Yellow fever vaccine support

Ten year turnaround in routine immunisation rates

WHO projections indicate that, since the Alliance’s inception , more than 26 million children have been immunised against yellow fever, averting an estimated 140,000 future deaths. Today, 17 of the 26 GAVI-eligible countries 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.

No more than two GAVI–eligible countries had ever introduced a yellow fever vaccine in a single year prior to 2000. Following the creation of GAVI, 11 countries introduced a yellow fever vaccine every year from 2002-2004.

Life-saving preventive campaigns

In its first 10 years, GAVI has played a key role in facilitating preventive campaigns across west Africa through its financial support for a series of landmark investment cases (see below).

Together, these initiatives have helped establish a permanent 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 Africa's regional vaccine requirements.

By the end of 2009, the stockpile had provided for the immunisation of almost 41 million people against yellow fever through preventive campaigns in eight countries: Benin, Burkina Faso, Cameroon, Libera, Mali, Senegal, Sierra Leone and Togo.

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

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.

Almost a century later, yellow fever is back, striking an estimated 200,000 people per year and claiming 30,000 lives.

Since the eighties, cases are occurring in areas that had previously not experienced outbreaks, such as southern Brazil, northern Argentina and central Paraguay, or that had no confirmed cases in decades - the Central African Republic, Chad, Congo, Liberia and Sierra Leone.

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.

West Africa risk

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

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 infant 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 45 endemic countries - 32 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, probably for life.

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

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 contributes to topping-up existing government financial commitments to yellow fever vaccination providing two conditions are met:

1. immunisation against yellow fever is already part of a routine immunisation programme;

2. yellow fever immunisation coverage is lower than that for measles.

If shortfalls occur in the availability of the vaccine, vaccines will firstly be allocated to countries already engaged in routine yellow fever immunisation to ensure sustainability of established programmes; and secondly to those at risk of yellow fever that are planning immunisation.

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

Outbreak and preventive campaigns

From early on, GAVI recognised that routine immunisation programmes alone could not lower the risk of epidemics. To date, only a few at risk countries can claim to have reached the vaccination coverage required - at least 60-80% of the population at risk - to prevent further outbreaks of yellow fever.

Countries at risk can apply for GAVI support for preventive campaigns, which can significantly reduce the risk of yellow fever disease and the occurrence of epidemics:

• The campaign is recommended for the entire population above nine months of age;
• GAVI will provide US$ 0.30 per capita for the target population of the campaign to cover operational costs -- equivalent to approximately 50% of the total cost. The support is provided in cash through WHO and UNICEF;
• 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;

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