text stringlengths 9 3.26k | document_url stringclasses 335
values | source_url stringclasses 335
values | country stringclasses 136
values |
|---|---|---|---|
Measles virus is difficult to control because of its contagious nature and the char- acteristics of the existing vaccine (see Box 1).
Disagreements about how best to tackle it have con- tinued for a decade.
The Americas have made dramatic progress towards eliminating the disease.a But some other regions have seen the... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Amid an overall stagnation in immunization programmes, the percent- age of children vaccinated against measles worldwide appears to have actually fallen, from 80% in the early and mid-1990s to 72% in 1999.
In many countries in sub-Saharan Africa, coverage is much lower. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Determined to change the current situation, the World Health Organization and UNICEF, together with the US Centers for Disease Control and Prevention (CDC), developing country health experts and others, have hammered out a consensus on what should be done. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
A p l a n1 to be published this month by WHO and UNICEF should be endorsed by the partner organizations and finalised by the end of the y e a r. The plan has two broad goals: G To cut measles deaths by two-thirds, saving 3 mil- lion lives, by 2005; and G To continue to prevent at least 600 000 deaths a y e a r, sustain... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The plan sets out details of how these goals may be reached (see Box 2).
The core of the plan is to increase routine coverage with measles vaccine and then use supplemental campaigns to cut the death toll f u r t h e r. “We have an agenda now to substantially reduce measles mortality,” says Ana Maria Henao- Restrepo, ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The argument has not been about the need to reduce the number of deaths—a f t e r all, few would question this—but about whether the world should embark on a campaign to eradicate measles, and if so, when.
By deferring the eradication decision until more data have been gathered, the plan allows the opposing camps to m... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“The programme was at a standstill,” says Edward Hoekstra, medical coordinator for measles activities at U N I C E F. “Now everyone is agreed.” Q GAVI Immunization Focus • November 2000 • Page 2 of 9 SPECIAL FEATURE Box 1: Why measles is a tough challenge Measles is the most contagious infection know to humans.
It may... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Measles can also cause permanent disabilities such as blindness.
Measles accounts for fully 30% of all deaths from vaccine-pre- ventable diseases including adult deaths caused by hepatitis B (See Figure 1).
Tw e n ty countries account for 85% of the deaths, and half of all deaths are concentrated in just four countri... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
C o m p l i cations of the disease are much more common in low - income countries, and in malnourished children, than in industrial- ized countries.
However, in some high-income countries, particular- ly in Europe, complacency about measles has created situations where vaccination coverage levels are lower than requir... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
However, because measles is so contagious, and because a small minority of those who are vacci- nated do not develop immunity, vaccination coverage levels need to be very high—above 90%—to stop the transmission of the virus.
Measles vaccine is given no earlier than 9 months.
Before this time, it fails to stimulate im... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Thus, immunization against measles must be delivered much later than the rest of the immunization schedule of vaccines against tuberculosis (BCG), polio and diphtheria, tetanus and pertussis (DTP).
This means that, even where coverage rates for BCG and DTP vaccines are at 80% or above, coverage for measles vaccine is ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Measles vaccine is also more difficult to handle than some other vaccines: it has to be reconstituted and is highly sensitive to heat.
Research to identify new vaccines against measles, particularly those that could be delivered earlier in life and/or by inhalation, is c o n t i nu i n g . | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Fig 1: Deaths from Vaccine-Preventable Diseases Tetanus 14% Hib 13% Pertussis 12% Yellow Fever 1% Diphtheria 0% Polio 0% Hepatitis B 30% Total deaths (including adults): 3 million Source: WHO/UNICEF Measles 30% Immunization Focus The grounds for the debate have shifted quickly. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
A s recently as 1996 experts at a meeting held by W H O , the Pan American Health Organization (PAHO) and the CDC concluded that global measles eradication was feasible and that a target date should be set for between 2005 and 20102.
But others were less cer- tain.
The World Bank, for example, has long arg u e d agai... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The Americas have almost eliminated indigenous measles, but only through a highly aggressive and active campaign.
Elsewhere, in the poorest high-bur- den countries, such tactics are currently “unthink- a b l e”, says Henao-Restrepo.
Fifteen countries, all but five of them in Africa, immunized less than half of their ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“The consensus is building that the world is not ready for a measles eradication campaign,” says Mark Kane, of the Bill and Melinda Gates Children’s Vaccine Program.
One reason, he believes, is that the Global Polio Eradication Initiative has proved more l a b o u r-intensive and costly in its final stages than most e... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Even at a predicted cost of US$2.5 billion spread over 20 years, the cost is likely to be dwarfed by the predicted $1.5 billion annual savings that will flow from polio eradication3; but, experts fear, before that final goal is achieved, a sec- ond disease eradication initiative could sap resources and attention from t... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Finish off polio first This view is also supported by Ciro de Quadros, head of vaccines and immunization at PAHO, who is cred- ited with being the driving force behind both the polio and the measles elimination initiatives in the Americas.
“It is essential that we act to reduce measles mortality, but of course we cann... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“The top priority must be to eradicate polio.” Also, it has become clear that countries’ c u r r e n t needs are too diverse to be straitjacketed into a single measles eradication campaign.
Each has diff e r e n t pressures and priorities. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Each has diff e r e n t pressures and priorities.
In Pakistan, for example, Rehan Hafiz, the national manager for the Expanded Programme on Immunization (EPI), says the programme’s resources are fully devoted to the polio campaign at present, and any additional campaign on measles should only be considered later and a... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“The basis for a strong programme should always be routine immunization.” In contrast, Uganda is under popular pressure from parents to conduct measles campaigns.
Issa Makumbi, the national manager for the EPI in Uganda, says that there is strong demand from ordi- nary people to act swiftly with mass vaccination cam- ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“We cannot wait to revitalise the routine programme while our people are dying,” s a y s Makumbi.
“We have to do campaigns first to reduce morbidity and mortality a bit and then put all our e fforts into improving routine coverage.” U g a n d a , with support from UNICEF and WHO, is currently doing mass campaigns in 2... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“We have to respond to this demand,” he says.
“It is a reality.” As polio’s devastating effects have begun to recede, the burden of measles has looked increasingly unac- ceptable, and some in Uganda—and in other coun- tries in Africa where polio is no longer endemic— have questioned the resources that polio attracts c... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“It is measles that kills them every m i n u t e .” Like some other countries, Uganda has made a virtue of this situation by combining polio campaigns with measles Q Box 2: Gaining the upper hand: a strategy to reduce measles deaths worldwide The WHO-UNICEF mortality reduction strategy will be focused on the 20 countri... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Initially, it is being adopted by a subgroup of those countries that are already free of endemic polio (Mozambique, Tanzania, Uganda, Indonesia and Myanmar), allowing the remainder to concentrate first on polio eradica- tion.
Countries will draw up 3 to 5-year plans to achieve and sustain the targets.
Countries are a... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
G Ensure a “second opportunity” for measles vaccination, either through a supplemental campaign or a routine sec- ond dose.
The second opportunity is needed both to increase the probability that everyone gets at least one dose, and to increase the proportion of the population that is suc- cessfully immunized.
(At 9 m... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
This advice is new and based on evidence that high measles mortality is more fre- quently found in settings where children have only one opportunity for measles vaccination.
G Establish an effective system for monitoring coverage and maintaining measles surveillance.
G Provide vitamin A supplements where needed along... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
GAVI Immunization Focus • November 2000 • Page 3 of 9 SPECIAL FEATURE SPECIAL FEATURE Immunization Focus campaigns.
In this way, staff resources are used eff i- ciently and the uptake for polio vaccine remains high, even though the threat of the disease is less visible, because families have strong motivation to get t... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
It is based on analyses of the evidence of what works, says Henao-Restrepo.
All countries, whatever their current measles status, can use the plan to reduce their measles deaths, while countries or regions that wish to be more ambitious, such as the Americas, Europe and the Eastern Mediterranean, which have eliminatio... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The targets for saving lives can be pursued by all countries immediately—and the economic arg u m e n t s for doing so are convincing.
Preliminary estimates of the cost of achieving the mortality reduction goals in the twenty highest-burden countries are $150 million a year, says Hoekstra, a relatively modest sum.
W ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
In high-burden countries, improving coverage from 50% to 80% is estimated to cost around US$2.50 for each life-year gained.
In general, health interventions that can be delivered in low-income countries for less than US$25 per year of life gained are considered to be excellent “b u y s” for governments, so this repres... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
But WHO and UNICEF recognize that this will be only a first step.
Even when fully implemented, routine coverage of 80% would still result in more than 250 000 children dying of measles each year. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Q Figure 2: Models used by WHO and UNICEF show the expected impact of different approaches to vaccination GAVI Immunization Focus • November 2000 • Page 4 of 9 Good but not good enough By increasing routine vaccine coverage to 80%, deaths are predicted to fall gradually but steadily by two-thirds, then plateau A ‘one-o... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The recommendations are based on the results of models devised by Nigel Gay and colleagues at the Public Health Laboratory Service in London, England.
Using real data from a typical high-burden country where measles vaccination coverage is only 30%, Gay and his colleagues modelled the impact on mortality of increasing... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Their results are shown in Figure 2.
If coverage is increased to 80%, the number of deaths will fall by two-thirds over five years, then plateau.
If, on the other hand, the country attempts to reduce measles deaths with a one-off cam- paign, deaths will fall sharply but transiently, return- ing to the previous high l... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“You have to do both things,” says Hoekstra.
“Wi t h high coverage and a campaign, it’s a few years before the number [of deaths] goes up again, so you have a longer period to work on improving routine immu- n i z a t i o n .” Repeated campaigns will, of course, reduce the death toll further.
“Measles campaigns could... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“They can only be in addition.” One critical issue is the supply of vaccine: off i c i a l s estimate that it will take up to two years for the manu- facturers of measles vaccine—some 12 companies in all—to scale up production to a level needed for countries to carry out the recommended steps in the mortality reduction... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Action by the year’s end WHO and UNICEF are keen to move ahead quickly with seeking endorsement for the plan from their technical experts, then implementing it.
This month, the GAVI Board will also be asked to decide on the role that the Alliance and its partners should play.
A s well as declaring measles a high prio... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
One of GAV I ’s key milestones is to increase routine immunization coverage to 80% by 20053, putting it firmly in line with a central goal of the measles plan.
Also in line with the plan, GAV I ’s partners are already working with countries to improve the sys- tems used to monitor vaccine coverage and safety. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
A t present, measles vaccine coverage is not included in G AV I ’s monitoring system, with the main indicator being the percentage of children who receive diphthe- ria, tetanus and pertussis (DTP) vaccine.
In future, measles coverage may be added to the indicators.
Decisions about whether or how the Global Fund for C... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
One of the Fund’s three sub-accounts provides support for countries to improve their routine immunization serv- ices so, in principle, this could be used in part to help improve routine measles vaccination coverage.
A more controversial question is whether the Fund might also support supplemental measles campaigns or ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Different experts hold d i fferent views.
For example, Kane, a member of the G AVI Working Group, says that he personally does not believe that the limited resources of the Fund should be used for buying measles vaccine or paying for campaigns today. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
But in 2-3 years’time, if routine coverage and monitoring has improved in the high- burden countries, he personally believes that the G AVI Board may want to consider using Global Fund resources for well-planned supplemental campaigns, if other support is not available.
Hoekstra, meanwhile, a rgues that the Fund shoul... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“Measles is the number one public health problem among vaccine-preventable diseases of children,” says Hoekstra, “and GAVI now has the opportunity to bring it under the umbrella of its programme.” I n t o d a y ’s atmosphere of consensus, next year’s one y e a r-olds could be the first to see progress.
I References 1.... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Morbidity & Mortality Weekly Report .
June 13 1997, 46 (RR11 ) 1 - 2 0 http://www.cdc.gov/mmwr/preview/mmwrhtml/00047959.htm 3.
Immunize Every Child, GAVI Policy Paper, February 2000. http://www.vaccinealliance.org/reference/immunize.html Footnote a.
Measles elimination is defined as a situation where endemic transm... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Measles eradication is defined as the interruption of transmission world- wide.
Immunization Focus SPECIAL FEATURE GAVI Immunization Focus • November 2000 • Page 5 of 9 Swift action: measles vaccination campaigns, like this one in East Timor, can only supplement a good routine programme ASK anyone in public health to ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
But some will mention other equally pressing problems.
One in four children worldwide is still not immunized routinely with existing, inexpensive vaccines.
Up to half of all vaccinations given worldwide may be unsafe, putting children at risk of fatal bloodborne infections.
A n d some important vaccines are stagnati... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
A growing number of specialists believe that these problems must be addressed, perhaps even before another dollar is spent on making new vaccines.
“There are things we already know how to do, and for those we don’t need research, we need implementation,” says Mark Kane, director of the Bill and Melinda Gates Children’... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“But we also need to do some operational research to learn more and document the effectiveness of newer approaches and t e c h n o l o g i e s .” This month, the GAVI Board will begin to answer the question of how the partners in the Alliance, and the Global Fund for Children’s Vaccines, should sup- port R&D to acceler... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The Fund will be one channel of support.
The size of the budget for R&D has yet to be determined (see Box).
G AVI was formed to close the gaps in the world’s current immunization efforts, not to duplicate the e fforts of others.
It is therefore expected to support a few carefully targeted areas of R&D that are curre... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Some of these targeted areas may include operational research—for example, analyses of what incentives companies need to develop products that benefit main- ly the poorest populations; measuring the outcomes of training health workers in safe practices; or measuring the burden of diseases in developing countries where ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Immunization Focus asked a number of major fund- ing bodies in infectious disease research for informa- tion about the relative amounts they spend on basic, clinical and operational research.
Not surprisingly, comparable data are not available, because research is categorized differently in diff e r e n t institutions... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
To define its priorities, GAVI will look at proposals from several sources, including its newly formed R&D Task Force.
T h e Task Force, co-chaired by Myron Levine of the Center for Vaccine Development at the University of Maryland and a member of the GAVI Working Group, Yasuhiro Suzuki of WHO and Rino Rappuoli, of Ch... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The group asked Peter Wilson, a consultant with more than 20 years’experience of working with the pharmaceutical and vaccine industry, to canvas the opinion of a broad range of individuals with a stake in immunization.
Wilson devised an 8-point questionnaire which asked respondents to prioritize aspects of R&D accordi... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The exercise identified three vaccines that are relatively near to market, but currently neglected, as strong candidates for support to overcome the final obstacles of development: pneumo- coccal conjugate vaccines that would protect against the strains of S t reptococcus pneumoniae that are prevalent in developing cou... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
These three were selected because, as the Task Force puts it, they are “low-hanging fruit” that is almost ready to be plucked, and their potential benefit to public health is clear.
The Task Force recognizes that malaria, HIV and T B vaccines are high priorities, but says that there is already a “massive global effort... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
By devot- ing resources instead to the three near-ready vaccines, the Alliance could also help to prepare the infrastruc- tures for delivering vaccines against malaria, HIV Q Immunization Focus UPDATE GAVI and the role of the Global Fund in R&D The Global Fund for Children’s Vaccines has three separate sub-accounts: On... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
While funds from the first two sub-accounts have already been allocated to coun- tries, the ground rules for the third are still being established.
As GAVI sets priorities for R&D, it is clear that the Fund will support only some of them, while others will be supported by individual partners in the Alliance.
Decision... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
It is agreed that the Fund should not support research that other bodies are already funding, nor replace traditional sources of money.
GAVI Immunization Focus • November 2000 • Page 6 of 9 Research that delivers results As GAVI decides on its R&D priorities, Karen Birmingham investigates neglected areas Phyllida Brow... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
In addition to the three products, the Task Force agreed to select up to three further projects.
The direc- tion that these will take is likely to emerge at the November meeting.
Respondents to Wi l s o n ’s questionnaire also put a high priority on research to measure the burden of spe- cific vaccine-preventable dis... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Such data are valuable, not only to policy-makers but also for vaccine manufacturers, who increasingly rely on this information to calculate the potential mar- ket value of new vaccines.
Disease burden data have been shown to be one of three key factors influencing take-up of hepatitis B and Haemophilus influenzae typ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Orin Levine of the US National Institutes of Health (NIH), who organized a two-day meeting on disease burden at the W H O ’s headquarters in Geneva in O c t o b e r, sums up the need for this data: “Simply put, countries are not going to consider paying for a vac- cine to prevent a disease that they don’t think they h ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“Unlike measles or polio, there is no clinical disease entity that is unique to these agents.
Carole Heilman, Director of the Division of Microbiology and Infectious Diseases at NIAID, whose organization is funding a trial in the Gambia of a 9-valent pneumo- coccus vaccine, also acknowledges the importance of this dat... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Improving injection safety Spending on research to establish disease burden is probably very small at present, but figures are, once again, difficult to obtain.
Heilman, for example, says she has hired a staff member specifically to work on the burden of Hib in the Gambia.
However, she admits that she cannot give an ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Take, for example, the Phase III trial of an 11 - valent pneumococcus vaccine in the Philippines.
Principal investigator, Hanna Nohynek of the Finnish National Public Health Institute, says: “Because the figures on prevalence of pneumococcal disease aren’t available, we’ve built a disease burden component into the tri... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
On the basis of this, we should be able to cal- culate the savings of introducing the vaccine into such a community.” Developing countries also need better methods to monitor vaccine coverage.
Chile is frequently held up as a model of success for its immunization pro- gramme.
“But our system for monitoring coverage i... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“Vaccination clinics have to resort to counting the number of doses at different ages—after a year or 6 months—to estimate the number of children v a c c i n a t e d .” Lagos says the programme desperately needs a computerized subject monitoring system.
Another concern is unsafe injection techniques.
Millions of inje... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
One model estimates that unsafe injection techniques may account for approximately 2.3-4.7 million hepatitis C infec- tions, 80,000-160,000 HIV infections, and a staggering 20% of all new hepatitis B infections in developing c o u n t r i e s3.
Research to document the impact of using auto-disable syringes on reducing... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Another area that the GAVI partners will be explor- ing is the need to document the impact of communica- tion efforts such as public education and advocacy campaigns.
Barry Bloom, dean of Harvard School of Public Health and a member of the R&D Task Force, points out that the diseases prevented by newer vac- cines, suc... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“T h e concept of a vaccine that can prevent liver cancer many years later is hard for people to grasp, ” he says.
With only limited funds, the Alliance must be selec- tive.
But as key tasks are chosen, there is hope that each will bring the objective of safe universal immu- nization a little closer.
I References 1.... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Miller MA, et al.
Vaccine 2000 18: 2223-30.
2.
Unsafe injections in the developing world and transmission of bloodborne pathogens: a review.
Simonsen, L. et al.
Bulletin of the WHO.
1999; 77: 789-800.
3.
Transmission of hepatitis B, hepatitis C and human immuno- deficiency viruses through unsafe injections in t... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Bulletin of the WHO.
1999; 77: 801-7.
Say “aaah”: Orin Levine investi- gates the burden of Hib in Alaska GAVI Immunization Focus • November 2000 • Page 7 of 9 Karen Birmingham is news editor of the journal Nature Medicine IF only it were as easy as telling a c o m p a n y, “We need three times more vaccine this year ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Not quite.
A c o m p a- ny must invest huge amounts of capital and time to build a new vaccine production unit, or create a significant expansion.
So when vaccine needs change over time, supply can be hard to find.
The emergence of GAVI and the Global Fund has generated a great deal of new demand for hepatitis B (he... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
While global capacity for supply of monovalent hep B vac- cine is sufficient to meet demand, a significant proportion of the demand is for combined diphthe- ria, tetanus and pertussis (DTP) and hep B.
And while a number of companies are developing this combination vaccine, only one c o m p a n y, SmithKline Biological... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
In the meantime, GAVI Board has made a policy decision to reserve the available stock of com- bination vaccines for countries with relatively weaker systems.
The burdens of introducing new v a c c i n e s—additional training, cold chain and logistics requirements— are minimized through the use of combination vaccines.... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
The countries with the stronger systems will be encouraged to introduce the monovalent vaccine into routine i m m u n i z a t i o n .
“The situation is not ideal, but until combinations become avail- able in greater quantity, we have tried to develop a transparent and equitable allocation policy that ensures the highe... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
At press time, officials from UNICEF and WHO were to meet with a number of developing country health officials to discuss the available vaccines, and try to match need with supply.
A predictable supply Vaccines are unlike most prod- u c t s—pharmaceutical and other- w i s e—in that they are biological compounds.
They... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
All components for their manu- facture must be constructed to very specific standards of temper- ature, moisture, air pressure and of course, safety and hygiene. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Not only is scaling up capacity time- consuming, vaccine production is also highly regulated with each Immunization Focus BRIEFING GAVI Immunization Focus • November 2000 • Page 8 of 9 A smarter way to buy As demand for vaccines outstrips supply, Lisa Jacobs finds out how the system for buying them is modernizing 2001 ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
When errors occur—a n d they do occur—a whole lot can be rendered useless.
The size of investment necessary to create and maintain vaccine manufacturing capacity, therefore, means that companies must oper- ate at or near full capacity, most of the time.
Sudden increases in demand cannot be easily met.
Scaling up can... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
If a manufac- turer underestimates demand, it Q risks losing market share; if demand is over-estimated, expen- sive facilities are underused, and investments turn into losses.
Buying vaccines for the world’s children The six vaccines introduced on a l a rge scale in the developing world through the global Expanded Pro... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Product maturity in the vaccine field means that vaccine produc- tion is smoother, more manufactur- ers in the field means that demand can be more easily met, and more manufacturing capacity means that costs are reduced, and prices can follow costs down.
In this environment, it made sense for UNICEF to pursue a pro- c... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
To do this, it has used what is known as a ten- der approach—issuing requests to all qualified manufacturers every or every other year for quotes on a specific amount of a particular vaccine.
This policy has its benefits; the low vaccine prices achieved through this method were critical in helping even the poorest cou... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
For one thing, since EPI began in the 1970s with six vac- cines, new vaccines have been developed.
Many children in the richer countries are now protected against 11 or 12 vaccine-preventa- ble diseases.
But the newer vac- cines are not available for most children in developing countries, for two reasons that are ine... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
In fact, vaccine costs are only a small fraction of the total estimated cost of providing routine immunization to a child.
Of the estimated $20 it costs to protect one child, the cost of the required doses of the six vaccines comes to less than $1— the great majority of costs involved are staff, vehicles and maintenan... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
But the focus on low prices has not helped to convince manufac- turers that making the necessary investments on development and manufacturing capacity for vac- cines for the developing world can make business sense.
A new approach to procurement With the emergence of GAVI, and its focus on reducing the gap between the... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
For the purchase of new and under-used vaccines, UNICEF has decided to use a ‘request for proposals’ m e t h o d .
Through this route, UNICEF is asking companies to make off e r s that cover a longer term, aff o r d i n g companies more stable commit- ments over three to five years to ensure sustained supply of vac- c... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
In addi- tion, the vaccine industry has o ffered UNICEF additional com- ponents to contribute to the GAV I objectives including: training and materials, donations, bundling of vaccines to improve delivery, and injection equipment.
How have the companies responded?
“The companies have exceeded our expectations,” s a y... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
“There are many interesting off e r s on the table.” “In the vaccine business, there are enough uncertainties during the development and manufacturing process; UNICEF is committed to working with industry to establish a reliable and predictable vaccine supply environment,” says Jarrett.
I Immunization Focus BRIEFING E... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Email: Gavi@unicef.org External Editorial Board: Maria Otelia Costales, Country Representative, AVSC International, The Philippines; Shawn Gilchrist, Vaccine Industry Representative, Aventis Pasteur, Toronto; Keith Klugman, Director, Pneumococcal Diseases Research Unit, South African Institute for Medical Research, Sou... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Designed and produced by: Synergy New Media, London N17, UK. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
http://www.synergy-interactive.co.uk Immunization Focus GAVI Immunization Focus • November 2000 • Page 9 of 9 Bulk orders With the global increase in immuniza- tion covera g e—from about 5% in 1974 to nearly 75% today, UNI CEF’s pur- chasing role has grown; in 19 9 9 , UNI CEF supply division shipped 10 4 million doses... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Of course, with the increasing demands of the global polio era d i ca- tion efforts, the bulk of UNI CEF’s vac- cine purchases in 1999 were for ora l polio vaccine (OPV )—UNI CEF shipped 8 81 million doses of OPV in 1999.
“The companies have exceeded our expectations and there are many interesting offers on the table” | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721906114231.pdf | https://www.vaccinealliance.org/resources/nov2000.pdf | Benin |
Congo, Democratic Republic of the NO ADVANCEMENT - EFFORTS MADE BUT COMPLICIT IN FORCED CHILD LABOR 1 2019 FINDINGS ON THE WORST FORMS OF CHILD LABOR In 2019, the Democratic Republic of the Congo made no advancement in efforts to eliminate the worst forms of child labor.
The government drafted a new anti-trafficking i... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
A military court also sentenced a former colonel to life imprisonment for the unlawful recruitment and use of child soldiers.
Moreover, the government implemented a new universal primary education decree, expanding funding for public schools and significantly reducing the number of children vulnerable to labor exploit... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
However, despite new initiatives to address child labor, the Democratic Republic of the Congo is receiving an assessment of no advancement because of the national army’s complicity in the worst forms of child labor. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
During the year, an Armed Forces of the Democratic Republic of Congo (FARDC) regiment supplied weapons and munitions to and allowed the free movement of a proxy non-state armed group known for recruiting children, enabling the armed group to expand its control over mineral-rich sites in the east.
In addition, a FARDC ... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
The FARDC also illegally detained children for their alleged association with armed groups and failed to hold some of its units accountable for perpetrating the worst forms of child labor.
Moreover, regiment commanders and their superiors actively interfered with investigations into forced child recruitment and the se... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
Children engage in the worst forms of child labor, including in the forced mining of gold, tin ore (cassiterite), tantalum ore (coltan), and tungsten ore (wolframite), and are used in armed conflict, sometimes as a result of forcible recruitment or abduction by non-state armed groups.
Other gaps remain, including a la... | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
Research also indicates that labor inspectors failed to conduct any worksite inspections for the fourth year in a row.
Labor inspections are a key tool for identifying child labor violations, and their absence makes children more vulnerable to the worst forms of child labor.
I. | https://docs-lawep.s3.us-east-2.amazonaws.com/thematic2f/pw_2/1721909385595.pdf | https://www.dol.gov/sites/dolgov/files/ILAB/child_labor_reports/tda2019/Congo-Democratic-Republic-of-the.pdf | Congo, The Democratic Republic of the |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.