Vaccines and Global Health: The Week in Review 25 April 2015

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version A pdf of the current issue is available here:   Vaccines and Global Health_The Week in Review_25 April 2015

blog edition: comprised of the approx. 35+ entries posted below on this date.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
.
Support:  If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary, and follow the relevant steps . Thank you…

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

UNICEF [to 25 April 2015] – Immunization actions

UNICEF [to 25 April 2015]
http://www.unicef.org/media/media_78364.html

.
:: Measles vaccination campaign aims to immunize over 2.6 million Syrian children
DAMASCUS, Syria, 24 April 2015 – A 10-day measles immunization campaign is underway in Syria to protect children from this deadly disease. Launched on 19 April, the campaign is aimed at children between six months and five years of age. Vaccination will be provided in 1,209 health centres, and nearly 6,000 health staff and mobile teams are participating in the campaign.

By the end of 2014, 594 children had been diagnosed with measles. Of these, almost half were not immunized. Since the conflict began in 2011, immunization rates across the country have fallen from 99 percent to just 52 per cent due to lack of access and severe damage to health infrastructure – nearly one third of the country’s health centres are either damaged or destroyed. UNICEF estimates that over 230,000 children in hard-to-reach areas across the country will likely miss out due to the ongoing conflict.

“In situations of conflict and upheaval, measles can be deadly, especially for children, which is why we must do everything possible to get all children vaccinated wherever they are across the country,” said Hanaa Singer, UNICEF Representative in Syria. “As long as children are left under-reached, the risk of children falling ill and diseases spreading will continue”.
The campaign coincides with World Immunization Week which focuses this year on “Closing the Gap” – sending a direct appeal to the global health community to focus on vaccinating the most marginalized children.

In Syria, the focus during this campaign will be on reaching displaced children. UNICEF estimates there are more than 3.8 million children internally displaced across the country, many of whom were missed out in previous measles campaigns. At least 646,000 are under the age of 5.

Children receiving the vaccines will also be checked for signs of malnutrition and provided with vital supplements and referral to medical services as needed.

This is the second campaign in less than a year. In 2014, UNICEF and partners reached 840,000 children with vaccination against measles.

UNICEF is supporting the Ministry of Health with the provision of vaccinations and syringes, cold chain equipment and the training of vaccinators. Mass media and community outreach activities are taking place including through the dissemination of short message services (SMS), community meetings, recreation activities and social media campaigns.

.
:: Immunization drive under way for 3 million children in Ebola-hit countries
DAKAR/GENEVA, 24 April 2015 – For the first time since the start of the Ebola outbreak, Guinea, Liberia and Sierra Leone are conducting major nationwide immunization campaigns to protect millions of children against preventable but potentially deadly diseases.

As World Immunization Week is marked from April 24 to 30, the three countries most affected by Ebola aim to vaccinate more than three million children against diseases such as measles and polio in UNICEF-supported campaigns that involve the provision of vaccines and the training and deployment of thousands of immunization teams.

“While the effort to get to zero cases of Ebola continues, it’s critical that basic health services are restored,” said Manuel Fontaine, UNICEF’s Regional Director for West and Central Africa. “Stepping up immunization programs that were disrupted by the epidemic will save lives and prevent a reversal of the health gains that were made in these countries before the outbreak.”

In Sierra Leone, a mother and child health week begins today with the provision of Vitamin A, deworming pills and screening for malnutrition. More than 10,000 vaccinators and distributors will be going door-to-door across the country to deliver the interventions, which also include updates for those aged 0-23 months who have missed routine vaccinations. In May, an immunization drive for 1.5 million children under five will cover measles and polio.

A nationwide measles campaign got under way in Guinea on April 18 to vaccinate 1.3 million children aged six months to nine years. Some 100,000 children were vaccinated during an initial response to a measles outbreak in February. UNICEF also conducted community sensitization campaigns to inform the public of the safety of the vaccinations.

In Liberia, a campaign to provide measles and polio vaccinations to over 700,000 children under five years old is planned for May 8-14. UNICEF has supplied over 750,000 doses of measles vaccines, and, together with its partners is training more than 3,000 vaccinators and county health officials. It is also working with the Government of Liberia on nationwide social mobilization efforts to raise awareness of the campaign.

As the immunization campaigns are taking place while the threat of Ebola remains, vaccinators are following strict protocols including the use of protective wear, such as gloves and aprons, as well as regular handwashing.

More than 26,000 cases of Ebola and 10,000 deaths have been reported across the three countries where the outbreak has weakened already fragile health systems while disrupting routine health interventions.

.
:: Nearly 8 million children in Sudan to be immunized against measles following deadly outbreak – UNICEF
KHARTOUM, Sudan/ GENEVA / NAIROBI 22 April 2015 – Following one of the worst measles outbreaks in Sudan’s recent history, the Ministry of Health with support from UNICEF, the Measles and Rubella Initiative (M&RI) and national partners, is launching a massive campaign to immunize 7.9 million children aged six months to 15 years against this life-threatening disease.

Since the start of the outbreak at the end of 2014, there have been 1,730 confirmed cases, 3,175 suspected cases and 22 fatalities. West Darfur remains the worst affected state, with 441 confirmed cases and five deaths. Kassala has had 365 confirmed cases and five deaths, while in Red Sea state there have been 263 cases and four deaths.

“Measles is a life threatening disease but one that can easily be prevented with timely immunization,” said Geert Cappelaere, UNICEF Representative in Sudan. “Every girl and boy must be reached no matter where they live. There are no excuses and no child can be left out.”

The campaign, which launches today will initially target 28 affected localities in six of the highest risk states, before expanding to other areas identified as being at risk of an outbreak. In total it will target 96 localities in 16 affected and “at risk” states.

The immunization campaign will be a complex operation, however, as ongoing conflict in some areas of Sudan could restrict humanitarian access. There are children in conflict zones in the Kordofans, Blue Nile and Darfur who have not received routine immunization since 2011. UNICEF has called on all parties to the fighting to facilitate humanitarian access so that these children can be reached.

Children are most at risk of the disease – children who are malnourished are even more vulnerable. In Sudan, some 36 per cent of children are stunted and the country has one of the highest levels of malnutrition in Africa. Of the total number of reported measles cases in Sudan, 69 per cent are below 15 years of age, including 52 per cent under the age of five. For malnourished children measles can cause serious complications, including blindness, ear infections, pneumonia and severe diarrhoea.

The upcoming campaign is expected to cost approximately US $13.9 million – funds that are needed to procure 9.6 million doses of vaccine, logistics, measles case management and activating social networks in communities to ensure local buy-in. UNICEF is appealing to all donors to make funding available to fight the outbreak, which is having a detrimental effect on the lives of children across Sudan and threatens neighboring countries. UNICEF, WHO and partners are coordinating with surrounding countries to stop this outbreak from crossing borders.

The measles virus is spread by respiratory transmission and is highly contagious. Up to 90 per cent of people without immunity who are sharing a house with an infected person will catch it.

EBOLA/EVD [to 25 April 2015]

EBOLA/EVD [to 25 April 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 22 April 2015
[Excerpts]
SUMMARY
:: The decline in confirmed cases of Ebola virus disease (EVD) has halted over the last three weeks. To accelerate the decline towards zero cases will require stronger community engagement, improved contact tracing and earlier case identification. In the week to 19 April, a total of 33 confirmed cases was reported, compared with 37 and 30 in the preceding weeks.
:: In the week to 19 April, Guinea reported 21 confirmed cases, compared with 28 cases the previous week. Sierra Leone reported 12 confirmed cases, compared with 9 cases reported the previous week. Liberia reported no confirmed cases…

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 26,044 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 10,808 reported deaths (outcomes for many cases are unknown). A total of 21 new confirmed cases were reported in Guinea, 0 in Liberia, and 12 in Sierra Leone in the 7 days to 19 April…

POLIO [to 25 April 2015]

POLIO [to 25 April 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 22 April 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The Global Polio Eradication Initiative mourns its fallen colleagues in Somalia. They leave behind a legacy of service to children that will endure, and always inspire. Read the full statement
:: The Strategic Advisory Group of Experts on Immunization (SAGE) met last week in Geneva to review the current epidemiological situation for polio, and to provide updates on readiness for oral polio vaccine withdrawal and the inactivated polio vaccine (IPV) introduction to routine immunization schedules. Read more
:: World Immunization Week, which will be held 24 to 30 April, focusses this year on closing the immunization gap to ensure that all children have access to life saving vaccines. Vaccinating every last child against polio is crucial to eradicate the virus for good.
[No new wild poliovirus type 1 (WPV1) or new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported in the country summaries.]

.
Two Polio Workers Killed in Garowe, Somalia
Thursday, April 23, 2015
Among UNICEF colleagues killed in an attack on a UN convoy were two polio heroes
Four UNICEF colleagues were killed in the attack on a UN vehicle in Garowe, Somalia on 20 April. Among them were two staff working in the Global Polio Eradication Initiative – and for some, our cherished friends – delivering Polio, Routine Immunization and Communication programmes in Somalia. Payenda Gul had been a polio eradicator since 1999, working to protect children in Afghanistan, Nigeria and Somalia. Brenda Kyeyune had joined the team in 2014, working to make sure communities are engaged in polio eradication.
The commitment of these colleagues to achieving polio eradication and improving children’s lives was tested in the most challenging circumstances and they were never found wanting. They are true heroes. This is a tremendously difficult time but we are deeply thankful for their accomplishments, and remember them with respect and gratitude.
Comments can be submitted to the UNICEF condolence book that has been opened in New York by email to icon@unicef.org

Message from the UNICEF Executive Director, Anthony Lake
New York, 21 April 2015: All of us within the UNICEF family remain stunned by yesterday’s horrific attack in Garowe, Somalia, which claimed the lives of seven people ― including four UNICEF colleagues ― and injured five others.
Today, we sadly confirm the names of the four UNICEF colleagues who were killed:
:: Mr. Payenda Gul Abed, who co-ordinated UNICEF’s polio programme in Garowe since May
:: Ms. Brenda Kyeyune, who managed social mobilization and communication initiatives in support of polio eradication in Somalia since 2014;
:: Ms. Woki Munyui, who supported UNICEF’s education programme in Somalia since 2007; and
:: Mr. Stephen Oduor, who provided essential administrative assistance to UNICEF Somalia’s programmes since 2010.
Many of you worked beside them ― sharing meals, laughter, ideas. You saw, first-hand, their dedication to our common cause: children. Please know that your colleagues around the world share in your grief ― as we share in your hopes that our five injured colleagues will recuperate as quickly as possible.
The families of each of these heroes have been contacted, and offered every assistance in this extraordinarily difficult time.
In 2013, we dedicated a memorial at UNICEF House honoring those colleagues ― those sisters and brothers ― who have fallen in their duties to serve the world’s most vulnerable children.
Today, we add four more names to this list.
As we remember them, let us recall not how these four were taken from us, but rather all they gave us in life ― their dedication, their ideas, their friendship ― and all they left behind: a legacy of service to children that will endure, and always inspire.

WHO: Summary of the SAGE meeting of April 2015

WHO: Summary of the SAGE meeting of April 2015 pdf, 52k
20 April 2015
[Editor’s text bolding]

SAGE reviewed progress towards eradication of wild poliovirus (WPV) and elimination of persistent circulating vaccine-¬‐derived poliovirus type 2 (cVDPV2) as well as the plans, preparedness and timeline for type 2 oral polio vaccine (OPV2) withdrawal.

SAGE noted that the program had made substantial progress since the October 2014 SAGE meeting. There were no polio cases due to WPV reported in the Middle East and Africa since April 2014 and August 2014, respectively. In polio-¬‐endemic countries there were definite improvements in the quality of supplementary immunization activities, increasing access to children in conflict-¬‐affected areas of Pakistan, improvements in AFP surveillance and expansion of environmental surveillance.

Persistent cVDPV2 transmission was detected only in Nigeria and Pakistan since 2014. The number of cVDPV2 cases declined in both countries after mid-¬‐2014 following increased use of tOPV and targeted use of IPV in Supplementary Immunization Activities (SIAs).

Between March 2015 and March 2016, Nigeria and Pakistan will conduct 7 and 8 large
-¬‐scale tOPV campaigns, respectively, especially targeting areas affected by persistent cVDPV2. IPV will be included in tOPV campaigns in selected highest-¬‐risk areas, and aggressive mopping-¬‐up will be implemented in response to detection of any cVDPV2. Both countries will focus on strengthening routine immunization to further reduce the risk of emergence of new cVDPV2.

SAGE endorsed the proposed cVDPV2 elimination strategies in Nigeria and Pakistan and the programme’s risk-¬‐based approach to prevent and respond to new cVDPV2 emergence in any location.

Overall, SAGE concluded that progress towards elimination of persistent cVDPV2 is on track. SAGE recommended that all countries and GPEI should plan firmly for April 2016 as the designated date for withdrawal of OPV2. SAGE will consider delaying OPV2 withdrawal only if the WG reports in October 2015 that the risk of continued cVDPV2 transmission is judged to be high. SAGE requested the polio WG to continue monitoring progress towards cVDPV2 elimination and ensuring that remaining challenges are addressed including contingencies for vaccine supplies (IPV, bOPV and tOPV), registration of bOPV for routine use, surveillance sensitivity, and reaching inaccessible children.

The Middle-¬‐Income Countries (MICs) Task Force, a group of nine immunization partners, presented a proposed way forward for coordinated action to enhance sustainable access to vaccines in MICs with focus on non-¬Gavi eligible countries. The Task Force has undertaken a detailed survey of the needs of non-¬‐Gavi MICs and the types of support currently provided to these countries by immunization partners. Based on this and on a modelled analysis of impact, the Task Force agreed that its strategy should address both new vaccine introduction and immunization coverage. Based on consultations and analyses, the Task Force confirmed that the issue of access to affordable prices and timely supply is a main challenge for MICs, yet agreed that this issue should not be tackled in isolation and that activities to consolidate demand are key to success. Four main areas of action have been identified as the pillars of the MIC strategy: i) Strengthening evidence–‐based decision-¬‐making; ii) Enhancing political commitment in specific countries and ensuring financial sustainability of immunization programmes; iii) Enhancing demand for and equitable delivery of immunization services; and iv) Improving access to timely and affordable supply. Within each of these areas, the Task Force has identified a set of focus activities and lead agencies, making this the first comprehensive and coordinated strategy targeting MICs.

Critical to the strategy is the central role of country-¬‐level political and financial commitments to immunization. To foster country ownership, the Task Force designed the strategy as a menu of options, from which countries will be able to select the kinds of assistance they identify as priorities. SAGE acknowledged that the strategy put forward represents a strong proposal for coordinated and comprehensive approach to the MIC issue. SAGE concurred with the direction of the strategy and valued the menu of option approach as a way to tailor activities to the needs of a very heterogeneous group of countries. SAGE also appreciated that the strategy builds upon lessons learnt and existing activities, and perceived this approach as the most efficient way to use resources and achieve impact.

With respect to Ebola vaccines and vaccination SAGE was updated on the status of: 1) the ongoing epidemic, 2) vaccine development, and 3) preparation for supporting countries with vaccine deployment. SAGE was presented with a framework for making recommendations, which aims to adopt a scenario-¬‐based approach for framing recommendations, while also taking a number of programmatic, socio-¬‐cultural and other issues into account. Considerations guiding the use of the framework are: the specific scenario relating to the epidemiology and the type of authorization for vaccine use; objectives for vaccination (primary -¬‐ stopping transmission, secondary -¬‐ individual protection); prioritization of target populations; additional considerations which would frame SAGE’s recommendations. The framework would be adjusted based on the evolution of the current epidemic, the type of regulatory or emergency use authorization given to a vaccine, and on data that become available from clinical trials.

SAGE members expressed concern about the likelihood that efficacy estimates may not be generated from the current phase 3 trials, given the declining number of cases in all three countries and felt that the trials must also contribute additional data, including those related to programmatic aspects, that could inform recommendations. Noting WHO’s unique position to coordinate the development of Ebola vaccines, SAGE highlighted the importance for transparent and prompt sharing of information on the trial protocols and data from the phase 3 studies and the need for a greater role for WHO in coordinating these trials.

SAGE supported the proposed framework for making recommendations, but asked that it be made explicit that the identification and prioritization of target populations for vaccination will be based on a thorough assessment of risks (from disease as well as from vaccination) and benefits. It was recognized that the final recommendations would be driven by the evolution of the current epidemic, the conditions laid down in the regulatory authorization for the use of vaccines and social and cultural considerations.

SAGE noted the probability that for some vaccines currently under test, efficacy data may not be available by the end of the current outbreak. SAGE further noted that in this scenario, future use of unproven Ebola vaccines should be in the context of a
Study with generation of safety and effectiveness data.

SAGE also discussed the administration of multiple injectable vaccines, the use of interventions aimed at reducing pain and distress at the time of vaccination, maternal vaccination, and pertussis immunization schedules.

The full meeting report will be published in the WHO Weekly Epidemiological Record on 29 May 2015. The meeting documents — including presentations and background readings — can be found at http://www.who.int/immunization/sage/meetings/2015/april/en/index.html

Global vaccination targets ‘off-track’ warns WHO

Global vaccination targets ‘off-track’ warns WHO
News release
22 APRIL 2015 | GENEVA – Progress towards global vaccination targets for 2015 is far off-track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. In the lead-up to World Immunization Week 2015 (24–30 April), WHO is calling for renewed efforts to get progress back on course.

In 2013 nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-pertussis-containing vaccines (DTP3), many of them living in the world’s poorest countries. WHO is calling for an end to the unnecessary disability and death caused by failure to vaccinate.

“World Immunization Week creates a focused global platform to reinvigorate our collective efforts to ensure vaccination for every child, whoever they are and wherever they live,” said Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health. “It is critical that the global community now makes a collective and cohesive effort to put progress towards our 6 targets back on track.”

In 2012, all 194 WHO Member States at the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a commitment to ensure that no one misses out on vital immunization. However, a recent independent assessment report on GVAP progress rings an alarm bell, warning that vaccines are not being delivered equitably or reliably and that only 1 of the 6 key vaccination targets for 2015 is currently on track – the introduction of under-utilized vaccines.

Many countries worldwide have experienced large measles outbreaks in the past year, threatening efforts to achieve the GVAP target of eliminating measles in 3 WHO Regions by end-2015.

Actions to get back on track
A global collaborative drive for immunization, begun in the mid-1970s — with the establishment of the Expanded Programme on Immunization in all countries — achieved dramatic results, raising vaccination levels from as low as 5% to more than 80% in many countries by 2013. WHO estimates that today immunizations prevent between 2 and 3 million deaths annually and protect many more people from illness and disability.

Although progress has stalled in recent years, this early success demonstrates the potential of vaccines, which are increasingly being extended from children to adolescents and adults, providing protection against diseases such as influenza, meningitis and cervical and liver cancers.

The GVAP recommends three key steps for closing the immunization gap:
:: integrating immunization with other health services, such as postnatal care for mothers and babies;
:: strengthening health systems so that vaccines continue to be given even in times of crisis; and
:: ensuring that everyone can access vaccines and afford to pay for them.

Dr Jean-Marie Okwo-Belé, Director of Immunization, Vaccines and Biologicals at WHO, says the Organization will work to increase its support to all countries that are lagging behind in meeting immunization targets. In May this year, WHO will bring together high-level representatives of 34 countries with routine vaccination (three doses of DTP3) coverage of less than 80% to discuss the challenges faced by countries and to explore solutions to overcome them.

Although many countries are already vaccinating four out of five children with DTP3, a full one-third of countries are still struggling to reach the ‘fifth child’, meaning millions of children remain at risk of illness, disability or death because they are not getting the immunizations they need.
“There is no one centralized approach that can ensure vaccines are delivered and administered to each child. Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” said Dr Okwo-Belé.“What is required is a truly concerted effort and much stronger accountability so that each one of the key players involved fulfills its mandate and helps close the immunization gap.”

Critical operational needs to ensure wider vaccination and delivery on the ground, include:
:: finding ways to simplify vaccination procedures in the field;
:: improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas;
:: ensuring vaccine affordability and strengthening vaccine supply chains;
:: training more health workers, skilled managers and providing supportive supervision;
:: improving the quality of data collected by countries and using this to improve immunization operations;
:: overcoming challenges posed by conflict, natural disasters and other crises;
:: increasing awareness and demand for immunization by communities; and
:: greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.

Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create equal access to new and underused vaccines for children living in the world’s poorest countries.

Note to editors
The Global Vaccine Action Plan envisions a world where everyone lives life free from vaccine preventable diseases by 2020. It set 6 targets for 2015:

Immunization against diphtheria, tetanus and whooping cough (DTP3)
Target: 90% immunization coverage against diphtheria, tetanus and whooping cough by 2015.
Gap: 65 countries

Introduction of under-utilized vaccines
Target: At least 90 low or middle income countries to have introduced one or more under-utilized vaccines by 2015.
ON TRACK

Polio eradication
Target: No new cases after 2014
Gap: 3 countries remain polio endemic

Maternal and neonatal tetanus: Global elimination by end-2015
Target: Eliminate maternal and neonatal tetanus
Gap: 24 countries

Measles elimination
Target: Eliminate from three WHO regions by end-2015
Gap: 16% of all children are not being immunized against measles

Rubella elimination
Target: Eliminate rubella from two WHO regions by end-2015
Gap: Half of all children do not receive the rubella vaccine

.
Together we can close the immunization gap
Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals
Commentary
22 April 2015
Sixty years ago this month, the results of extensive field trials of Jonas Salk’s polio vaccine were published. The trials, which had involved a total of 1.8 million children, had been a resounding success. Later that year the vaccine was licensed for manufacture and the US launched the world’s first mass vaccination campaigns.

By 2014, WHO had certified 4 of its 6 regions polio-free and 80% of the world’s population now lives in countries where this highly infectious and devastating disease has been eradicated.

As a young medical student in the Democratic Republic of the Congo (DRC) in the late 1970s, I knew I wanted to focus my efforts in an area that could bring the greatest benefits to the greatest number of people. I feel very fortunate that this ambition took me straight into the field of vaccinations and to the work of the Expanded Programme on Immunization (EPI), a global, collaborative drive for immunization that began in 1974.

When EPI was first launched, only about 5% of the world’s children were protected from 6 diseases (diphtheria, measles, pertussis, polio, tetanus and tuberculosis). By 2013, that figure had risen to more than 80% in many countries and the number of vaccines used had almost doubled.

Stopping vaccine-preventable diseases
In DRC, I saw vaccination rates increase from less than 10% to around 60% in the course of just a few years. That we could achieve these results in a country such as DRC, which is the size of western Europe but faces immense challenges in terms of infrastructure and health systems, should give us all hope that we can now take immunization to the next level where no child, regardless of where they live or their economic status, is left vulnerable to vaccine-preventable diseases.

At WHO, we estimate that between 2 and 3 million deaths are prevented each year through immunization. Work in vaccine development means protection is increasingly being extended beyond the original 6 diseases. Many countries now vaccinate against Haemophilus influenzae type b, a bacteria responsible for severe pneumonia and meningitis in children, hepatitis B, and pneumococcal disease. This list will only continue to grow.

Yet, tragically, there are still around 1.5 million deaths each year as a result of vaccine-preventable diseases. We are way off-track to meet our end-2015 targets set out in the Global Vaccine Action Plan, which was endorsed by all Member States at the World Health Assembly in 2012. In figures that means 1 in 5 children are missing out on life-saving vaccinations. In practice it means millions of families around the world still witness loved ones suffer illness, disability and even death from diseases that we have the knowledge and the tools to prevent.

Tailoring vaccination strategies to meet challenges
Of course there is no one-size-fits-all solution to this global health challenge. Often those infants who are missing out on vaccinations live in rural, isolated communities and urban slums in some of the world’s poorest communities. Many also live in areas that are seriously affected by conflict or insecurity.

We do know what needs to be done and the tools and the capacity do already exist in most countries. We need to work at both global and country levels to mobilize resources and support immunization in each and every community. This involves micro-planning to tailor vaccination strategies to suit the needs of myriad different situations and environments, it involves finding new ways to simplify vaccine processes in the field, and it involves monitoring outcomes, measuring progress and taking collective actions.

The hallmark of successful immunization programmes is their simplicity – they can be adapted to every setting, even where there is conflict or other crises. They work at all different levels of health systems to ensure sustainable delivery of immunization services, be it in fixed health facilities or through outreach and mobile vaccinators, so that each child is reached.

Closing the immunization gap through accountability
At the grassroots level, community leaders have an important role to play in immunization programmes, ensuring that parents and caregivers understand the importance of vaccination. Ensuring accountability at every stage of immunization programmes is critical. In Nigeria, which is on the verge of eradicating polio, local government officials are held accountable for vaccinating children, thus ensuring better management of polio campaigns and of the resources that are allocated to them.

To fulfil our vision of a world free of vaccine-preventable diseases, each key player must fulfil their mandate from parents, to health workers, to programme managers, governments and partners.

Together we can close the immunization gap. When I began my career in public health 34 years ago, I could not have imagined that in my working life I would witness an Africa free of polio. We are so close to achieving this goal now. My dream now is to see much faster improvement in routine immunization coverage so that in 2 years’ time we are not still talking about how to reach that fifth child.

GAVI [to 25 April 2015] :: Next five years vital for childhood immunisation – Gavi CEO

GAVI [to 25 April 2015]
http://www.gavialliance.org/library/news/press-releases/
:: Next five years vital for childhood immunisation – Gavi CEO
Once-in-a-generation opportunity to improve vaccine access and coverage in developing countries
Geneva, 24 April 2015 – Developing countries have a unique opportunity over the next five years to build and strengthen immunisation programmes that will protect generations of children, Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said today.

Speaking at the start of World Immunization Week, Dr Berkley highlighted the opportunity to not only immunise hundreds of millions of children against life-threatening diseases but also to ensure that developing countries across Africa and Asia have the right infrastructure in place to keep on delivering vaccines and other vital health interventions.

“Immunisation touches more lives than practically any other health intervention on the planet,” said Dr Berkley. “As we look ahead to 2020 we must ensure that the systems being built in developing countries will be there for the long term and will continue to save lives and protect health for generations to come.”

During World Immunization Week, the Solomon Islands will begin protecting girls against cervical cancer through a human papillomavirus vaccine (HPV) demonstration project with Gavi support while the Democratic Republic of Congo will begin protecting its children with the inactivated polio vaccine.

“New vaccines bring new protection to children in the world’s poorest countries, many of whom do not have access to effective treatment when they fall ill,” added Dr Berkley. “By introducing these vaccines, these countries are taking firm action to ensure their children are protected against major killer diseases and have the opportunity to live long and productive lives.”
Immunisation touches more lives than practically any other health intervention on the planet
Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance

Although significant global progress has been made on immunisation, as the second half of the Decade of Vaccines begins there are still a number of areas requiring action, as highlighted by the WHO’s Strategic Advisory Group of Experts (SAGE) report on the Global Vaccines Action Plan.

As one of the GVAP partners, Gavi is supporting the plan in a number of ways including supporting countries to introduce new and underutilised vaccines. All 73 Gavi-supported countries are now immunising their children with the five-in-one pentavalent vaccine, which protects against diphtheria, tetanus and pertussis as well as hepatitis B and Haemophilus influenzae type b.

Additionally, Gavi now supports more than 50 developing countries to protect their children against the leading cause of pneumonia with the pneumococcal vaccine and more than 30 countries to protect their children against a major cause of severe diarrhoea with the rotavirus vaccine.

Gavi also plans to support the immunisation of 30 million girls in 40 developing countries against cervical cancer by 2020 with the HPV vaccine. An estimated 266,000 women die every year from cervical cancer, of which more than 85% live in low-income countries, according to statistics published by the International Agency for Research on Cancer (IARC)

Since 2000, Gavi has supported developing countries to immunise more than half a billion children, saving approximately seven million lives. Following a successful Pledging Conference in Berlin, where donors pledged more than US$ 7.5 billion towards Gavi, the Vaccine Alliance aims to support the immunisation of an additional 300 million children between 2016 and 2020, which will lead to a further five to six million lives being saved.

.

:: Pakistan vaccinators’ salaries
Clarification from Gavi, the Vaccine Alliance
Geneva, 23 April 2015 – In light of recent reports in Pakistan regarding the non-payment of vaccine workers and subsequent industrial action, Gavi, the Vaccine Alliance, would like to clarify the following points:

The health workers, known locally as ‘Gavi vaccinators’, are employees of the Pakistan government.
:: Gavi contributed to the salaries of some vaccinators in Pakistan between 2007 and 2010 through an Immunisation Services Support grant to the federal government. This support ended, as agreed, in 2010.
:: As per the grant agreement, the Pakistan authorities, either at federal or provincial level, are now responsible for the salaries of vaccinators, which should come from domestic resources. In previous years this has happened but on an irregular basis.
:: Gavi has repeatedly raised the issue of vaccinators’ salaries with state and federal leaders in Pakistan. Salaries should be paid in full and on time.

The regularisation of vaccinators’ salaries and their systematic inclusion in government annual budgets is part of an on-going discussion with the Government of Pakistan and has implications for any future Gavi support to the country.

Gavi’s work in Pakistan
Gavi currently supports pentavalent vaccine which offers protection against five diseases (diphtheria-tetanus-pertussis (DTP), hepatitis B, and Haemophilius influenzae type b) as well as pneumococcal vaccine as part of Pakistan’s routine schedule. Gavi also funds measles vaccination campaigns in the country.

Gavi has invested more than US$ 23 million in health system strengthening and US$ 43 million in immunisation service support since 2000. In total, Gavi has disbursed more than US$ 720 million for immunisation in Pakistan, making it the largest recipient of Gavi support.