Vaccines in Egypt On March 14, 2019, the vaccination company Pfizer, in partnership with Gavi, The Vaccine Alliance reduced the price of the pneumococcal vaccine (PCV) to $2.90 per dose for eligible countries. Gavi’s mission since 2000 has been to “improve access to new and underused vaccines for children living in the world’s poorest countries”. Public and private sectors fund the creation and distribution of important vaccines in 73 developing countries partnered with Gavi.

The Benefit of Price Drops

In 2017, the price of a single dose PCV was $3.30. However, as a result of negotiations between Pfizer and Gavi there have been three pneumococcal vaccine price drops since January 2017. It is expected to save developing countries $4.1 million this year. Dr. Seth Berkley, the CEO of Gavi says “pneumonia remains the single largest cause of death for children worldwide and [the] pneumococcal vaccine is one of our largest weapons against it”. The price drop comes at a pivotal time.

PCV is a Priority

PCV takes as long as 15 years to reach developing countries that need it the most. Whereas the vaccine is already easily accessible and widespread in industrialized nations. Vaccines have not been easily accessible in developing nations. They are expensive and difficult to distribute effectively in nations lacking funds and resources. The focus is on different areas. For example, the proportion of developing countries’ exports that is needed to service their overseas debt rose from 11 percent in 1970 to 18 percent in 1996, while overseas aid from the U.S. plummeted $14 billion. With the drop in PCV pricing, developing countries can invest in their public health.

The value of vaccines as a long-term investment for developing countries is leading to pneumococcal vaccine price drops. Vaccinating the youth population of developing countries, according to Gavi, creates a “virtuous cycle”.

The Cycle Follows This Order of Cause and Effect

  • Children have vaccines before the age of two
  • These children are likely to be healthier and live longer
  • Children have fewer and less serious illnesses
  • This leads to lower care costs for health systems and family
  • Which means more family money available to spend or save
  • Children will attend school more, fueling better outcomes
  • A family’s economic outlook will strengthen based on these outcomes
  • Birth rates drop and mother’s health improves
  • A community becomes more economically stable and productive
  • Contributing to politically and economically stable countries

By looking at the cost-benefit analyses for vaccinations, scientists are able to see this “virtuous cycle” in action. A study, conducted by the Cebu Longitudinal Health and Nutrition Survey in 1975, took data from a sample of Filipino children. Researchers compared test scores of children who received six vaccines in their first two years versus those that did not. The study reveals the association of immunization with improved IQ scores, language and mathematics tests. Untreated childhood illness can impair cognitive development.

Developing countries often have large obstacles to face such as food scarcity, a lack of widespread education and low GDPs. Investing in vaccines is a long-term solution that will benefit the economic, health, societal and governmental sectors of these nations. With the pneumococcal vaccine price drops, this seems to be an attainable reality for developing countries.

– Meredith Breda
Photo: Flickr

All You Need to Know About HPV in the Developing WorldHuman papillomaviruses (HPV) are DNA viruses that infect skin or mucosal cells. Depending on the severity of the infection, HPV can lead to either cervical cancer and other head and neck cancers or low-grade cervical tissue changes and genital warts. Virtually all cervical cancer cases result from a sexually transmitted infection with HPV.

Cervical Cancer and HPV in the Developing World

Globally, cervical cancer is known as the second most common cancer among women, with about 500,000 new cases being diagnosed annually. Of the total deaths that occur due to cervical cancer each year, more than 80 percent are concentrated in developing countries.

Immunization coupled with regular screenings and consistent treatments are the best strategies for reducing the burden of cervical cancer and HPV in the developing world. In resource-poor countries that lack adequate access to cancer screenings and treatment services, it is even more essential that younger girls be immunized before they are sexually active and are exposed to HPV.

The HPV Vaccine

The HPV vaccine protects against the strains that cause up to 90 percent of cervical cancer cases. It is typically available in most routine immunization programs of high-income countries. Historically, the major barriers to reducing the burden of cervical cancer and HPV in the developing world are due to the high costs of the HPV vaccines and the difficulty of reaching adolescent girls.

The GAVI Alliance–formally known as the Global Alliance for Vaccines and Immunization–is a partnership of national governments, the World Health Organization (WHO), the World Bank Group, the Bill and Melinda Gates Foundation, the vaccine industry and many public health institutions. GAVI provides technical and financial support for vaccines in countries that have a gross national income of less than $1,000 per capita and other poverty-stricken countries including China, India and Indonesia.

Thanks to the efforts of GAVI, the HPV vaccine is at a record low price and the poorest countries are able to access it for as little as $4.50 per dose. Additionally, the WHO decided to change the recommended dosage of the HPV vaccine from three to two doses, which helped facilitate the country rollout of the vaccine as well as significantly reducing costs.

The first HPV vaccine demonstration program took place in Kenya in 2013, and since then, 1,000,000 girls have been vaccinated. By the end of 2016, GAVI had initiated HPV vaccine demonstration programs in 23 countries, which is the first step toward introducing the vaccine to national immunization programs. So far, Honduras, Rwanda and Uganda have introduced the HPV vaccine into their national immunization programs.

Potential Roadblocks in the Push for the HPV Vaccine

Unfortunately, the transition from the demonstration programs to national introductions is taking longer than expected for some countries. Consequently, GAVI has developed a new approach to HPV vaccine support, which draws from the valuable lessons learned from previous demonstration programs.

Some of these lessons include:

  1. The fact that school-based delivery works very well when administering the vaccine to young girls. It is more cost effective to integrate HPV immunization efforts into routine immunizations at existing health clinics and schools.
  2. When promoting HPV vaccination programs and cervical cancer prevention, the facilitation of effective and factual communication within the community is particularly critical.
  3. GAVI has made tremendous progress in reducing the prevalence of HPV in the developing world through its vaccination initiatives. Eight GAVI-supported countries have integrated the HPV vaccine into their national vaccination programs and 30 countries have started a demonstration program.

However, despite the strong signs of interest from GAVI-eligible countries and the rapid and effective integration of the HPV vaccine, GAVI’s original goal of immunizing 40,000,000 girls by 2020 may be at risk due to supply constraints.

GAVI chief executive Dr. Seth Berkley stated, “Scaling up cervical cancer prevention and control strategies should not be delayed, as we have the tools to achieve this goal. With the right commitment from vaccine manufacturers as well as political support, strategic partnerships and investments, this particular battle to improve women’s health can be won.”

Thus far, GAVI has helped low-income countries access the HPV vaccine at affordable and sustainable prices. Dr. Berkley is confident that the organization is capable of meeting its goal. GAVI is dedicated to ensuring that its progress is maintained and that millions of girls in the poorest of countries are protected from the perils of HPV and cervical cancer.

– Lolontika Hoque
Photo: Flickr

How Vaccines Reduce PovertyHealthcare expenses push about 100 million people into poverty every year. This average makes medical deprivation one of the main factors forcing families below the World Bank’s poverty line of less than $1.90 per day. More shockingly, this results in the deaths of more than 1.5 million children annually from diseases that can be prevented by vaccination. However, a study published by Health Affairs found that by 2030, vaccines can reduce poverty for 24 million people.

The Ways That Vaccines Reduce Poverty

Vaccines will have the greatest impact on reducing poverty caused by hepatitis B, helping an estimated 14 million people avoid medical bankruptcy. Cases of poverty caused by measles and meningitis A will also be reduced by vaccines, with an estimated five million and three million cases averted respectively. The measles vaccine is estimated to prevent by far the highest number of deaths: 22 million of the 36 million total.

The Harvard study, co-authored by Gavi, the Vaccine Alliance and a wide range of partners, modeled the health and economic impact of vaccines for 10 diseases in 41 developing countries. According to the study, the poorest 20 percent of the population from the study represented over a quarter of deaths preventable by vaccination. These findings assert the notion that vaccines reduce poverty when introduced to developing countries.

A healthy child is more likely to go to school and become a more productive member of society in later life. Their families can also avoid the crippling healthcare costs that diseases can bring. This is enough to save millions of people from the misery of extreme poverty when vaccines reduce poverty.

Addressing the Obstacles to Universal Vaccination

Vaccines have made possible some of the greatest public health successes of the past century. Basic childhood immunization is one of the few health interventions to which most of the world’s poor have access, free of charge and through the public sector. In fact, immunization is one of the most reasonable health interventions. Vaccines protect girls and boys alike, and reach the poor at higher rates.

However, according to Doctors Without Borders, there are multiple factors that make delivering vaccines to children in developing countries difficult. To start, the newest vaccines are often too expensive, mostly because of a lack of competition in the market, obstructing their use in developing countries. Secondly, there is a lack of research and development for better-adapted and needed vaccines, as there is little incentive for pharmaceutical companies to conduct R&D for diseases that affect populations with limited purchasing power. Lastly, weak health systems with corresponding health worker shortages make it difficult to administer the vaccines to those in need.

UNICEF Programs See Great Success in Improving Vaccination Rates

UNICEF is one of many organizations reaching out to aid developing countries in gaining easier access to vaccines. UNICEF works with partners in government, NGOs, other U.N. agencies and the private sector to provide immunization to the children who need it the most. UNICEF’s immunization program also helps identify those children that have been left behind by the health system and can bring other life-saving care to these mothers and children. UNICEF and its partners support immunization programs in more than 100 countries to help realize children’s right to survival and good health.

As a result of these programs, vaccines have reduced poverty in every country aided. In 2016, UNICEF procured 2.5 billion vaccine doses reaching almost half of the world’s children. Measles vaccinations averted an estimated 17.1 million deaths between 2000 and 2014. Since 2000, 2.5 billion children have been vaccinated and the number of polio cases has fallen by more than 99 percent, dropping to just 22 cases in 2017. Continued investments in immunization in low- and middle-income countries could avert up to 36 million deaths and 24 million cases of impoverishment due to medical costs. Thanks to these efforts, the world’s poor have affordable access to proper medication.

– Richard Zarrilli, Jr.
Photo: Flickr

 Ghana
In recent years, researchers, doctors and health organizations have begun to target the high rate of pneumonia deaths. As one of the largest causes of death in children, pneumonia and researchers’ search for its solutions have not been taken lightly. The Ghana Health Service and partner GAVI, supported by UNICEF, launched vaccines to combat the infection in 2012.

What is Pneumonia?

Pneumonia is a bacterial, fungal or viral infection of the air-sacs in one’s lung or lungs, usually caused by the inhalation of specific or diseased germs. The infection causes fluid build up in the lungs, difficulty breathing, high fever, sweating, chills, chest pain and discoloration of fingertips. The best way to treat this infection is through immunizations and antibiotics.

Historically, pneumonia has been the leading cause of death in those under-five years old. Steps have occurred to decrease death rates from year-to-year, but yet unfortuantely, the number of deaths and the percentage of children lost to pneumonia is still staggering.

What Are the Impacts of Pneumonia?

In the year 2010 alone, pneumonia caused the deaths of 16,200 children, and the total number of deaths brought about because of pneumonia was a reported 13 percent. Subsequently, this percentage remained consistent between the years 2000 and 2010, and the percentage of deaths at the hands of this infection remained between twelve and thirteen percent, without substantial improvement.

Despite the decade-long absence of progress in pneumonia prevention and treatment, advancements have started taking place in more recent years. In April 2012, UNICEF supported the Ghana Health Service and partner GAVI, the Global Alliance for Vaccines and Immunizations, in launching pneumonia and diarrhea vaccines and the first ever World Immunization Week. The introduction of these vaccines to Ghana was a monumental step towards decreasing fatalities.

Ghana Health Service and its Aid

Although the establishment of vaccinations was a large logistical undertaking — including increasing hospital refrigeration storage in all ten regions of Ghana — the children of the country have benefited greatly from such measures. Pneumonia, for the first time ever in 2013, was not the leading cause of death for those under-five, though it was still the second-largest cause. Consequently, the total percentage of pneumonia causing fatalities decreased by 44 percent by 2015.

The installation of the pneumonia vaccine to Ghana has helped combat the vast amount of children who are annually impacted by the infection; however, there is still much progress to be made. As of 2017, UNICEF worked diligently to decrease pneumonia cases through fighting poor sanitation and open defecation.

How to Create Sustainable Solutions

To combat such massive undertakings, the organization implemented latrines and water pumps to as many communities as possible. Many have poured great effort into this ‘war against pneumonia’ and the Ghana Health Service, but measures must increase for significant and permanent changes to be sustained.

– Lydia Lamm

Photo: Flickr

Increase Child Immunization
Orange, GAVI and Côte d’Ivoire Ministry of Health are coming together for a mobile phone project, “M-Vaccin Côte d’Ivoire,” which will increase child immunization by focusing on regions with the lowest immunization rates in the Côte d’Ivoire.

 

GAVI, the Vaccine Alliance

GAVI, the Vaccine Alliance, is dedicated to protecting children’s lives and health by providing immunizations in developing countries. Orange works towards providing technology to use as tools in both healthcare and also education and finances and believes that their digital outreach supports those aspects of underdeveloped countries.

The project will use Orange mobile technology to both inform parents about the importance of vaccinations through text and voice messages and to also make sure parents don’t forget about immunization appointments by sending reminders of the date and time of their child’s session.

 

Orange Technology

Orange will also be providing health care workers with the M-Vaccin mobile application that allows them to view data, create vaccination schedules for individual families they are caring for and monitor the results, which in turn should increase child immunization.

The partnership between these organizations will continue for five years; during this time, Orange and GAVI will combine to invest a collective $5.47 million in the project. Half of the investment will be from the GAVI Matching Fund, and the other half from the Bill and Melinda Gates Foundation.

This funding will go to support the outreach program and provide both mobile devices to those in need and healthcare workers, and also inform citizens about the importance of immunizations, and keeping up with vaccination appointments and learning sessions.

 

Project Implementation

The Project will be implemented in the 29 districts of Côte d’Ivoire where immunization is lower than the national average. Many of the parents living in these districts aren’t fully informed about immunizations, and often aren’t living close enough to healthcare centers in the first place. Côte d’Ivoire’s infant mortality rates are some of the highest in the world, and only continue to increase; about half of children under age one are immunized.

 

The M-Vaccin Program

The M-Vaccin Program expects to reach more than 800,000 children and could possibly be expanded into other countries in West Africa upon evaluation. Dr. Seth Berkley, the CEO if GAVI, said the partnership is really important for the children of Côte d’Ivoire, and that their parents do not receive enough information about vaccinations because of where they live.

Solving or working around these situational obstacles will significantly improve the rates of child immunization in the Côte d’Ivoire, and also hopefully serve as a catalyst for further increases in child immunization across the continent.

– Chloe Turner

Photo: Flickr

Foreign aid
Angus Deaton won the 2015 Nobel Prize in Economics for his research on the effects of foreign aid on economic development in developing countries. The most important message to be taken from his work is that foreign aid is only one small piece of the equation. To say that foreign aid directly translates into economic growth is an oversimplification. Without transparent and effective governmental institutions and sound economic policies, research shows that aid is not always effective.

Foreign aid works when all of these different variables come together. It’s a simple equation. It has become popular sentiment to denounce aid as ineffective, based on specific case studies where all of these variables were not in place and results fell short of their targets. While not all aid is effective, this rhetoric flies in the face of all of the progress that has been made because of aid. The truth is that foreign aid works when all of the variables — effective institutions, policies, and transparency — are in place.

Aid has been especially effective in improving health in Least Developed Countries (LDCs). Malaria rates dropped by 51 percent between 2000 and 2012 after 300 million bed nets were given out by the World Health Organization (WHO). Ten million HIV-infected individuals are now receiving life-saving medicine. Tuberculosis rates have dropped by 45 percent since 1990, and 122 million children’s lives have been saved since 1990. This progress is largely due to the work of the Global Alliance for Vaccines and Immunization (GAVI), which has immunized 580 million children around the world. Extreme poverty has been cut in half since 1990, and African poverty rates have dropped by 10 percent since 1999.

These are huge success stories that deserve recognition. Foreign aid works. Not only does it work, but it is also in the interest of U.S. national security. Former Homeland Security secretary Tom Ridge said, “The programs supported by the International Affairs Budget are as essential to our national security as defense programs. Development and diplomacy protect our nation by addressing the root causes of terrorism and conflict.”

The questions asked in U.S. policymaking circles today shouldn’t be whether to cut aid or not; the question that needs to be asked is how to increase the efficacy of aid and to grow upon our successes. Cutting the International Affairs Budget would discredit all of the hard work and successes that have come out of these operations in recent decades.

Josh Ward

Photo: Flickr

Somalia
One of the world’s leading organizations in the fight for global health has just begun to carry out a nationwide campaign in Somalia to fight Cholera. Gavi, the Vaccine Alliance, issued a press release on March 15 announcing its comprehensive strategy to stop the spread of cholera among Somali citizens. This Gavi cholera vaccine campaign seeks to save potentially thousands of lives in the drought-stricken African country.

According to the Centers for Disease Control, the southern half of the continent (where Somalia resides) is home to the bulk of cholera cases reported worldwide, and those cases have a higher likelihood of causing death than in other regions. This is primarily due to the lack of access to safe, clean water and sanitation as the disease-causing bacteria, Vibrio cholera, thrives in public water sources and is spread through the waste products of those infected.

The situation in Somalia has been worsened by an ongoing harsh drought, which has forced people to use contaminated water and has hastened the spread of the disease.

Notorious for its contagiousness, cholera infected over 170,000 people globally in 2015. Year to date, more than 10,500 cases of cholera have been reported across 12 regions of Somalia, resulting in nearly 270 fatalities. The spread of the epidemic has been swift, with 400 new cases appearing in a single day in early March.

The Gavi cholera vaccine campaign plans to reduce these alarming numbers by delivering 953,000 doses of oral vaccine to a population of more than 450,000 people at risk of being infected. Administration of the vaccines will be completed by the Somali government, focusing on the regions of Somalia with the highest concentration of cases: Banadir, Beledweyne, and Kismayo. The doses will be administered over two waves, the first taking place from March 15-19, and the second from April 18-22.

The campaign marks an alliance between the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and Gavi, who has provided the vaccines themselves as well as an additional $550,000 to support the program.

“Cholera is a major health issue in Somalia. The current drought has worsened the situation for many. Therefore we’re very glad to have the support of Gavi to implement the first oral cholera vaccine campaign in Somalia,” said Dr. Ghulam Popal, Somalia’s WHO representative.

Recognizing that cholera is not bound by political borders, Gavi is also launching a simultaneous vaccine campaign of 475,000 doses in South Sudan. This latest campaign is another step in realizing Gavi’s continuous mission to save lives and protect the health of all people in lower-income countries.

Dan Krajewski

Photo: Flickr