Yellow fever vaccine support

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GAVI supports a multi-pronged control strategy for yellow fever

GAVI provides yellow fever support for routine immunisation, campaigns in high-risk countries and emergency stockpiles in case of outbreaks

Togo Yellow Fever WHO

At the heart of the Alliance partners’ strategy lies the introduction of the yellow fever vaccine in national childhood routine immunisation.

The World Health Organisation (WHO) estimates that, since the Alliance’s inception, more than 64 million children have been immunised against yellow fever. Today, 17 of the 33 highly endemic GAVI-eligible countries in Africa are receiving support for routine yellow fever immunisation.

The turnaround has occurred in only 10 years. According to the Alliance’s Second Evaluation study (2010), the cumulative number of countries introducing yellow fever vaccines increased from 46% in 2000 to 86% in 2009 – a nearly two-fold improvement.

GAVI support for routine immunisation programmes has already averted 140,000 future deaths.

GAVI supports Nigeria's first new national yellow fever vaccination campaign in 30 years

Mass preventive campaign will protect close to 60 million children and adults.

 

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Life-saving preventive campaigns

From 2006-2012, a collaboration of national governments with the GAVI Alliance, the World Health Organisation (WHO), UNICEF and other partners reached a population of 69 million people at high risk of yellow fever through preventive campaigns in 13 GAVI eligible countries.

As of December 2012 the following countries had been reached: Benin, Burkina Faso, Cameroon, Central African Republic, Cote d’Ivoire, Ghana, Guinea, Libera, Mali, Senegal, Sierra Leone and Togo. Nigeria, the last country in the 2008 investment case, began its campaign in November 2013.

The planned preventive campaigns are estimated to have so far reduced the burden of disease caused by yellow fever by approximately 27% across the region, achieving up to an 82% reduction in countries targeted by these campaigns. As a result, the risk of yellow fever outbreaks has been significantly reduced in West Africa and public health catastrophes have been avoided.

In November 2013, GAVI Board decided new support would be made available for additional yellow fever campaigns in light of a resurgence of the disease in some parts of Africa.

Emergency stockpile in case of outbreaks

The emergency stockpile funds extension provided by GAVI to WHO and UNICEF allowed the International Coordinating Group (ICG) to efficiently respond to yellow fever epidemics occurring in the endemic region.

Approximately 20 million doses from the stockpile were received by several countries in response to outbreaks. Together, these initiatives have helped establish a global stockpile of yellow fever vaccine that developing countries eligible for GAVI support can rely on for use in emergency outbreaks. They have also helped widen knowledge by accurately forecasting west and central Africa's regional vaccine requirements.

For instance Ethiopia launched an emergency mass vaccination campaign in June 2013 and the ICG, with support from GAVI, provided the yellow fever vaccines.

GAVI support to Yellow Fever 2002-2012

2002:
 
GAVI funds the first yellow fever vaccine stockpile to ensure adequate supplies for mass vaccination campaigns and rapid responses to sudden outbreaks.
2005:

GAVI-funded Yellow Fever Investment Case boosts the stockpile to 57 million vaccines for use in preventive campaigns in 13 high risk west African countries from 2006-2010. GAVI and partners start the Yellow Fever Initiative, a joint collaboration of national governments with GAVI, WHO, UNICEF and other partners.

2008:

Grant agreements signed with WHO and UNICEF for a total of USD 44.8 million. This extension provided additional support to complete the planned preventive vaccination in five target countries (Guinea, Benin, Cote d’Ivoire, Sierra Leone and Liberia) between 2009 and 2010.

2010:

GAVI’s Executive Committee approves additional funding to continue support for the yellow fever stockpile.

2013:

GAVI Board decided new support would be made available for additional yellow fever campaigns in light of a resurgence of the disease in some parts of Africa.

Outbreaks of yellow fever virus erupts despite availability of an effective vaccine since the 1930s

Yellow fever is back, with 200,000 lives at risk per year and claiming 30,000 lives

Before the development of a life-saving vaccine in the 1930s, the yellow fever virus was responsible for devastating epidemics in large cities in Africa, South, Central & North America and Europe.

The virus, which is transmitted by infected mosquitoes, is endemic in tropical regions in Africa and Latin America, with more than 900 million people at risk of contracting the disease.

In the last twenty years, the number of yellow fever cases has increased due to declining population immunity, climate change and deforestation. A few cases also occur in countries free of yellow fever due to population movement. There are an estimated 200 000 cases of yellow fever (causing 30 000 deaths) worldwide each year.

Rapid urbanisation has exacerbated the issue by concentrating non-immune populations in settings where yellow fever virus thrives. City areas provide fertile breeding grounds for mosquito larvae: stagnant water collects in water containers, cans, tyres etc. Overcrowded housing does the rest, accelerating the viral effect.

Africa risk

Yellow fever's recent resurgence is especially pronounced in West and Central Africa, where mass vaccination campaigns from 1933-61 had effectively resulted in the disappearance of the virus.

Yellow fever's recent resurgence is especially pronounced in West and Central Africa, where mass vaccination campaigns from 1933-61 had effectively resulted in the disappearance of the virus. However, the recent epidemics in Uganda and Sudan illustrate how suddenly yellow fever can re-emerge after decades, requiring a prompt and effective response.

This alarming trend started in equatorial Africa with a 1990 epidemic in Cameroon before spreading across the region. By 2005, failure to immunise successive birth cohorts through routine immunisation had led to an estimated 206,000 yellow fever cases and 52,000 deaths in West Africa's 12 highest risk countries.

Disease burden

As an acute viral haemorrhagic disease transmitted by mosquitoes, yellow fever causes devastating epidemics in areas where infected mosquitoes can come in contact with non-immunised populations. Up to 50% of people severely affected by yellow fever will die.

Yellow fever virus poses the greatest threat to 900 million people in more than 45 endemic countries - 33 in Africa and 13 in Central and South America. Together, deforestation, urbanisation, climate change and low population immunity have contributed to its re-emergence since the 1980s.

Yellow fever can be prevented by a safe, affordable and highly effective vaccine. One injection protects an individual for at least 35 years, and possibly for life.

GAVI finances routine infant immunisation against yellow fever in endemic countries as well as outbreak and preventive campaigns

GAVI's response to the re-emergence of yellow fever is based on WHO's recommended three-pronged strategy: early routine immunisation and preventive mass vaccination campaigns to rapidly increase population immunity in high-risk areas, and outbreak response.

Routine immunisation

Yellow fever vaccine is one of the priority vaccines that GAVI has supported since its foundation in 2000, both to protect populations at risk and lessen the need for emergency response. GAVI supports yellow fever vaccines for use both in routine immunisation programmes and vaccine campaigns in countries at high risk of outbreaks.

WHO estimates that, by the end of 2012, more than 64 million children had been vaccinated against yellow fever as a result of GAVI-supported routine immunisation programmes. Of these, nine million were immunised in 2012 alone.

Map of countries approved for GAVI's yellow fever vaccine support

Countries approved for yellow fever vaccine support 

Vaccine campaigns

From early on, GAVI recognised that routine immunisation programmes alone could not lower the risk of epidemics. GAVI has played a key role in facilitating preventive campaigns across Africa through its financial support.

By the end of 2013, the preventive campaigns had reached 69 million people against yellow fever in 13 GAVI eligible countries: Benin, Burkina Faso, Cameroon, CAR, Cote d’Ivoire, Ghana, Guinea, Liberia, Mali, Senegal, Sierra Leone and Togo. Nigeria, the last country to implement, began its campaign in November 2013.

In 2013, GAVI Board also decided new support would be made available for additional yellow fever campaigns in light of a resurgence of the disease in some parts of Africa.

  • Campaigns are recommended for the entire population above nine months of age;
  • GAVI provides US$ 0.65 per capita for the target population of the campaign to cover operational costs -- equivalent to approximately 50% of the total cost.
  • Countries are expected to meet the remaining half of the operational expenses for the campaign, although no co-financing of the vaccine is required for such campaign support.

Stockpiles

These initiatives have helped establish a global stockpile of yellow fever vaccine that developing countries eligible for GAVI support can rely on for use in emergency outbreaks.

In 2011, because of a shortage of yellow fever vaccine during an outbreak in Guinea, a global reserve of 2 million doses of vaccine was created to ensure a rapid response to outbreaks in the future. Now approximately 20 million doses from the stockpile were received by several countries in response to outbreaks.

The stockpile is managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG). Countries facing an epidemic can apply for support from the emergency stockpile and GAVI eligible countries have financial support to cover emergency vaccination campaigns.

US$ 8.4 billion

By 31 August 2013, GAVI had committed US$ 8.4 billion in programme support until 2016 to the world’s poorest countries.

GAVI Alliance, 30 April 2013

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