Vaccine experts at GAVI meeting in India announce progress in injection safety

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In collaboration with WHO, UNICEF, Seattle-based PATH and GAVI help improve safety of injections in developing nations

NEW DELHI,7 December 2005 - At an international vaccine meeting in New Delhi today, the GAVI Alliance (the Global Alliance for Vaccines and Immunization), announced that the Alliance and its partners have distributed 1.214 billion single-use, auto-disable (AD) syringes, protecting millions of children in developing countries from blood-borne pathogens that might otherwise be transmitted through sloppy injection practices.

"The decision to fund auto-disable syringes, inspired and supported by UNICEF, is an important part of GAVI's mission to expand access to vaccines for the world's poorest children," said Julian Lob-Levyt, MD, Executive Secretary for GAVI. "Virtually every child immunized in the world is safer today as a result of UNICEF's work in procuring AD syringes and the commitment of national leaders to protect their children from diseases such as hepatitis or HIV, which can be transmitted via dirty needles."

Experts meeting this week at the 3rd GAVI Partners' Meeting in New Delhi cited India's recent decision to adopt safe injection practices nationally, including immunization with AD syringes, as a model solution--one that could help accelerate the adoption of safe injection practices in other countries as well. PATH, an international nongovernmental organization, developed one of the first AD syringes. This design and others are now produced by private manufacturers in both developing and industrialized nations.

Immunization of children accounts for only 10 percent of 16 billion injections given worldwide every year, but efforts to improve injection safety in childhood immunization programs are expected to have a broader impact because of vaccination's prominent place in public health policy. The World Health Organization (WHO) estimates that more than 17 percent of all injections are administered with re-used, un-sterilized injection equipment, a practice the agency blames for "a silent epidemic" of disease-20 million hepatitis B infections, 2 million hepatitis C infections, and 250,000 infections with HIV annually.

Last month in the WHO Weekly Epidemiological Record, an expert committee reported that AD syringes are now used for routine immunizations in 62 percent of non-industrialized countries-up from 42 percent in 2001- and noted that GAVI support has played a major role in this progress. The Safe Injection Global Network (SIGN), an international coalition of stakeholders has also been instrumental in addressing the need for safe and appropriate use of injections throughout the world.

India has one of the world's largest immunization programs in a country where vaccine-preventable illness still poses a major public health threat. Earlier this year, the World Bank reported that up to 70 percent of India's 4 billion injections given each year for curative or prevention purposes were either incorrectly administered or given with improperly sterilized needles. Indian health officials have responded with a pledge to use AD syringes for all routine immunizations.

The Indian Government made its decision to expand use of the AD syringe after observing a dramatic reduction in injection-related abscesses in the Indian state of Andhra Pradesh (AP), where the new syringes were first introduced as part of a model initiative between Seattle-based PATH and the AP government. A co-founder of GAVI, PATH negotiated an agreement with Indian manufacturers that lowered the cost of AD syringes, making the syringes available for widespread use.

The move to encourage use of the AD syringes is part of a trend to speed transfer of new technologies to the field in order to promote not just injection safety at the point of vaccination, but the safe disposal of "sharps waste" post-immunization as well. Among the innovations PATH has introduced in several countries are "needle cutter" devices that remove and break needles, reducing the risk of needle pricks to the health provider and eliminating improper disposal of the needles in residential areas. Perhaps most important, needle cutters eliminate the dangerous practice of selling used syringes for re-use, an activity that has been fairly common in India's poorer communities.

"We have been working with manufacturers to reduce the price of needle remover devices and to make them more widely available," said Dr. Raj Kumar, director of PATH's AP program, based in Hyderabad. "Our staff is also developing specifications for needle removers as part of the World Health Organization's waste management working group for performance, quality, and safety system."

By the end of 2005, GAVI will have disbursed US$115 million to support injection safety in some of the world's poorest countries. GAVI Executive Secretary Julian Lob-Levyt noted that 15 countries whose support ended in 2004 have found resources to continue to fund safety measures.

"We face many challenges in our efforts to encourage injection safety worldwide," Lob-Levyt said. "But it's important that GAVI support is serving as a catalyst in a number of countries where national governments have continued to support the purchase of AD syringes, even after exhausting their GAVI funds."

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The GAVI Alliance (Global Alliance for Vaccines and Immunization) was launched in 2000 to increase immunization rates and reverse widening global disparities in access to vaccines. Governments in industrialized and developing countries, UNICEF, WHO, the World Bank, non-governmental organizations, foundations, vaccine manufacturers, and public health and research institutions work together as partners in the Alliance, to achieve common immunization goals, in the recognition that only through a strong and united effort can much higher levels of support for global immunization be generated. Funds channeled through GAVI's financing arm, The GAVI Fund, are used to help strengthen health and immunization services, accelerate access to selected vaccines and new vaccine technologies - especially vaccines that are new or under-used, and improve injection safety. In addition to substantial funding from the Bill & Melinda Gates Foundation, The Vaccine Fund has been financed by 11 governments to date, as well as the European Union and private contributors.

PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions that enable communities worldwide to break longstanding cycles of poor health. More information on PATH's vaccine initiatives is available by contacting Laura Cooley, tel: +1 206 285 3500; email: lcooley@path.org

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