China immunises millions of children in historic collaboration between government and GAVI Alliance

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WHO, UNICEF helping China battle cause of deadly liver cancer, achieving dramatic increase in delivery of vaccines to most remote provinces

BEIJING 25 July 2006 - Since 2002, China has immunised 11.1 million children in the country's poorest and most remote western and central provinces against hepatitis B, reducing their risk of developing a deadly and common liver cancer, according to an announcement made today by the Chinese government and the GAVI Alliance.

Following a ceremony in Beijing, held to commend the Chinese for their dramatic progress, GAVI and Chinese health officials told journalists that the boost in immunisations represents a 60 percent increase in hepatitis B vaccine doses delivered to children in target provinces. The children reached include newborns, who receive a "birth dose" of vaccine plus two more doses at one and six months of age, as well as previously unvaccinated children under five, who must also receive a full three-dose vaccine series.

"Our goal is to protect all the babies at birth from this virus," said China Minister of Health Gao Qiang. "The China-GAVI Hepatitis B Immunisation Project has propelled us forward on this path, covering one-third of all children born in China since the project began in 2002."

According to an estimate based on a 1992 national hepatitis epidemiological survey, 120 million people in China are chronically infected with hepatitis B (HepB). Those infected are at risk of liver cancer or failure, and can spread the disease to others. In the western provinces, the campaign, with technical guidance from the World Health Organization (WHO) and UNICEF, has reached almost 70 percent of newborns with a birth dose of vaccine in 2005, up from 47 percent in 2002. Newborns are a key target of the effort, since vaccination within the first 24 hours of life is the only way to protect an infant from transfer of virus from an infected mother.

Since its inception, the campaign has averted over 200,000 future deaths due to the chronic consequences of hepatitis B, mainly from cancer of the liver and cirrhosis. Death typically comes decades after children are exposed to the virus during childbirth or in their first years of life.

The breakthrough is the result of a five-year US$76 million project, co-funded equally by the Government of China and the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization). Known as the China Ministry of Health/GAVI Hepatitis B Vaccination Project, the GAVI-supported campaign has targeted newborns and children under five across an area that encompasses 470 million people, including six million newborns every year. It has reached babies born in hospitals, as well as those born at home in mountain villages or in the tents of nomadic herders on the vast steppes.

"This breakthrough was 20 years in the making," said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. "That is how long children in the industrialised world have had a vaccine to fight this virus, but, until recently, progress in emerging countries and poor remote areas, such as western China, had been painfully slow. China's success is a model for other countries still struggling to stop the spread of the hepatitis B virus and other vaccine-preventable diseases."

According to preliminary data, provincial governments have added to the funds provided by GAVI and the central government, contributing more than US$10 million in co-payments. Lob-Levyt noted as well that the support of the World Health Organization (WHO) and UNICEF has been critical.

"Worldwide, GAVI's support has made it possible to immunise 90 million children against hepatitis B and avert an estimated 1.4 million deaths from this disease alone," he added.

WHO and UNICEF are among the GAVI partners and other key immunisation groups1 in China that support the China National Immunisation Programme efforts to reach all children with life-saving vaccines and technologies, as well as with polio eradication, measles control, and new vaccine introduction. WHO and UNICEF have supported the development and implementation of the China-GAVI project, through the national Interagency Coordinating Committee and project Operations Advisory Group.

GAVI's efforts are critical to achieving the Millennium Development Goal on child health, which calls for reducing childhood mortality by two-thirds by 2015. Of the more than 10 million children who die before reaching their fifth birthday every year, 2.5 million die from diseases that could be prevented with currently available or new vaccines. Since 2000, the catalysing efforts of the GAVI Alliance have ensured that 90 million children in the world's poorest countries were immunised against hepatitis B.

New laws, home-grown vaccine, and dedicated partners

Progress in China has been the result of national commitment to control this disease; strong partnerships; new national laws; and a home-grown vaccine industry able to supply the huge quantities of vaccine needed.

The Government of China and the GAVI Alliance embarked on the five-year project in 2002, with the goal of reaching 75 percent of newborns with a birth dose of vaccine and 85 percent of children under the age of 12 months with all three doses of HepB vaccine necessary to prevent infection. GAVI financial support was used to purchase and distribute 55.39 million doses of hepatitis B vaccine and 145.6 million safe, auto-disable (AD) syringes. That financial support was also designed to catalyse national action and sustained commitment to HepB vaccination in China.

In 2002 the Chinese national government added hepatitis B to all routine childhood immunisations (known as EPI vaccines). Then, in March 2005, it passed a new regulation stating that all EPI vaccines be given at no cost to parents. The Ministry of Health also designated hepatitis B as one of four high priority diseases for national control and developed a national hepatitis B control plan for 2006-2010, with the goal of reducing to less than one percent the proportion of children under the age of five who are carriers of the hepatitis B surface antigen.

The Chinese vaccine industry, which has produced HepB vaccines since the 1980s and had a licensed vaccine since 1990, was also prepared to scale up. The GAVI-supported project used this vaccine, purchased through a national bid and tender process with international observers.

Reaching babies with safe injections wherever they are born

Success has also been bolstered by China's Safe Motherhood Initiative, which urges mothers to give birth in hospitals. In addition, unprecedented cooperation between grassroots vaccination staff and child and maternal health staff in hospitals has fostered the approach of "whoever delivers the infant should give the immunisation."

As a result, today more than 90 percent of the babies in the project area hospitals receive their birth dose of hepatitis B vaccine on time-within 24 hours of delivery.

The biggest challenges remain reaching babies born at home in the most remote rural areas. Efforts to scale-up immunisation there include increased coordination between village doctors, vaccinators, midwives and mothers, as well as regular vaccine deliveries to remote areas.

In addition, a key component of the project has been ensuring safe injections through the use of auto-disable (AD) syringes. By design, these syringes cannot be reused, thus eliminating the danger of spreading multiple diseases through injections given with dirty needles. As a result of the project, today all childhood vaccines in the targeted regions are delivered using AD syringes.

Challenges remain

About three-quarters of the 1301 project counties have reached the target of 85 percent of children receiving the complete HepB vaccine series, and half have reached the timely birth dose target. However, over one million babies born each year in GAVI project counties are still not receiving a timely birth dose.

In the project's final years, it will concentrate on achieving those targets in every county, both through reaching more babies born at home and by waging a "catch-up" campaign to reach still unvaccinated children. The project will also focus on enhancing injection safety through wider use of AD syringes, and will encourage the expanded use of AD syringes for all immunisations given in China.

"Finally, long-term success depends on assuring that no new financial barriers arise to block HepB immunisation in the future," Lob-Levyt said. "This is one of the greatest challenges, and the solution lies not just within China, but with a global community mobilised to ensure access to vaccine financing for all developing nations."

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The GAVI Alliance

An alliance of all the major stakeholders in immunisation, the GAVI Alliance includes among its partners developing country and donor governments, the World Health Organization (WHO), UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, NGOs, and the Bill & Melinda Gates Foundation. It is estimated that more than 1.7 million early deaths will have been prevented as a result of support by GAVI up to the end of 2005.

GAVI's efforts are critical to achieving the Millennium Development Goal on child health, which calls for reducing childhood mortality by two-thirds by 2015. Of the more than 10 million children who die before reaching their fifth birthday every year, 2.5 million die from diseases that could be prevented with currently available or new vaccines.

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