Consortium and is about to resume his trusteeship of the Liverpool School of Tropical Medicine. He is the Conservative MP for Eddisbury.
Maggie CarterDeputy Director, Shot@Life Campaign
"Immunizations are how we can give all children a fair start at a healthy life," said GAVI Board Chair Dagfinn Hoybraten this morning. As we gather in Dar es Salaam for the GAVI Partners' Forum, we are reminded in the simplest way why we have come together and our work is reaffirmed.
Over the past several days, I have participated in gatherings of Civil Society Organizations and traveled several hours outside of Dar es Salaam to the Morogoro region for a field visit. In Morogoro, our delegation met with Dr. Mtey at the Morogoro Regional Medical Office who oversees health activities in this region. He provided us with a landscape of their work at the country, region, district and local level. What struck me was how high the immunization rates are in this region – above 90 percent – even with insufficient health systems. Yet, the largest killers of children under 5 in Morogoro are:
The Tanzanian government has committed one million insecticide treated bed nets to protect against malaria. And there is a significant need for the pneumococcal and rotavirus vaccines to protect these children from pneumonia and diarrhea.
Morogoro is the second largest region in Tanzania with six districts, 181 wards and 613 villages. The region covers more than 73,000 kilometers. However, there are only three hospitals, 48 health centers and 358 dispensaries. Ideally, they would have one hospital per district, one health center per ward and one dispensary per village.
Dr. Mtey then took us to a district health center and a village dispensary in Malera and Doma. We witnessed children receiving routine immunizations like the oral polio vaccine, Vitamin A and deworming tablets. At one site we visited, health days are provided in a "hut" where there is no electricity so immunizations and supplies have to be transported from the nearest dispensary. As these families don't have access to regular health care or emergency services, regular immunizations provide these children with the first line of defense – protecting them from disease and potential death.
As we transition today to the GAVI Partners’ Forum, we come together to discuss creative and effective ways we can assist families like the ones we just met in Morogoro, as well as millions of others across developing countries, to give them access to the health care they need and ensure that all of their children get a shot at a healthy life.
This blog post also appears on shotatlife.org.
Katherine MooreCountry Programmes, GAVI
Watched by Benin President, Dr. Thomas Boni Yayi, Health Minister Dr. Dorothée K.Gazard, administers the MenAfriVac.
GAVI and partners, the World Health Organization (WHO), UNICEF and PATH, gathered in Cotonou this week to mark an upcoming milestone in public health – later this year the 100th million person will be vaccinated with MenAfriVac, less than two years after the start of our mass campaign programme.
While the Alliance will not reach the number until December, Benin President Dr. Thomas Yayi Boni, senior government representatives, 2,000 Beninois and international guests held a major party on 15 November complete with traditional poetry, Guedele dancing and singing.
We all have reasons to celebrate the success of the meningitis A vaccine. Just 17 years ago, Meningitis, an inflammation of the protective membranes covering the brain and spinal cord, ravaged a broad swath of Africa, extending from Senegal in the West to Ethiopia, commonly known as the ‘meningitis belt’.
With a mortality rate of 50 percent for those unable to seek immediate treatment, it robbed many countries of the very young, children and adults aged less than 30. In 1996, the region’s worst epidemic infected a quarter of a million and killed 25,000.
Responding to pressure from African Ministers of Health, the Meningitis Vaccine Project, a collaboration between the WHO and PATH funded by the Bill & Melinda Gates Foundation, worked on the development of a vaccine specifically tackling the strain of meningitis in the region. Together with the Serum Institute of India, they have brought to the market an affordable vaccine easily accessible to countries that most need it.
GAVI has funded the campaigns, providing more than US$162 million for vaccine support and preparations for the 10 countries that have launched to date. GAVI’s plans include continued support for preventive campaigns in the additional meningitis A belt countries as well as help with epidemic response, surveillance and routine immunisation going forward.
Benin President Dr. Thomas Boni Yayi shows-off a child's vaccine card freshly stamped with MenAfriVac.
It is fitting that all partners in this extraordinary collaboration paused for one day to applaud the collective efforts.
Burkina Faso, Niger and Mali, the first African nations to conduct campaigns, sent representatives to the festivities to tell their stories. Burkina Faso reported 40,000 meningitis cases in 2006 and 2007. In 2010, the country vaccinated 12 million people aged one to 29. Since then, there have been no new cases of meningitis A reported among vaccinated populations.
Ouagadougou’s Eric Nabyoure, the project’s first vaccinee, was only 20 months when he received MenAfriVac. He is now a pre-schooler and thriving.
In the small country of Benin, two million children and young people will receive MenAfriVac in an efficient 10 day sweep of the central and northern part of the country that starts tomorrow. They will join neighbours in Ghana, Cameroon, Chad, Sudan, Nigeria and Senegal, countries that have or will launch mass campaigns in 2012 to beat back the epidemic.
Thursday’s ceremony included many official speeches, awards, declarations, felicitations, hand shaking and back slapping. However, the finale was the most meaningful. President Boni Yayi, healthcare workers, and the Minister of Health participated in the immunisation of another toddler, the first to be vaccinated with MenAfriVac in Benin. To her obvious surprise, the event included not only a large needle, but 4,000 eyes, loud band music, the blinding lights of dozens of television cameras and soothing pats from many important-looking strangers.
From Eric Nabyoure to another toddler on a stage at the Palais de Congres in Cotonou we have jumped from one to approximately 90 million protected against the devastating disease of meningitis. Now that is really something to write home about.
Rob KellyGAVI spokesperson
EPI officials, GAVI's Deputy CEO Helen Evans and Mir Hazar Khan Bijaroni, Minister of the Inter-Provincial Committee, talk about Pakistan's rollout of the pneumococcal vaccine.
I never expected to be so cold in Pakistan in October that I wished I’d brought my fleece. But as I stood in the sub-zero temperatures of Islamabad’s vaccine storage room, surrounded by hundreds of thousands, if not millions, of doses of pneumococcal conjugate vaccines (PCV), I wouldn’t have wanted to be anywhere else.
The introduction of pneumococcal vaccines has the potential to save many thousands of lives, drastically reducing Pakistan’s under-five mortality rate. Today I was privileged enough to have an inside view as the process of vaccinating Pakistani children with PCV started in the national capital.
The PCV vaccine is a complex, conjugate vaccine that has, until now, proved prohibitively expensive to the average Pakistani family, many of whom have seen firsthand the terrible effect of pneumonia on babies and small children. Now, with GAVI support, Pakistan aims to introduce pneumococcal vaccine across the country, hopefully vaccinating the country’s entire annual birth cohort of 4.8 million each year from 2015.
As I walked out of the cold room into the stifling heat, I was reminded of the challenges the Government and its partners face in meeting this objective.
Because of its complexity, PCV must be handled with care. It must be stored at a low temperature, between two and eight degrees centigrade, and used within six hours of opening.
These practical issues underline why GAVI has funded an overhaul of Pakistan’s cold chain, to ensure vaccines are stored and transported at the correct temperature, and paid for training for 100,000 female health workers who will vaccinate children in urban and rural communities.
It is hard to comprehend the sense of relief that parents across Pakistan will feel when their children are vaccinated against pneumococcal disease as a result of this work.
Sadly, more than 400,000 children in Pakistan die before their fifth birthday each year. Pneumonia, which is often caused by pneumococcal disease, accounts for one fifth of these deaths. By choosing to work with GAVI through co-financing (paying a proportion of the cost of each dose of PCV) and vaccinate millions of its children against pneumococcal disease, Pakistan is making an investment in its future.
An ambitious target? Yes. One worth pursuing? Absolutely.
Head, Media and Communications, GAVI Alliance
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
Former Chairman and CEO of MTV Networks International, GAVI Envoy
People throughout the UK have come together in an extraordinary way in recent weeks for a cause greater than themselves. They literally are helping to repair the world through an extraordinary charity, Comic Relief, and its inspiring Sport Relief fundraising campaign.
The efforts of hundreds of thousands in the UK, from stars such as Miranda Hart and John Bishop to everyday people, are making a huge difference.
One of the issues Sport Relief is focusing on this year is child immunisation. I personally have seen in health clinics and villages throughout Africa the impact of these efforts. For just a few pounds, vaccines not only provide protection and save lives, but they also cut healthcare and treatment costs, help reduce poverty, boost local economies and contribute to political stability.
It's a small investment that reaps huge benefits as children grow to be healthy and live a productive life. Yet one in five children still don't have access to this life-saving protection and sadly every 20 seconds a child dies from a disease that could have been prevented with a vaccine.
This is why the funds raised through Sport Relief are so important. Another critical player in this effort is the private sector. Increasingly we are seeing that global health also means economic health and that vaccines produce a huge return on investment.
One of the recipients of this year's Sport Relief campaign is the GAVI Alliance, a cutting-edge international non-profit that has helped immunise 326 million children in more than 70 countries since it was founded in 2000. The support of GAVI and its partners has helped save more than 5.5 million lives.
GAVI has recently launched an innovative private sector programme that will make the Sport Relief campaign even more impactful. The GAVI Matching Fund welcomes contributions from companies, foundations, their customers, employees and business partners which are than 100% matched by the UK Government and the Bill & Melinda Gates Foundation - a longstanding partner of Comic Relief.
This means that Comic Relief is able to make a £5 million grant toward child immunisation through GAVI, with £2.5 million raised through Sport Relief and £2.5 million matched by the Gates Foundation.
This combination of non-profit and private sector support led by the British public's extraordinary support to Comic Relief and the GAVI Matching Fund is quite an impactful way of addressing global health challenges.
The expansion of public and private efforts - especially in wealthy countries like the U.S - would mean that critical goals are reachable, such as GAVI's goal of immunising an additional 225 million children and saving 4 million lives by 2015. But it also would mean that entire villages, communities and nations can begin to engage more profitably in the global economy, standing strong thanks to a handful of effective and affordable vaccines.
Many private sector champions already have joined the efforts of U.K. charities such as Comic Relief, the ARK Foundation and the Children's Investment Fund Foundation as well as global multinationals - J.P. Morgan, Anglo American and "la Caixa". I look forward for others to do also.
They are proving that doing social good is also good business.
This blog features on the Huffington Post.
Honourable Walter T. Gwenigale
Minister of Health and Social Welfare of the Republic of Liberia
Women in poor countries are at risk of many deadly diseases – such as HIV, malaria and TB - in part because there are no vaccines available yet to protect them. But there is a vaccine that can prevent the most deadly form of cancer.
Cervical cancer is the number one cancer-killer of women in my country, Liberia.
Cervical cancer is overwhelmingly a problem of the developing world. Almost 90% of the 275,000 women who die from it every year live in developing countries. These numbers are growing, and if the problem isn’t tackled right now, by 2030 cervical cancer could kill 430,000 women every year.
Yet though women in the world’s poorest nations are at the highest risk of the disease, they have no defence. Unlike in the West, women here often don’t have access to screening and treatment. And what people might not realise is that though the virus is spread through sexual contact, using condoms doesn’t necessarily protect against it. This is why the vaccines are so important to us – to protect girls before they are infected with the virus.
Those vaccines are available to girls and young women in the developed world. Yet, they are not available yet in my country. The high price of HPV vaccines has kept it out of reach of poor women. But thanks to GAVI, vaccine prices for developing countries are falling.
I am delighted that the GAVI Alliance is supporting HPV vaccines in developing nations. A staggering 28 million girls and young women will be immunised by 2020. With these vaccines, the GAVI Alliance is opening the door for women in developing countries to enjoy equal access to these life-saving vaccines as our sisters in rich countries.
We are happy that GAVI has answered our call for HPV vaccines. Now, we must get ready to show we can deliver them. The World Health Organisation recommends giving the vaccine to girls aged between 9 and 13; with three doses within six months. This means coordination between schools and health clinics and the girls’ families – so each country will have to work out how to best reach the girls.
The importance of this vaccine cannot be overestimated. Like many African countries, Liberia’s economy has gone through enormous difficulties, but we are rebuilding our country and making progress in improving healthcare. We need this vaccine. The health of our economy depends entirely on the health of our people. When you save women and girls, you save the very fabric of society.
Leila NimatallahSenior Programme Officer, Advocacy, GAVI
“I always bring my children in on time for their vaccines. I know how important that is for keeping them healthy,” said Misael Amador as he sat in the waiting room at a public hospital in Tegucigalpa, Honduras, holding his four-year-old daughter, Karen Maria on his lap. “I am proud that I am never late to bring them in.”
This sense of pride in ensuring children’s health could be felt everywhere we went in Honduras last week—from the Minister of Health to the health monitors who regularly travel out to rural communities (without pay) to check that children are up to date on their immunisations.
Somehow, this small nation, burdened with deep poverty and violent crime, has achieved what most others (including the United States) have not: a near-perfect vaccination coverage rate. This means fewer child deaths because immunisations have saved the lives of more children than any other medical intervention in the last 50 years.
I had the honour of accompanying members of the United Nations Foundation’s Shot@Life Campaign and six congressional staffers to view Honduras’ national immunisation programme, and I learned that the public health success story of Honduras is directly related to the deep commitment and strong teamwork of everyone involved in the programme.
Back in 2009, my organisation, the GAVI Alliance, paid for immunisations in Honduras to prevent the leading cause of diarrhoea, which is one of the two biggest killers of children worldwide. Two years after the rotavirus vaccine was rolled out, GAVI financed Honduras’ rollout of pneumococcal vaccine as well, taking aim at the other major cause of death for children under five, pneumonia. But buying vaccines at an affordable and sustainable price is only part of the story.
Delivering vaccines, which must be refrigerated from the moment they are developed until the time they are administered, is an incredibly complex task—especially in a place like Honduras, where 45 percent of the rural population lacks reliable electricity. It takes all stakeholders— PAHO, the CDC, the US Agency for International Development, the Honduran Expanded Program on Immunization, doctors, nurses, volunteers, civil society, teachers and parents—working in concert to achieve this incredible success.
Here in the US, advocates of the Shot@Life Campaign are bringing this inspirational story to American citizens and leaders to make the case for why our country should continue its investment and leadership in global health, vaccines and organiSations like GAVI.
In April 2012, Shot@Life will roll out nationally. Everyday citizens, who have been inspired by success stories like Honduras’ and who have been trained to take action to make a difference, will be reaching out to engage their families, their communities and their leaders to educate them and raise awareness about the power of vaccines.
To prepare for this launch, the campaign will be gathering a powerful group of committed Americans together this week in Washington, D.C., to strategiSe and design their efforts to bring the story of vaccines’ impact to the masses. Once Americans learn more about what vaccines can do, they will want to be a child’s shot at life.
Diane SummersSenior Specialist Advocacy and Public Policy, GAVI Alliance
In many countries, cancer is no longer considered a death sentence.
But for the world’s poorest people it remains a stark reality.
startling statistic underpins this situation. Of the more than seven
million people who die from cancer every year, about 70% lived in low-
and middle-income countries. Preventive technology like vaccines, and
effective screening and treatment programmes that we take for granted in
industrialised countries, are simply unavailable to the poor.
This year’s World Cancer Day
calls on everyone to do their part to reduce cancer deaths. GAVI is a
member of the Union for International Cancer Control and supporter of
World Cancer Day. On this day, I want to highlight how GAVI contributes
to the fight against cancer through accelerating the reach of vaccines
that prevent cancer-causing infections.
One in five cancers is
caused by chronic infections. For example, viral hepatitis infections
contribute to liver cancer, one of the top three causes of cancer deaths
worldwide. Cervical cancer, the third most common cause of cancer
deaths among women, is primarily caused by human papillomavirus (HPV). The bacterium Helicobacter pylori contributes to stomach cancer.
vaccines now exist that prevent the viruses that are the primary causes
of liver and cervical cancers. GAVI works to accelerate the reach of
those vaccines to people living in low-income countries.
Hepatitis B vaccine
was the world’s first anti-cancer vaccine. The vaccine prevents
infection with hepatitis B virus, a primary cause of liver cancer and
cirrhosis. When the vaccine became first available in 1981 it was too
expensive for low-income countries to introduce, despite their high
burden of disease.
However, price reductions achieved with GAVI
support spurred a spectacular acceleration of hepatitis B vaccine
introduction in low-income countries. Between 2000 and 2010, the vaccine price dropped by 68% from US $ 0.59 cents to US $0.18 cents.
Consequently, by 2006 more low-income countries than high-income
countries had introduced the vaccine into routine immunisation.
GAVI’s support to developing countries for hepatitis B vaccine has now prevented over three million deaths.
China is a well-documented success story.
Following the introduction of hepatitis B vaccines into national
routine immunisation programme, the percentage of immunised newborns has
risen to 90% and the prevalence of hepatitis B virus carriers is
markedly reduced. Less than 1% of children under five are now chronic
carriers of hepatitis B.
Now, the World Health Organization identifies hepatitis B vaccines as a ‘best buy’
on a population-wide basis – that is, an immediate action that can
accelerate lives saved, diseases prevented and heavy costs avoided.
Vaccines against the human papillomavirus infection that causes cervical cancer in women offer a similar potential.
cancer kills 275,000 women every year. Over 85% of those deaths are in
developing countries. Safe and effective human papillomavirus (HPV)
vaccines can prevent around 70% of cervical cancer cases.
vaccines have been available since 2007. Although HPV vaccines quickly
became part of routine immunisation of girls and young women in many
industrialised countries, they are still largely unavailable in
low-income countries. The high price of the new vaccines remains a
barrier to introduction.
GAVI is working with the two
WHO-prequalified vaccine manufacturers on strategies to lower the price
of the vaccines to make them more affordable. A milestone was reached in
June 2011 when one manufacturer offered to provide its HPV vaccine at
$US 5 per dose to GAVI-eligible countries, a 67% reduction in the
current lowest public price. This was the first-ever public offer of an indicative price for HPV vaccines for low-income countries.
A second milestone was achieved in November 2011, when GAVI took first steps towards introducing HPV vaccines in GAVI-eligible countries.
GAVI will invite countries to apply for funding for HPV vaccines
provided that further price reductions from manufacturers can be secured
to ensure affordability. Funding proposals will have to demonstrate
country’s ability to deliver the vaccines successfully or deploy pilot
projects. By 2015, nine countries are expected to apply and an estimated
1.6 million young women and girls immunised.
The power of
vaccines to prevent the infections that cause cancers has yet to be
fully harnessed. Research continues to better understand the role of
infections in cancer. With this work comes the promise of dramatic new
developments of vaccines to reduce cancer deaths, and the need to roll
out these vaccines in low-income countries.
GAVI is committed to
accelerating the reach of life-saving vaccines, a mission aligned with
the UN General Assembly’s declaration to increase access to
cost-effective vaccinations to prevent infections associated with
No one should die because of where they are born.
Managing Director, Innovative Finance, GAVI Alliance
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.
15 NovPneumonia: No friend of mine - Seth Berkley, CEO of the GAVI Alliance
12 NovPneumococcal vaccine is saving lives already - Mwai Kibaki, President of the republic of Kenya
12 NovShot in arm breathes hope into lives of world's most vulnerable (The Age) - Sir Gus Nossal, former President of International Union of Immunological Societies, former Chair of WHO's expert advisory group on vaccines
12 NovFighting pneumonia in Bangladesh (ONE.org) - UK Parliamentarian Jim Dobbin, MP
9 NovThe WPD Generation: Moving the needle to fight childhood disease (ONE.org) - Bill Roedy, former CEO of MTV, GAVI Envoy
9 NovPneumonia takes the lives of millions of babies…vaccinate! (Results.org) - Kate O'Brien, Deputy Director, International Vaccine Access Center (IVAC)
9 NovRwanda is Proud to Pioneer the Pneumococcal Vaccine (ONE.org) - Agnes Binagwaho, Rwanda’s minister of health
8 Nov'No child should die of a disease we can prevent' (ONE.org) - Joseph Yieleh Chireh, Ghana’s minister of health
8 Nov Pour lutter contre la pneumonie – vaccinez vos enfants ! - Guy Aho Tete Benissan Coordinateur régional du REPAOC, membre du Comité de pilotage du Forum des OSC partenaires de GAVI Alliance
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.
Chief of Staff, GAVI Alliance
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
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.
This post also appears on the ONE International site.
Dr. Amani Abdelmoniem MustafaManager, Expanded Programme on Immunisation, Sudan
This is a guest blog by Dr. Amani Abdelmoniem Mustafa, Manager of the Expanded Programme on Immunisation for Sudan. In August, she wrote about the launch of the rotavirus vaccine in Sudan in the blog: We started! The first child in Sudan to receive a rotavirus vaccine. Here she updates readers about the country’s progress.
KHARTOUM, Sudan — Two months ago, a 42-day-old infant named Jasir Tarig was vaccinated against rotavirus at a ceremony here in Khartoum. He was the very first child in Sudan to be vaccinated against a disease that kills more than a quarter million African children each year. Almost every child in Sudan suffers terribly from diarrhea, especially during the first year of their life, and rotavirus is the leading cause of severe diarrhea. So it was very exciting to watch as Jasir—and hundreds of other infants—were finally given a chance at a future free from the misery of this disease and its possible death sentence.
My immunization team was determined that the vaccine would reach infants not only in the cities, but throughout the country. We can now say we achieved this goal, but it wasn’t easy. Sudan is an immense country with geographical
challenges, isolated villages without health facilities, and security issues. If there was flooding, we used boats or rafts. If roads were blocked, we used tractors. Sometimes vaccines were transported on camels. Sudan has waited so
long for this vaccine that we will not let these challenges get in our way. We will not miss any child.
We also worked hard to get the word out to communities that
the new vaccine would help prevent severe diarrhea and save children’s lives.
We shared the message in schools, and students then shared it with their
mothers who shared it with their neighbors. We placed announcements and
information in newspapers and SMS, on radio and TV, at health centers and on
road signs. If you were walking down the road, you got the message. If you
watched TV, you got the message.
Because the rotavirus vaccine is new to us we’ve monitored
the introduction of the vaccine closely. Recently I returned to the health
clinic where Jasir received his vaccine. I had been especially touched by Jasir
and his mother, who had waited ten years for a child. When I learned that
he—and all the other children vaccinated that day—had come in for their second doses
on schedule and were well, I felt I could finally relax.
Sudan is the first country in Africa to introduce the
rotavirus vaccine with the support of the GAVI Alliance. We hope our experience
will encourage other African countries to apply for support from GAVI, so our
continent no longer carries the staggering burden of a quarter million deaths
due to rotavirus.
All children deserve to be vaccinated and live healthy lives.
Vaccination is a human right. The rotavirus vaccine must reach every child by
any means, irrespective of their situation. We should all work to make this a
Today, GAVI announced that rotavirus vaccines will soon be rolled out in other African countries. Watch a short film in which immunization experts, health workers, and mothers from Sudan
and Tanzania talk about the need for the vaccines and their hope for the future.
John WeckerPh.D., director of Vaccine Access and Delivery, PATH
Last month, I visited the pediatric ward of a district hospital in Dar es Salaam, Tanzania, and found it relatively empty. Relative, that is, to what I would expect to find in the rainy season, when three to four children typically fill each bed. Children hospitalized during the rainy season mainly suffer from respiratory disease or severe diarrhea. Of the children with severe diarrhea in that ward in Dar es Salaam, as throughout hospitals in Africa, the majority will be infected with rotavirus.
Rotavirus is the leading cause of severe diarrhea in children under five years of age, killing as many as half a million each year. A staggering 50 percent of these deaths occur in Africa; six of the seven countries with the highest child death rates from rotavirus are located on the continent.
While these statistics are disturbing, there is hope. Rotavirus vaccines are already saving children’s lives today in countries where children have access to them—and could be saving millions more in Africa and around the world if they were more widely used.
Three recent scientific studies strengthen the case that rotavirus vaccines reduce the risk of disease, decrease deaths and hospitalizations, and save health care costs. Prior to the introduction of the vaccines in Mexico in 2006, 50 percent of deaths due to childhood diarrhea were caused by rotavirus. The country has since seen an impressive 56-percent reduction in the number of children under age five dying from diarrhea.
In the US, a study by the Centers for Disease Control and Prevention (CDC) found that vaccinating infants against rotavirus led to a significant reduction in the number of older children hospitalized with severe diarrhea. The authors conclude that very young children transmit much of the rotavirus disease in communities and, by vaccinating them, severe forms of the disease can be prevented even in those who have not been vaccinated. Another CDC study reported dramatic decreases in health care visits and costs for diarrhea-related illnesses in children under age five following the introduction of rotavirus vaccines.
The evidence supporting the use of rotavirus vaccines around the world is compelling, and African countries are beginning to demand this lifesaving tool. In July of this year, Sudan became the first country in Africa to introduce rotavirus vaccines nationwide with the support of the GAVI Alliance. This is the first step in a coming wave of introductions sweeping across Africa. By rapidly introducing rotavirus vaccines across the continent, we look forward to the day when pediatric wards in places such as Tanzania are nearly empty of children with severe diarrhea throughout the year.
Dr. Wecker directs PATH’s activities in vaccine access and delivery, which focus on developing and advancing strategies, technologies, and interventions that help move research achievements in immunization into routine use in the field.
This blog post is also featured on the Bill & Melinda Gates Foundation website.
Nilgun AydoganSenior Programme Manager, Programme Delivery, GAVI Alliance
I’ve just come back from a field visit to Sri Lanka, still recovering from a 25 year civil war.
Despite this and a tsunami in 2004, the tropical island has maintained its immunisation coverage at consistently close to 100%. (footnote ref: UNICEF/WHO country estimate for 2009 is 97%).
Sri Lanka’s government and 20 million population are extremely committed to immunisation. And, even without the stunning beaches and coconut tree, mountain scenery, it’s a pleasure to be assisting.
GAVI’s health system strengthening support (HSS) programme is helping rebuild clinics in the island’s north-east regions, where entire communities are returning to their villages since the war ended two years ago.
Not that the war dented Sri Lankan desire for immunisation.
Fleeing the fighting, Sri Lankans would leave their money and possessions but never their immunisation records. Even when crossing rivers and other barriers to run away, they wrapped their immunisation cards in plastic.
GAVI’s money is helping to train medical staff in a wide range of primary health care issues, as well as renovate the health centres.
There’s no shortage of commitment from the communities, where mountains of paperwork follow every child’s nutrition status, growth, as well as immunisation.
And in one village that I visited, a landlord had donated a room in a house for public health midwife so that so his community could have access to primary care.
Another village, the community built their own health center so that government can staff the clinic for MCH services.
With an average annual income per person of more than US$ 1,500, Sri Lanka will soon graduate from GAVI support, wealthy enough to be needing no more GAVI support.
One day, we can hope, the civil war will be a distant memory. Immunisation, I’m sure, will be present for many years to come!
View GAVI blogs by authors
GAVI’s Special Representative to GAVI Eligible Countries
Senior Programme Manager, Programme Delivery, GAVI
Director, Media and Communications, GAVI
CEO of the GAVI Alliance
Deputy CEO, GAVI
Managing Director, Innovative Finance, GAVI
Honourable Walter T. Gwenigale
Minister of Health and Social Welfare of the Republic of Liberia
Board Chair of the GAVI Alliance
President of the republic of Kenya
Senior program manager (Afghanistan), GAVI
Clarisse Loe Loumou
Paediatrician and member of the Steering Committee of the GAVI CSO Constituency
Amani Abdelmoniem Mustafa
Manager, Expanded Programme on Immunisation, Sudan
Former Chairman and CEO of MTV Networks International, GAVI Envoy
Senior Specialist Advocacy and Public Policy, GAVI
Head, Media and Communications, GAVI Alliance
Chief of Staff, GAVI
© GAVI Alliance 2014
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