GAVI blogs

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Thursday

26 April

2012

Why immunisation is an act of immeasurable love

I had the chance to help protect a life today, the life of a little girl named Madeleine Isaac.

My part was brief and ceremonial, squeezing out two drops of polio vaccine. Madeleine made a funny face and then sat up from her mother’s lap and smiled.

The part played by Madeleine’s mother was immeasurable. Those two drops of vaccine will protect her little girl for life and help ensure that their nation – Haiti – remains polio-free.

The mother’s effort to bring Madeleine to the Palais Municipal de Delmas to be vaccinated, amid the cacophony of traffic and people in the heat of Port-au-Prince, was remarkable. It was, as our partner PAHO describes for its broader immunisation campaign, “an act of love for you, me and everyone.”

That also is why the ceremony itself also was important. It marked the launch of World Immunization Week (WIW) and the tenth anniversary of Vaccination Week in the Americas. WIW builds on nine years of ever-growing Vaccination Week regional campaigns that have led to the vaccination of more than 365 million people.

This has been led by the Pan American Health Organization/World Health Organization (PAHO/WHO), and strongly supported by other key GAVI partners, such as UNICEF. This year, more than 180 countries are participating in WIW, including 45 countries and territories in the Americas, where 44 million people are expected to be immunised.

I was in Haiti to represent GAVI’s participation in WIW, which began on Saturday with the intensification of a vaccination campaign against measles, rubella and polio by Haiti’s Ministry of Health.

That is how I came to cross paths with Madeleine, whose mother had brought her to the ceremonial kickoff because it included a free immunisation clinic. It provided a tangible symbol of Haiti’s remarkable leap in public health just two years after its devastating earthquake.

And Haiti is going further. In late spring, it also will roll out pentavalent vaccine in partnership with GAVI to help protect its children from five other deadly diseases.

As a former minister of health for Norway, I salute Haiti’s leaders for making child health a top-priority. Their commitment to routine immunisation services will create a backbone that supports the rest of society as Haiti rebuilds.

GAVI has been a partner with Haiti for more than 10 years, helping to bolster its immunization services. In addition to pentavalent vaccine, GAVI has approved Haiti’s plan to provide vaccines against the two leading causes of child deaths worldwide: pneumonia and rotavirus.

It is an honour that GAVI can play a role in Haiti’s rebirth. When I see the faces of children such as Madeleine, I see the future of Haiti and appreciate the lasting difference that immunisation makes.

I know that it was through a mother’s act of love that my path crossed that of Madeleine. GAVI’s mission is to multiple that act of love millions of times over.

Mercy Ahun
GAVI’s Special Representative to GAVI Eligible Countries

Tuesday

17 April

2012

District Ownership in Akwapim North, Ghana

I was in Ghana last week, following up on preparations to introduce two new vaccines against diarrhoea and pneumonia. I had visited Akwapim North district, some 50km from the hustle and bustle of Accra. The view from the hills was serene and the air felt fresh after a light rain. Dr Joseph Opare, the District Director of Health Services (DDHS) and Rachel, the District Disease Control Officer took me round the district, visiting health facilities and outreach centres.

As we chatted between visits to villages I probed deeper to get a better understanding of why immunisation coverage is increasing in his district, (DTP3 >90%). I had attended the 2011 performance review meeting of senior health managers in Accra the previous day. The national DTP3 coverage is stagnating around 88% and there was general agreement that it was mainly due to late release of funds for service delivery.

He described how his team strategized to increase coverage:

• Better estimates of target population - The target population was re-estimated based on the most recent census data and monthly target populations was provided to each of the 8 sub districts.

• Revised outreach points - The number and frequency of outreach points was increased to cover the target population.

• Availability of funds - The DDHS used innovative approaches in raising funds for outreach activities: allowed use of OPD fees to cover transport costs. For health facilities without medical personnel, he organised special OPD sessions which attracted more patients and raised funds through the national health insurance scheme. The local parliamentarian and the district assembly (local government) also contributed to pay off some debts from previous outreach activities.

• Supervision - Regular visits by DHMT members to supervise outreach activities.

• Social Mobilisation - Volunteers were given incentives to help with social mobilisation.

• Monitoring - Performance was reviewed at monthly DHMT meetings. Peer reviews motivated staff to reach targets. Regular data quality checks done to address discrepancies.

What struck me was how the DDHS focused on his area of influence to improve service delivery and coverage without pointing fingers at others. He had other issues to deal with as we went round: suspected measles outbreak (5 cases), industrial action by some health workers, a cholera case, plus the fact that I had taken him away from other duties he had to perform that morning…

Much discussion has gone into the importance of country ownership in ensuring sustainability of programmes. District ownership is critical to increasing and maintaining high coverage. Districts like Akwapim North need to be encouraged to continue innovating to save lives.

Dan Thomas
Head, Media and Communications, GAVI Alliance

Friday

13 April

2012

Tragedy, hope and raw determination!

Have you ever been to the movies and seen a trailer for a film that you previously had no interest in seeing and then suddenly thought to yourself, “That is a film I CANNOT MISS”?

That was the idea behind GAVI’s most recent production. It’s a three-minute film by a talented young American film maker called Ryan Youngblood that I stumbled across in Kigali one day and I think he and producer Doune Porter more than fulfilled their brief.

On April 26, during WHO’s first-ever World Immunization Week, Ghana will introduce not just one but two new vaccines into its immunisation programme.

The pneumococcal and rotavirus vaccines will protect infants against the leading causes of the two biggest killers of children in Ghana and throughout the developing world – pneumonia and diarrhoea.

The GAVI Alliance and our partners UNICEF and WHO are working with Ghana’s Ministry of Health to plan a massive celebration in Accra at which the first children will be vaccinated.

On the same day, halfway across the world in Atlanta, Georgia, USA, our friends at the UN Foundation will be launching the Shot@Life campaign to encourage the American public to champion vaccines as one of the most cost-effective ways to save children’s lives around the world.

It’s such an exciting time to be working in global health and, as more and more power brokers embrace the value of investing in people’s health, we are literally seeing progress across the world on a daily basis.

As you can imagine, back in Ghana our colleagues are feeling more than a little pressure and this film brilliantly captures the careful, methodical planning process that is involved in introducing new vaccines into the national health programme.

It also portrays the skill, wit and energy that Ghanaian health professionals are investing in this extraordinary initiative.

Like the best movie trailers, our little film has all the right ingredients to make you want to know what happens next: handsome men, beautiful women, tragedy, suspense, despair, hope and raw determination!

It is also available in French and German.

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

Wednesday

28 March

2012

Sport Relief's Push for Immunisation

People throughout the UK have come together in an extraordinary way in recent weeks for a cause greater than themselves. They literally are helping to repair the world through an extraordinary charity, Comic Relief, and its inspiring Sport Relief fundraising campaign.

The efforts of hundreds of thousands in the UK, from stars such as Miranda Hart and John Bishop to everyday people, are making a huge difference.

One of the issues Sport Relief is focusing on this year is child immunisation. I personally have seen in health clinics and villages throughout Africa the impact of these efforts. For just a few pounds, vaccines not only provide protection and save lives, but they also cut healthcare and treatment costs, help reduce poverty, boost local economies and contribute to political stability.

It's a small investment that reaps huge benefits as children grow to be healthy and live a productive life. Yet one in five children still don't have access to this life-saving protection and sadly every 20 seconds a child dies from a disease that could have been prevented with a vaccine.

This is why the funds raised through Sport Relief are so important. Another critical player in this effort is the private sector. Increasingly we are seeing that global health also means economic health and that vaccines produce a huge return on investment.

One of the recipients of this year's Sport Relief campaign is the GAVI Alliance, a cutting-edge international non-profit that has helped immunise 326 million children in more than 70 countries since it was founded in 2000. The support of GAVI and its partners has helped save more than 5.5 million lives.

GAVI has recently launched an innovative private sector programme that will make the Sport Relief campaign even more impactful. The GAVI Matching Fund welcomes contributions from companies, foundations, their customers, employees and business partners which are than 100% matched by the UK Government and the Bill & Melinda Gates Foundation - a longstanding partner of Comic Relief.

This means that Comic Relief is able to make a £5 million grant toward child immunisation through GAVI, with £2.5 million raised through Sport Relief and £2.5 million matched by the Gates Foundation.

This combination of non-profit and private sector support led by the British public's extraordinary support to Comic Relief and the GAVI Matching Fund is quite an impactful way of addressing global health challenges.

The expansion of public and private efforts - especially in wealthy countries like the U.S - would mean that critical goals are reachable, such as GAVI's goal of immunising an additional 225 million children and saving 4 million lives by 2015. But it also would mean that entire villages, communities and nations can begin to engage more profitably in the global economy, standing strong thanks to a handful of effective and affordable vaccines.

Many private sector champions already have joined the efforts of U.K. charities such as Comic Relief, the ARK Foundation and the Children's Investment Fund Foundation as well as global multinationals - J.P. Morgan, Anglo American and "la Caixa". I look forward for others to do also.

They are proving that doing social good is also good business.

This blog features on the Huffington Post.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Wednesday

21 March

2012

Hope for the hard to reach

I met her in Kabul. Suraya Dalil had just been approved by the Afghan Parliament as the new Minister of Public Health. As of January this year she is also a GAVI board member. She has been serving the hard to reach people in hard to reach areas throughout her medical career, not only in her own country, but also through UNICEF in such places as Somalia. One out of three female members in her government she carries one of the toughest posts in the whole cabinet.

They are really hard to reach, many of Afghanistan’s children. This poor and mountainous country, so tired of war and conflict, is working every day to give all their young inhabitants a basic health package. Between 15 and 25 percent of the population has no access to immunization services. Two thirds of the vaccination is carried out through outreach and mobile services. However, DPT3 Coverage has been increasing substantially over the last ten years thanks to a close partnership with civil society organisations and funding from GAVI among others.

Now Dr.Dalil has set out on a journey to build a health system that can better ensure basic coverage to all. There are huge communications challenges and human resource shortages in the country.  One of her main strategies is building the skills of health workers such as midwives and other Public Health officers. The cold chain so critical to an efficient immunization system needs to be strengthened.

Minister Dalil has a rough road ahead. There is certainly hope. Recent survey data indicate that the record high child mortality rates have dropped substantially the last few years. But there is much more to do. The plan is to introduce pneumococcal vaccine in 2013 and rotavirus vaccine in 2014/15. - We are working hard to fulfil the conditions that will make this happen, the minister told me.

Afghanistan is in a phase of transition. As the Afghans resume more and more responsibility for their own security, they will still need strong support and cooperation to build services to their people. The civil society organisations will have a key role to play in areas like public health. Other partners should also stand ready to support the plans developed by Dr. Dalil and her team.

I am certainly looking forward to work with our new GAVI Board member as she is taking on the huge task of reaching every Afghan mother and child with basic public health interventions. Her voice on behalf of partner countries will help to enable GAVI reach the overall goal of granting every child access to basic vaccines.

Honourable Walter T. Gwenigale
Minister of Health and Social Welfare of the Republic of Liberia

Thursday

8 March

2012

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

Women in poor countries are at risk of many deadly diseases – such as HIV, malaria and TB - in part because there are no vaccines available yet to protect them. But there is a vaccine that can prevent the most deadly form of cancer.

Cervical cancer is the number one cancer-killer of women in my country, Liberia.

Cervical cancer is overwhelmingly a problem of the developing world. Almost 90% of the 275,000 women who die from it every year live in developing countries. These numbers are growing, and if the problem isn’t tackled right now, by 2030 cervical cancer could kill 430,000 women every year.

Yet though women in the world’s poorest nations are at the highest risk of the disease, they have no defence. Unlike in the West, women here often don’t have access to screening and treatment. And what people might not realise is that though the virus is spread through sexual contact, using condoms doesn’t necessarily protect against it. This is why the vaccines are so important to us – to protect girls before they are infected with the virus.

Those vaccines are available to girls and young women in the developed world. Yet, they are not available yet in my country. The high price of HPV vaccines has kept it out of reach of poor women. But thanks to GAVI, vaccine prices for developing countries are falling.

I am delighted that the GAVI Alliance is supporting HPV vaccines in developing nations. A staggering 28 million girls and young women will be immunised by 2020. With these vaccines, the GAVI Alliance is opening the door for women in developing countries to enjoy equal access to these life-saving vaccines as our sisters in rich countries.

We are happy that GAVI has answered our call for HPV vaccines. Now, we must get ready to show we can deliver them. The World Health Organisation recommends giving the vaccine to girls aged between 9 and 13; with three doses within six months. This means coordination between schools and health clinics and the girls’ families – so each country will have to work out how to best reach the girls.

The importance of this vaccine cannot be overestimated. Like many African countries, Liberia’s economy has gone through enormous difficulties, but we are rebuilding our country and making progress in improving healthcare. We need this vaccine. The health of our economy depends entirely on the health of our people. When you save women and girls, you save the very fabric of society.

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

Thursday

8 March

2012

Celebrating International Women’s Day – saving the lives of women

Martha lives in Dar es Salaam, Tanzania. As a mother and grandmother, she is a main caretaker of her family. Martha has cervical cancer.

It will probably kill her if the cobalt radiation therapy does not do more harm to her fragile body.

Martha is probably one of the lucky ones. She was diagnosed in time and is being treated. Most poor women like her die simply because they do not have access to screening or treatment.

Cervical cancer usually kills women in their 40s or 50s – in the prime of their lives. And when it strikes, its impact goes beyond one woman’s death.
In poorer countries, it also usually deprives children and families of the primary bread winner and caretaker. When a mother falls sick and dies, the lives and health of her own children are jeopardised and her entire family can collapse.

An innovative solution exists. Safe and effective human papillomavirus (HPV) vaccines can prevent 70 percent of cervical cancer cases. HPV vaccines have been a part of routine immunisation for girls in many industrialised countries since 2007. But high vaccine prices and delivery challenges of reaching adolescent girls have been major obstacles to introducing the vaccines into poorer countries.

Good news. GAVI Alliance, a global health partnership that includes UNICEF, the World Health Organization, the World Bank and the Bill & Melinda Gates Foundation, has prioritised the introduction of HPV vaccines in countries which need them the most. GAVI is working with manufacturers to reduce vaccine prices and to help countries deliver the vaccines cheaply and with other important interventions for girls.

In celebration of International Women’s Day 2012, Women Deliver chose GAVI’s HPV vaccine work as one of the “Top 50 technological innovations that are delivering for girls and women” worldwide.

GAVI’s steps toward delivering HPV vaccines holds enormous promise. By 2020, over 28 million girls can be protected from cervical cancer. Women like Martha – and their families -- will no longer have to suffer. Every girl in the developing world should be immunised against HPV. It can mean the difference between life and death.

This blog features on the Reuters Trust Law.

Helen Evans and Andrea Gay
Deputy CEO, GAVI

Friday

22 Feb

2012

Doubling our Impact in a Single Shot

We have a chance to make history in the fight against rubella and measles. The human and economic toll of these diseases is huge and preventable.

In some places, rubella -- often referred to as German measles -- is no longer the threat it used to be. During the last large-scale epidemic in the United States, in the mid-1960s, about 12.5 million people were infected and more than 20,000 infants were born with related birth defects. Thanks to widespread vaccination in almost 50 years since the epidemic, rubella has disappeared from the Americas.

But for millions of mothers and children in poorer countries with limited access to vaccines, rubella poses an on-going danger. Pregnant women who contract rubella in the first 10 weeks risk a miscarriage or stillbirth and there's a 90% chance their child will be born with serious birth defects -- such as blindness, deafness, or heart disease -- known as Congenital Rubella Syndrome, or CRS. With at least 110,000 babies born with CRS every year, the consequences can be staggering.

The GAVI Alliance, the Measles Initiative, and our partners are committed to creating a dramatically different scenario by building on the success of accelerated measles control efforts. This year, GAVI will begin to fund catch-up campaigns to provide a combined Measles-Rubella (MR) vaccine. Following guidelines from WHO, the campaigns will target children aged 9 months to 14 years inclusive and ensure the impact is lasting by embedding MR vaccine into continuing immunisation programmes. In response to country demand, we anticipate introducing MR vaccine into 30 countries by the end of 2015 and by 2018 we expect to support at least a further 20 developing countries.

In 2000, measles killed more than 700,000 children. A global drive led by the Measles Initiative to increase access to measles vaccine has protected more than 1 billion children, raised measles routine coverage to 85% and reduced measles deaths by 78%. This has contributed to about a quarter of the reduction of child mortality globally since 1990 as we strive to reach the Millennium Development Goals.

Investments in measles control have also led to tens of thousands of trained health workers, detailed plans and mapping, community demand and logistics systems to reach children with vaccines no matter how remote their village. Now to combat rubella, countries can use the sameplatform and deliver MR vaccine.

The Measles Initiative, which has already mobilised and invested US $875 million for measles control including generous support from GAVI, will continue to raise funds for immunisation, surveillance, and research, and provide technical support to countries to ensure childrenhave opportunities to receive MR vaccine.

Developing countries supported by GAVI and the Measles Initiative will play their part by continuing to fully fund and provide MR after the catch-up campaigns.

While GAVI and the Measles Initiative rightly focus resources in developing countries, industrialised countries must alsostep-up efforts as outbreaks have led to measles importation across borders. More than 33,000 people in Europe suffered measles last year due primarily to a failure to vaccinate, according to WHO. A recent meeting of health experts in Rome on progress toward eliminating rubella and CRS in Europe underscores the need to address both diseases simultaneously and globally through partnership, political commitment and funding. There's no better time to seize this opportunity.

A young woman receives immunisation against measles and rubella during an immunisation campaign in Laos, November 2011. The rubella virus can lead to miscarriage, still births, or birth defects when passed from mother to child during pregnancy. An estimated 90,000 birth defects, known collectively as congenital rubella syndrome (CRS), happen every year in the world’s poorest countries. Photo credit: The Measles Initiative/C. McNab/2011.

Leila Nimatallah
Senior Programme Officer, Advocacy, GAVI

Wednesday

8 Feb

2012

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

“I always bring my children in on time for their vaccines. I know how important that is for keeping them healthy,” said Misael Amador as he sat in the waiting room at a public hospital in Tegucigalpa, Honduras, holding his four-year-old daughter, Karen Maria on his lap. “I am proud that I am never late to bring them in.”

This sense of pride in ensuring children’s health could be felt everywhere we went in Honduras last week—from the Minister of Health to the health monitors who regularly travel out to rural communities (without pay) to check that children are up to date on their immunisations.

Somehow, this small nation, burdened with deep poverty and violent crime, has achieved what most others (including the United States) have not: a near-perfect vaccination coverage rate. This means fewer child deaths because immunisations have saved the lives of more children than any other medical intervention in the last 50 years.

I had the honour of accompanying members of the United Nations Foundation’s Shot@Life Campaign and six congressional staffers to view Honduras’ national immunisation programme, and I learned that the public health success story of Honduras is directly related to the deep commitment and strong teamwork of everyone involved in the programme.

Back in 2009, my organisation, the GAVI Alliance, paid for immunisations in Honduras to prevent the leading cause of diarrhoea, which is one of the two biggest killers of children worldwide. Two years after the rotavirus vaccine was rolled out, GAVI financed Honduras’ rollout of pneumococcal vaccine as well, taking aim at the other major cause of death for children under five, pneumonia. But buying vaccines at an affordable and sustainable price is only part of the story.

Delivering vaccines, which must be refrigerated from the moment they are developed until the time they are administered, is an incredibly complex task—especially in a place like Honduras, where 45 percent of the rural population lacks reliable electricity. It takes all stakeholders— PAHO, the CDC, the US Agency for International Development, the Honduran Expanded Program on Immunization, doctors, nurses, volunteers, civil society, teachers and parents—working in concert to achieve this incredible success.

Here in the US, advocates of the Shot@Life Campaign are bringing this inspirational story to American citizens and leaders to make the case for why our country should continue its investment and leadership in global health, vaccines and organiSations like GAVI.

In April 2012, Shot@Life will roll out nationally. Everyday citizens, who have been inspired by success stories like Honduras’ and who have been trained to take action to make a difference, will be reaching out to engage their families, their communities and their leaders to educate them and raise awareness about the power of vaccines.

To prepare for this launch, the campaign will be gathering a powerful group of committed Americans together this week in Washington, D.C., to strategiSe and design their efforts to bring the story of vaccines’ impact to the masses. Once Americans learn more about what vaccines can do, they will want to be a child’s shot at life.

Diane Summers
Senior Specialist Advocacy and Public Policy, GAVI Alliance

Friday

3 Feb

2012

World Cancer Day 2012: Together it is possible

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

A startling statistic underpins this situation. Of the more than seven million people who die from cancer every year, about 70% lived in low- and middle-income countries. Preventive technology like vaccines, and effective screening and treatment programmes that we take for granted in industrialised countries, are simply unavailable to the poor.

This year’s World Cancer Day calls on everyone to do their part to reduce cancer deaths. GAVI is a member of the Union for International Cancer Control and supporter of World Cancer Day. On this day, I want to highlight how GAVI contributes to the fight against cancer through accelerating the reach of vaccines that prevent cancer-causing infections.

One in five cancers is caused by chronic infections. For example, viral hepatitis infections contribute to liver cancer, one of the top three causes of cancer deaths worldwide. Cervical cancer, the third most common cause of cancer deaths among women, is primarily caused by human papillomavirus (HPV). The bacterium Helicobacter pylori contributes to stomach cancer.

Two vaccines now exist that prevent the viruses that are the primary causes of liver and cervical cancers. GAVI works to accelerate the reach of those vaccines to people living in low-income countries.

Hepatitis B vaccine was the world’s first anti-cancer vaccine. The vaccine prevents infection with hepatitis B virus, a primary cause of liver cancer and cirrhosis. When the vaccine became first available in 1981 it was too expensive for low-income countries to introduce, despite their high burden of disease.

However, price reductions achieved with GAVI support spurred a spectacular acceleration of hepatitis B vaccine introduction in low-income countries. Between 2000 and 2010, the vaccine price dropped by 68% from US $ 0.59 cents to US $0.18 cents. Consequently, by 2006 more low-income countries than high-income countries had introduced the vaccine into routine immunisation.

GAVI’s support to developing countries for hepatitis B vaccine has now prevented over three million deaths.

China is a well-documented success story. Following the introduction of hepatitis B vaccines into national routine immunisation programme, the percentage of immunised newborns has risen to 90% and the prevalence of hepatitis B virus carriers is markedly reduced. Less than 1% of children under five are now chronic carriers of hepatitis B. 

Now, the World Health Organization identifies hepatitis B vaccines as a ‘best buy’ on a population-wide basis – that is, an immediate action that can accelerate lives saved, diseases prevented and heavy costs avoided.

Vaccines against the human papillomavirus infection that causes cervical cancer in women offer a similar potential.

Cervical cancer kills 275,000 women every year. Over 85% of those deaths are in developing countries. Safe and effective human papillomavirus (HPV) vaccines can prevent around 70% of cervical cancer cases.

HPV vaccines have been available since 2007. Although HPV vaccines quickly became part of routine immunisation of girls and young women in many industrialised countries, they are still largely unavailable in low-income countries. The high price of the new vaccines remains a barrier to introduction.

GAVI is working with the two WHO-prequalified vaccine manufacturers on strategies to lower the price of the vaccines to make them more affordable. A milestone was reached in June 2011 when one manufacturer offered to provide its HPV vaccine at $US 5 per dose to GAVI-eligible countries, a 67% reduction in the current lowest public price. This was the first-ever public offer of an indicative price for HPV vaccines for low-income countries.

A second milestone was achieved in November 2011, when GAVI took first steps towards introducing HPV vaccines in GAVI-eligible countries. GAVI will invite countries to apply for funding for HPV vaccines provided that further price reductions from manufacturers can be secured to ensure affordability. Funding proposals will have to demonstrate country’s ability to deliver the vaccines successfully or deploy pilot projects. By 2015, nine countries are expected to apply and an estimated 1.6 million young women and girls immunised.

The power of vaccines to prevent the infections that cause cancers has yet to be fully harnessed. Research continues to better understand the role of infections in cancer. With this work comes the promise of dramatic new developments of vaccines to reduce cancer deaths, and the need to roll out these vaccines in low-income countries.

GAVI is committed to accelerating the reach of life-saving vaccines, a mission aligned with the UN General Assembly’s declaration to increase access to cost-effective vaccinations to prevent infections associated with cancers.

No one should die because of where they are born.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Friday

27 Jan

2012

The Perfect Match

The immunisation of children is an investment with guaranteed results: child survival. And once you know that the investment will double if put toward such a principled cause, how could you not contribute?

Leaders from the business world and civil society were presented with this compelling case at a breakfast meeting in Davos this week. It was a joy for me as Chair of the GAVI Alliance to moderate the event. 

Davos is site of the World Economic Forum, a beautiful place framed by a bleak economic environment. The 2012 WEF annual meeting is devoted to finding bold ideas, personal courage and new models to reshape the global economy and improve rather than cap human potential. That’s also what the GAVI Alliance was demonstrating at the breakfast meeting. 

GAVI, in fact, was launched in January 2000 at WEF in Davos. Twelve years later, the bold ideas and courage that formed our Alliance has become a dynamic success story. It stands as a light in a rather dark state of the world. 

Its newest programme is the GAVI Matching Fund. Through it at our breakfast, Bill Gates and British International Development Secretary Andrew Mitchell offered the Matching Fund as a perfect investment for the leaders around the board room table: for every pound given to this GAVI programme by organisations and businesses in the United Kingdom, the British Government will give another. 

For every dollar that is given by similar enterprises in other parts of the world, the Bill & Melinda Gates Foundation will give the same. 

Thus, at the breakfast meeting in Davos, the GAVI Matching Fund attracted another US$ 9 million to immunise the children of the world, bringing the total to US$ 38 million dollars in just a handful of months.

From the world of organ transplant, we know that a “perfect match” means that an organ is perfectly compatible for the recipient, saving life in a highly sustainable way. This is also the case with GAVI, an alliance that is pooling the demand for vaccines from lower income countries in order to deliver them in a secure, low-cost way. 

In the case of the Matching Fund, GAVI now is matching the best experience and knowledge from the private and public sectors to develop an innovative financial solution. GAVI is matching those around the boardroom those who can make a sustainable difference in global immunisation. And this leads to the most important match of all: the vaccine and the child, protecting life, enhancing healthy populations and building nations.

For me, this is a perfect match. It saves life in the most sustainable way. That is why I went to Davos. That is why I devote much of my time to the GAVI mission.

David Ferreira
Managing Director, Innovative Finance, GAVI Alliance

Thursday

26 Jan

2012

A breakfast of champions for public health

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

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

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

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

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

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

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

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

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

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

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

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

It represents a new era of champions for public health.

Mercy Ahun
Dr Mercy Ahun, GAVI’s Special Representative to GAVI Eligible Countries

Tuesday

20 December

2011

Kerala and Tamil Nadu become the first Indian states to introduce pentavalent vaccine into their national immunisation schedules

I landed at 4.30 am in Trivandrum, Kerala State, and I could hardly contain my excitement. We have been working with India’s Ministry of Health and Family Welfare for the past two years after they were approved by the GAVI Board for pentavalent vaccine introduction; and finally it’s happening, with Kerala and Tamil Nadu, two states with high immunisation coverage, taking the lead.

At the Women and Children’s Hospital, Thycaud, Trivandrum, the media were out in force to report on the first launch of pentavalent vaccine in the public sector in India.

Speaking in Malayalam, The Minister of State of Health told the crowd of 150 why the state was introducing pentavalent vaccine. He said they had put together a group of experts and determined they could further reduce by half their relatively low infant mortality of 16 per 1000 live births by 2015.

I said a few words on behalf of GAVI, expressing our support for Kerala’s achievement. The first baby was vaccinated and by the end of the first day about 6,000 infants had been vaccinated. The target is 530,000 infants for the year.

The Director of Immunisation of an adjacent district I visited asked “Where do you come from?”, “Ghana,” I responded. “Have you introduced Penta in your country?”, “Yes, we introduced in 2002”. “You mean you introduced almost 10 years ago!?”. This was followed by a reflective silence.

On my traffic jammed way back to Trivandrum, I reflected about my experiences of seeing countries introduce new vaccines -- the excitement, the involvement of politicians and other key stakeholders and how the profile of the immunisation programme has increased after the doldrums of the post-Universal Childhood Immunisation years. We still have a long way to go in improving the programme.

My next stop is Tamil Nadu.

After arriving in Chennai, I called Dr Jameela , the state director of health services in Kerala, to thank her for the warm reception. She told me about the upsetting news of an adverse event following the previous day’s immunisation. Together with the state government, our partners from WHO and UNICEF immediately started investigating.

The venue for the launch of pentavalent vaccine in Tamil Nadu is the Alamelrangapuram Primary Health Care centre in Vellore.

We met a bigger crowd; twice the size of Trivandrum, the dais was decorated with flowers and had big banners to mark the occasion. The state was organising a double launch for pentavalent and a campaign against smoking. I met the PHC director and her staff who showed me round the centre. The mothers with their babies to be vaccinated were seated and wore their numbered badges. It was clear which baby was to be vaccinated first. A very orderly arrangement!

The press with their cameras were also there in numbers. I was introduced to WHO and UNICEF staff and also met Dr Jacob John, the former chair of the National Technical Advisory Group on Immunisation (NTAGI). He was clearly excited about the introduction of pentavalent vaccine into the public health system after it has been used in private clinics for some eight years.

The State Minister of Health arrived at 11am with his retinue. Among the speakers at the ceremony were the Minister for Development, Mayor, Local Assembly representative. The State Minister of Health who is a doctor gave the first shot. I jostled with the cameramen to get a good view and a photograph.

Finally, an hour and a half later, the launch had gone smoothly, all the babies have been vaccinated.

Mission accomplished. Pentavalent vaccine is finally launched in the public sector in India.

At a point in time it looked like it wasn’t going to happen this year, but the GAVI Alliance has “country-driven” as one of our core principles and India determined when it was ready to introduce and informed us. All I did was rely on my colleagues in India to make it happen. And they did. Additional states have indicated their interest to introduce penta in the near future.

Thanks to all who made this possible.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Tuesday

15 Nov

2011

Pushing back the boundaries of public health in Bangladesh

As I chair the GAVI Alliance Board meeting in Bangladesh and discuss decisions that will shape the future of immunisation in the developing world, it will be important to remember health worker Rabbi Aztor who I met on a field trip earlier this week.

It is people like Rabbi who fulfill the GAVI mission every single day: delivering vaccines through a weekly ‘Vaccination Day’ held in the living room of her home at Bara Goan, a village set 55km south of Dhaka amid the tributaries of the Padma river.

I watched as mothers waited patiently for Rabbi to register the weight, height and health of their newborn babies.  Her measurements complete, she pulls life-saving vaccines out of a cold box.

This morning it is 10-week-old Fatema’s turn. Like children across the world, she cries as Rabbi drops rotavirus vaccine into her mouth and administers a second dose of pentavalent vaccine.  Her mother Maksuda Aketer, aged 41, looks on calmly: she has already seen Rabbi deliver the same vaccines to her two elder daughters and knows this simple five-minute act will offer life-long protection against the biggest child killers in Bangladesh: diarrhoea and pneumonia.

Immunisation sessions like these are held once a week at Rabbi’s house. In between, the health worker makes daily calls on the community’s young babies to check on progress and ensure mothers do not forget immunisation schedules.

Rabbi says that during the monsoon season, when Bangladesh’s rivers can flow four metres above their normal depth and local homes become small islands perched on raised embankments, Rabbi uses a small paddleboat to reach her patients.
Rabbi works for the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), the medical centre based at nearby Matlab, whose pioneering research has laid the foundations for Bangladesh’s routine immunisation rates to reach an astonishing 95% of infants.

Forty years ago, icddr,b successfully piloted the concept of Bangladeshi health workers deliberately selected from the local community to ensure they have the trust and respect of their neighbours. Today 46,000 trained health workers underpin the nation’s maternal and child health programme.

This is just one example of iccdr,b pushing back the boundaries of public health in developing countries.

The centre’s medical and demographic surveillance programme has been running for almost 50 years: the longest running in the developing world.

Ever since a group of scientists conducted research on a cholera vaccine in the early 1960s, based on a boat in the Padma River, icddr,b has monitored the health and welfare of some 220,000 people – from cradle to grave.

Three generations of local villagers have grown used to icddr’s surveys, with studies ranging from the impact of new vaccines against influenza and pneumococcal disease to the reasons why drowning is the number one cause of death among young children in Bangladesh.

The rotavirus vaccines that Rabbi is administering are part of an impact assessment study funded by GAVI.

Round the corner from Rabbi’s house, I watch as another villager uses a handheld PDA to input data about the health of a newborn child; the information is fed via satellite into a giant database back at iccdr,b’s centre in Matlab.

Later in the day, I am taken by motor launch down the Padma, navigating fishing boats and brightly coloured water hyacinths, to Matlab to see the result of this research: a library of yellowing folders and a state of the art database that contains information about four generations of Bangladeshis.

Scientists from international medical schools around the world, such as the London School of Tropical Medicine in London and the Johns Hopkins University regularly consult the medical equivalent of an oracle.

Matlab runs its own hospital, and as I meet the staff and patients I am reminded of the need of the vaccines that Rabbi administered to Fatema earlier in the day.

On one side of the hospital’s courtyard, I visit a ward for newborn babies suffering from diarrhoea – the doctor explains that it is approaching the peak season for diarrhoea cases in Bangladesh and most of the beds are already taken-up.

On the other side, a 17-day-old baby in the neonatal clinic wheezes gently and snuggles deeper into the comfort of her mother’s arms – she has contracted pneumonia. Thanks to Matlab’s amazing medical care and antibiotics, she will survive.

Diarrhoea and pneumonia – Bangladesh’s (and the developing world’s) number one killers of infants. Both are vaccine-preventable diseases: rotavirus vaccine for diarrhoea, pneumococcal vaccine for pneumonia.

Bangladesh has applied for GAVI funding for the introduction of these vaccines, with pneumococcal vaccine support set for approval in 2012.

As we focus on points of order and policy decisions at the GAVI Board this week, we should keep in mind what it is all about: health workers like Rabbi who need GAVI support to continue to do their job on the frontline of immunisation.

Guy Aho Tete Benissan
Coordinateur régional du REPAOC, membre du Comité de pilotage du Forum des OSC partenaires de GAVI Alliance

Mardi

8 Nov

2011

Pour lutter contre la pneumonie – vaccinez vos enfants !

Le 12 Novembre prochain, le monde va célébrer la deuxième journée mondiale contre la pneumonie. A cette occasion, il est important pour le Réseau des Plates-formes nationales d'ONG d'Afrique de l'Ouest et du Centre (REPAOC) chargé d’assurer la coordination de la plate-forme africaine des OSC francophones, de rappeler au monde entier les dégâts énormes que causent la pnemonie - plus de 1,5 million d’enfants de moins de cinq ans succombent chaque année à la pneumonie, soit plus que n’importe quelle autre maladie. Un enfant meurt toutes les 20 secondes des suites d’une pneumonie. C’est la maladie la plus meurtrière chez les enfants de moins de cinq ans dans les pays en développement, touchant de plein fouet notre continent, l’Afrique.

Fort heureusement, des moyens de prévention et de traitement efficaces existent (cf. Le GAPP - Plan d'action mondial pour prévenir et combattre la pneumonie). Aujourd’hui, la vaccination permet de réduire considérablement le nombre de ces décès dus à la pneumonie. Pour la première fois dans l’histoire, les vaccins contre la principale cause de pneumonie sont pratiquement administrés en même temps aux enfants des pays en développement et à ceux des pays riches. Inédit jusqu’à présent ! Ceci n’aurait pas été possible sans GAVI Alliance, qui a pour mission de sauver la vie des enfants et de protéger la santé des populations en élargissant l’accès à la vaccination dans les pays pauvres. L’introduction de ces vaccins constitue la pierre angulaire du plan ambitieux de GAVI Alliance pour assurer à tous les enfants un accès équitable aux vaccins dont ils ont besoin.

Cette journée permet de reconnaitre l’effet salutaire des vaccins anti-pneumococciques qui contribuent à éviter des millions de décès parmi les jeunes enfants et de mettre en avant les progrès accomplis grâce à l’introduction rapide de nouveaux vaccins pour lutter contre la pneumonie. Aucun enfant ne devrait mourir d’une maladie que nous savons prévenir.

Le REPAOC est fortement mobilisé pour continuer à mener des actions de sensibilisation et de plaidoyer pour une utilisation plus large de la vaccination. Il est de notre devoir d’informer le public et les décideurs politiques sur la nécessité d’introduire ces nouveaux vaccins au plus vite. Le REPAOC continuera à mener ses actions en faveur de l’optimisation des vaccins pour que nous donnions aux enfants la joie de vivre. La mobilisation de la société civile en Afrique est cruciale pour la bonne mise en œuvre des programmes de vaccination par nos gouvernements. Nous assurer de l'accès des plus pauvres au droit à la santé, éduquer la population, observer la quantité et la qualité de l'administration des vaccins sur le terrain, tel est le sens de la mobilisation du REPAOC auprès de GAVI dans l'espace francophone africain.

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

Friday

4 Nov

2011

Saving Lives: Could There Be Any Better Return on Investment?

Vaccines have been touted by economists, health experts and world leaders alike as one of the best buys in public health, and they are one of the safest and most effective ways to save children's lives and protect entire communities from infectious diseases. A quick jab in the arm or drop in the mouth can provide a lifetime of protection against some of the deadliest threats we face.

With the tools at hand to prevent disease and help save millions of lives, why not do everything in our power to help? And in this economy, why not invest in a sure thing?

The Global Alliance for Vaccines and Immunisation (GAVI Alliance), which has helped immunize nearly 300 million children in more than 70 countries since it was founded in 2000, has just announced a major new initiative aimed at engaging private sector leaders: the GAVI Matching Fund.

Through this program, the British Government's Department for International Development (DFID) and the Bill & Melinda Gates Foundation will provide a 100% match of contributions to GAVI from corporations and foundations as well as their customers, members and employees. Together, DFID and the Gates Foundation have pledged $130 million to support this effort, which means there's the potential to generate $260 million for global childhood immunization efforts.

So, why GAVI, with so many good causes vying for support?

With a low overhead and an unprecedented track record of success, GAVI is a lean and results-focused Alliance that leverages the best of the public and private sectors for the common global good. Over the next four years alone, it is set to double the life-saving impact it had over the last decade -- but GAVI can't do it without our help.

One child dies every 20 seconds from pneumonia -- a disease that could have been prevented with a vaccine, and that's just unacceptable -- especially when you consider many of these deaths happen in countries that often don't even have the facilities needed to treat deadly infectious threats. Prevention is key and achievable, so let's make it happen.

After more than 30 years in the business world, I appreciate performance and any business would aspire to GAVI's return on investment. There's no doubt that doing social good is good business when done smartly. I commend the four entities that have already contributed to this project -- ARK, "la Caixa" Foundation, J.P. Morgan and AngloAmerican plc -- and I urge other CEOs to consider joining the effort together with their employees, customers and business partners.

Today, the world is too interconnected for corporate leaders not to think globally. Getting involved in such an initiative offers a chance to expand your reach, strengthen your brand, tap into new channels, and impress your staff and customers by doing social good with the best experts in the field. This is your chance to do something bigger than your brand, something lasting and life changing -- giving a shot at a healthy life to the poorest kids in the world.

With financial support, the GAVI Alliance can vaccinate 250 million children by 2015. With a sound investor offering to double your money, there's even more reason and urgency to act now.

Just think: A $3 million donation -- matched by DFID or the Gates Foundation -- would buy enough vaccines to immunize more than a half million children against pneumococcal disease in 2012 -- one of the main causes of death from pneumonia -- or nearly a million children against diarrhea caused by rotavirus. I can't think of a better return on investment.

So I ask you, why not invest in a sure thing, when a 100% match to your investment is guaranteed?

Bill Roedy is the former CEO of MTV Networks and a GAVI Alliance Envoy.

This blog features on the Huffington Post.

Raj Kumar
GAVI senior program manager

Friday

21 Oct

2011

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

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

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

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

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

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

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

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

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

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

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

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

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

Victory against polio will be triumph for us all.

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

Daniel Thornton
Chief of Staff, GAVI Alliance

Sunday

16 Oct

2011

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

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

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

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

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

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

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

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

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

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

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

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

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

David Ferreira
Managing Director, Innovative Finance, GAVI Alliance

Wednesday

5 Oct

2011

A Public-Private Innovation to Save Children’s Lives

The deadly tole of rotavirus diarrhoea on infants in Sierra Leone, where the rotavirus vaccine will be introduced to combat one of the leading childhood killers. Source: Ryan Youngblood, Doune Porter/GAVI/2011.

Not all children have the same lucky escape as Abdul, a young boy in Sierra Leone whose very life was in jeopardy only a few months ago, when I visited.

Abdul was severely dehydrated, weak from diarrhoea and barely able to move.  He was suffering from rotavirus the leading cause of death due to diarrhoea in children under five. But he need not have suffered: vaccines are now available to prevent severe rotavirus disease.  We made a video about Abdul’s fight to stay alive (see right of page, or click here).

In May, I witnessed the ravages of rotavirus and other vaccine-preventable diseases on children, families and communities in Sierra Leone – Abdul’s home country. It was a humbling experience and gave a renewed sense of purpose to my work for the GAVI Alliance.

GAVI’s mission is to save children’s lives and protect people’s health by increasing access to immunisation in poor countries, where infrastructure, clinics, health workers and even refrigeration to preserve vaccines are limited. I saw people in Sierra Leone so committed to children’s health that they strapped coolboxes full of vaccines to their backs and travelled by bicycle on dirt roads to reach remote villages, delivering vitamin A and micronutrients at the same time.

Health authorities have used immunisation as a foundation on which to build other basic healthcare services – healthy kids mean healthy moms, communities and societies. When I attended immunisation events at local health centers, I saw mothers also receive instruction on nutrition, hygiene and breastfeeding, often through song and dance. It was inspiring.

Thanks to GAVI and its many partners, the same vaccines that are available to children in rich nations are being rolled out across developing countries in Africa, Asia and Latin America faster than ever before. With sufficient funds, GAVI will be able to vaccinate more than 250 million children in the world’s poorest countries by 2015, and save an estimated four million lives.

Now, the private sector can join GAVI in its mission by helping it raise sufficient funds through a unique public-private partnership to help protect children like Abdul from preventable diseases, and by becoming part of a global coalition seeking to provide access to vaccines for all children, regardless of where they are born.

Through the GAVI Matching Fund, private companies and foundations can greatly leverage their contributions to global health. That’s because every dollar contributed to the Matching Fund by the private sector, their customers, employees and even business partners is matched by the Bill & Melinda Gates Foundation or, in the case of British companies, by the British government.  They have pledged US$50 million and UK£50 million, respectively – the equivalent of US$130 million, which, if matched by private contributions, will raise US$260 million for immunisation.

The Matching Fund is a smart investment not only for global health – it is aligned with U.N. Millennium Development Goal 4: reduce by two-thirds the mortality rate of children younger than five years by 2015 – but also an opportunity to champion a global initiative alongside our world class partners.

Launched this summer, the initiative now has four private sector partners: the “la Caixa” Foundation, J.P. Morgan, AngloAmerican and Absolute Return for Kids (ARK).

The GAVI Matching Fund is an important innovation in global health financing. And it is certainly needed. Without additional resources for immunisation, a child will die every 20 seconds due to a vaccine-preventable disease. But for every $1.5 million received, for instance, GAVI could buy enough vaccines to immunise 142,000 children against pneumococcal disease in 2012, or 272,000 children against rotavirus.

The GAVI Matching Fund promotes awareness and advocacy for immunisation by engaging private sector management, employees and consumers; helps support new vaccines (we hope one for malaria is very near); and helps ensure that all children – like Abdul, who survived after being treated in a local hospital – have access to life-saving vaccines.

This is a rare chance to be part of something that is guaranteed to change the lives of millions of people for the better. If you work for a company and think it might be interested in becoming GAVI’s next corporate partner, please send an e-mail to Marian Leitner at mleitner@gavialliance.org.

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

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Thursday

29 Sept

2011

Every woman, every child in Manyara, Tanzania

While world leaders recently gathered at the United Nations in New York to discuss how to reach every woman and every child with lifesaving health care, mothers and their children gathered at a remote health post in Tanzania’s Manyara region to receive vaccinations, prenatal care and anti-retroviral therapy against HIV/AIDS.

This is just one of the approximately 30 of such health posts in the region that is served by the  Haydom Lutheran Hospital located about 300 kilometers from Arusha in northern Tanzania.  Every month a dedicated band of health workers travel over bumpy roads and in single engine planes to reach far-flung communities with life-saving assistance. While leaders were discussing how to reach” the hard to reach,” these health workers were on the ground actually doing just that.

The hospital, which was originally set up by a Norwegian civil society organisation and is now run by a local church group, was all a bustle on the sunny afternoon of my arrival. There, as at the health post, large groups of mothers with their children were lining up for registration, vaccination, check-ups and medication, some shading their babies from the hot sun and swatting away the ever-present flies.

Maternal and child health is a priority for Tanzania. And mothers are responding.  Since 2008, vaccine coverage has gradually improved. Routine immunisation for babies has increased from 83% in 2007 to 91% in 2010. And the government has plans to soon provide new life-saving vaccines against rotavirus and pneumococcal, the two main causes of severe diarrhoea and pneumonia, respectively.

I spoke to one of the pregnant women waiting in the registration line. She is expecting her second child. And thanks to a free ambulance service, she will be able to give birth at the clinic under the supervision of a trained midwife.  In-hospital deliveries have doubled over the last three years due to these free services. Last year there were more than 5,000 deliveries at this hospital and only six maternal deaths – much lower than in years past.

Three days prior to my visit, a young mother died on her way to the hospital. She had not used the ambulance service.  Back at the hospital, I held her baby in my arms – he managed to survive. Strong and lively, he will be taken care of in a special ward for a few months until his extended family is able to take care of him.

Here in Manyara, as in other areas of sub-Saharan Africa, the critical role of civil society organisations is evident, and the efforts of local health workers are making a difference in the lives of every woman and child – every day.

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

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

Tuesday

27 Sept

2011

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

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

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

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

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

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

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

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

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

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

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

Version français.

This post also appears on the ONE International site.

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

Friday

23 Spt

2011

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

Last month, I visited the pediatric ward of a district hospital in Dar es Salaam, Tanzania, and found it relatively empty. Relative, that is, to what I would expect to find in the rainy season, when three to four children typically fill each bed. Children hospitalized during the rainy season mainly suffer from respiratory disease or severe diarrhea. Of the children with severe diarrhea in that ward in Dar es Salaam, as throughout hospitals in Africa, the majority will be infected with rotavirus.

Rotavirus is the leading cause of severe diarrhea in children under five years of age, killing as many as half a million each year. A staggering 50 percent of these deaths occur in Africa; six of the seven countries with the highest child death rates from rotavirus are located on the continent.

While these statistics are disturbing, there is hope. Rotavirus vaccines are already saving children’s lives today in countries where children have access to them—and could be saving millions more in Africa and around the world if they were more widely used.

Three recent scientific studies strengthen the case that rotavirus vaccines reduce the risk of disease, decrease deaths and hospitalizations, and save health care costs. Prior to the introduction of the vaccines in Mexico in 2006, 50 percent of deaths due to childhood diarrhea were caused by rotavirus. The country has since seen an impressive 56-percent reduction in the number of children under age five dying from diarrhea.

In the US, a study by the Centers for Disease Control and Prevention (CDC) found that vaccinating infants against rotavirus led to a significant reduction in the number of older children hospitalized with severe diarrhea. The authors conclude that very young children transmit much of the rotavirus disease in communities and, by vaccinating them, severe forms of the disease can be prevented even in those who have not been vaccinated. Another CDC study reported dramatic decreases in health care visits and costs for diarrhea-related illnesses in children under age five following the introduction of rotavirus vaccines.

The evidence supporting the use of rotavirus vaccines around the world is compelling, and African countries are beginning to demand this lifesaving tool. In July of this year, Sudan became the first country in Africa to introduce rotavirus vaccines nationwide with the support of the GAVI Alliance. This is the first step in a coming wave of introductions sweeping across Africa. By rapidly introducing rotavirus vaccines across the continent, we look forward to the day when pediatric wards in places such as Tanzania are nearly empty of children with severe diarrhea throughout the year.

Dr. Wecker directs PATH’s activities in vaccine access and delivery, which focus on developing and advancing strategies, technologies, and interventions that help move research achievements in immunization into routine use in the field.

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

Nilgun Aydogan
Senior Programme Manager, Programme Delivery, GAVI Alliance

Friday

8 July

2011

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

I’ve just come back from a field visit to Sri Lanka, still recovering from a 25 year civil war.

Despite this and a tsunami in 2004, the tropical island has maintained its immunisation coverage at consistently close to 100%. (footnote ref: UNICEF/WHO country estimate for 2009 is 97%).

Sri Lanka’s government and 20 million population are extremely committed to immunisation. And, even without the stunning beaches and coconut tree, mountain scenery, it’s a pleasure to be assisting.

GAVI’s health system strengthening support (HSS) programme is helping rebuild clinics in the island’s north-east regions, where entire communities are returning to their villages since the war ended two years ago.

Not that the war dented Sri Lankan desire for immunisation.

Fleeing the fighting, Sri Lankans would leave their money and possessions but never their immunisation records. Even when crossing rivers and other barriers to run away, they wrapped their immunisation cards in plastic.

GAVI’s money is helping to train medical staff in a wide range of primary health care issues, as well as renovate the health centres.

There’s no shortage of commitment from the communities, where mountains of paperwork follow every child’s nutrition status, growth, as well as immunisation.

And in one village that I visited, a landlord had donated a room in a house for public health midwife so that so his community could have access to primary care.

Another village, the community built their own health center so that government can staff the clinic for MCH services.

With an average annual income per person of more than US$ 1,500, Sri Lanka will soon graduate from GAVI support, wealthy enough to be needing no more GAVI support.

One day, we can hope, the civil war will be a distant memory. Immunisation, I’m sure, will be present for many years to come!

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

Mercy Ahun
Managing Director, Programme Delivery, GAVI Alliance

Wednesday

6 July

2011

Mercy shares her experience of witnessing the tragic effects of pneumonia first-hand, which remains the biggest killer of children under five years in developing countries.

Immunising children against polio in remote Ghanaian villages a decade or so ago, I came across a case of pneumonia that has haunted me to this day.

After riding pillion on a motorbike for hours through cornfields, we arrived in a small hamlet of three mud huts. The men were eating lunch and the women were on the periphery, attending to their ‘household chores’. We extended traditional greetings and asked to see any children under the age of five.

From the corner of my eye, I noticed a young child, about 18 months old, lying on a mat and I took a closer look. She was an ill looking toddler with fast and shallow breaths. I touched her. She was feverish. I did not need my stethoscope to diagnose pneumonia.

We did not have antibiotics with us, the only effective treatment. So I told the father he must take her to the nearest clinic.

You must not be serious, his body language said. He could only get to the nearest clinic, more than 20 miles away by borrowing a neighbour’s tractor. But he would still have to find fuel and his daughter would be dead on arrival.

He turned away, pain in his eyes. This was clearly not the first time he had faced a similar situation. I stood there riveted. How could I leave this child to die?

A couple of decades later, I still wonder what happened to this child. My mind refuses to accept the obvious. But this is my motivation for working at the GAVI Alliance.

GAVI now supports developing countries to introduce the pneumococcal vaccine that protects against pneumonia, the biggest killer of children. With sufficient donor support, this vaccine could save 7 million lives by 2030.

And then maybe, I’ll never see such a tragic scene again.

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

Ed Harris
Communications Manager, Media and Communications, GAVI Alliance

Monday

16 May

2011

Ed reports from a recent trip to Madagascar, where the pentavalent vaccine continues to save lives.

Travelling around Madagascar with a group of journalists and UNICEF colleagues, I’m struck by how many people are receiving the pentavalent vaccine and the lengths they are going to get it.

This life-saving pentavalent vaccine protects against a handful of deadly diseases and the percentage of infants here who receive basic immunisation has risen from 57% in 2000 to 78% in 2009, according to WHO/UNICEF figures.

Droughts, cyclones, and political instability complicate poverty reduction in Madagascar, an enormous island in the Indian Ocean more famous for its wildlife.

But in the rural south, where much of our travel is along dirt roads, a group of women are sitting patiently with their babies in the shade, away from the midday heat. Some have trekked through the tall yellow grass from as far as 18km away, taking care to avoid the bandits.

But then, many mothers, like Tahiri, have lost other children to vaccine-preventable diseases and are glad they can now protect their children.

“I had a two-year-old and a three-year-old child and they both got sick and died,” she said.

Around the world, vaccine preventable diseases kill an estimated 1.7 million children every year, about a fifth of all child deaths worldwide.

But more and more babies in the developing world receive life-saving vaccinations and getting vaccinated depends less and less on the country where you were born. With GAVI support, 230 million children in developing countries will receive the pentavalent vaccine by 2015.

In Madagascar, the pentavalent is having impressive impact, says Hanintsoa Rakotoarimanga, a medic.

But, talking to journalists at the end of a busy morning, she can’t remember whether it protects against five or six, or even seven deadly diseases. 

In fact the pentavalent vaccine protects against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B (Hib). But - killing more than quarter of a million children every year - Hib is a major cause of pneumonia and meningitis.

“And since we started to use the pentavalent vaccine, we have seen much less cases of pneumonia and meningitis,” Hanintsoa says. 

This blog post is also featured on the Bill & Melinda Gates Foundation website. For more images of Ed's trip to Antananarivo, visit this slideshow.

    

Mercy Ahun
Managing Director, Programme Delivery, GAVI Alliance

Friday

13 May

2011

Mercy reflects on her time working with patients in Ghana suffering from the effects of meningococcal meningitis A, Ghana’s most common form of meningitis.

Growing up in a Ghanaian coastal village, the dry and dusty trade winds that blew in from the Sahara were associated with Advent, Christmas, and happiness.

But as I moved inland with my work, they also became linked with meningococcal meningitis A, Ghana’s most common form of meningitis, which brought major epidemics every 8 to 12 years.

Meningitis A strikes children and young adults suddenly, causing severe headaches, fever, and a stiff neck. Patients can die within 48 hours.

I still remember the hospital wards, where I used to work. Meningitis patients were usually on the floor because their seizures made them fall off the bed. As a medical student, I often had to bend the rigid patients into a foetal position so that I could extract the cloudy fluid from their spinal cord and confirm the suspected diagnosis. Year after year, we gave intravenous antibiotics every four hours and prayed the patient would survive without major complications.

MenAfriVac, a new vaccine against Meningococcal Meningitis seroptype Nm A, is expected to prevent meningitis epidemics in Africa's "meningitis belt" of 25 countries that stretch from Senegal in the west to Ethiopia in the east.
Source: Youngblood/GAVI/2010

In 1989, I became the district medical officer responsible for preventive health of a city of one million people. On one memorable occasion, with an epidemic threatening, a terrified crowd of people nearly broke down the vaccine cold store door in an attempt to get the vaccine. The fear on their faces was palpable.

Then, in 1997, the biggest ever meningitis A epidemic struck, not just in the four northern regions as usual - but throughout the country - hitting about 20,000 people.

And just a few years later, in 2001, a close relative of mine - a healthy 20 year old - began complaining of a headache. He later collapsed and was given intravenous antibiotics. Within 48 hours he was dead.

His death devastated my family, with rumours amok about the role of evil spirits. A decade later, my extended African family is still coming to terms with the loss.

I’m proud to say the GAVI Alliance has just committed another US$100 million to support the roll-out of a new conjugate vaccine, MenAfriVac™, to rid the region of these meningitis A epidemics. If our pledging conference is successful on 13 June, GAVI will be able to roll this vaccine out to all African countries at risk.

This Christmas, I am taking my children back to Ghana. The new MenAfriVac™ vaccine gives us the opportunity to celebrate without fear of this ancient scourge. It provides us hope for the future.

Raj writes about why he’s looking on the bright side in terms of child health in Afghanistan.

My recent trip to Afghanistan is one of the most satisfying trips I have done for GAVI. Security remains difficult, but the sense of optimism is palpable. We’re supporting immunisation in Afghanistan, working with our partners in-country who are bursting with innovation and enthusiasm.

This exquisitely beautiful country introduced the pentavalent vaccine in 2009, protecting Afghan children against five deadly infectious diseases with a single course of three injections. This incredibly cost-effective vaccine literally saves tens of thousands of young Afghan lives every year. And because it’s a five-in-one vaccination, it saves on money, time and transport, too.

Now our colleagues in the health ministry are pressing to know more about the new pneumococcal and rotavirus vaccines that help protect against pneumonia and diarrhea, two of the world’s biggest killers of children. I’ve always gotten a buzz from working with immunisation, an incredibly simple technology at heart. The challenge is to save lives on an enormous scale in the most sustainable and cost-efficient manner.

There’s something even more special about doing it in a context of murderous instability. A previous visit in 2008 began with news of a suicide bomb that killed two of our colleagues from WHO. Conflict has been rumbling throughout this mountainous country for more than 30 years now.

No wonder its health system is such a wreck.

As in many other fragile states, though, Afghanistan’s NGOs do a fantastic job of providing basic health services to the population. That partly explains why some of Afghanistan’s basic health indicators have been improving rapidly.

Maternal mortality ratios have fallen by about a quarter in the past six years, and with immunisation coverage rates doubling in the previous decade, we will soon see large reductions in child mortality, too.

Afghanistan is still one of the world’s poorest countries, likely to remain heavily dependent on external donors for quite a while to come. But with GAVI helping protect young children from vaccine-preventable diseases, I'm also optimistic for the future.