2012 saw a record number of GAVI-supported vaccine introductions in the world’s poorest countries.
Country introductions OF NEW AND UNDERUSED VACCINES
By the end of 2012, the pentavalent vaccine had been introduced in a total of 70 GAVI-supported countries, slightly above the target of 69. The cumulative number of pneumococcal and rotavirus vaccine introductions reached 24 and 12, short of expectations for the year. This is partly due to supply constraints for preferred product formulations. The number of introductions is expected to be back on track to meet 2015 targets.
Number of countriesGAVI Alliance 2012
Number of countries
Number of countries
Coverage OF NEW AND UNDERUSED VACCINES
Across the 73 GAVI-supported countries, coverage in 2012 was estimated at 43% for pentavalent vaccine, 10% for pneumococcal vaccine and 3% for rotavirus vaccine. Supply constraints for particular formulations and/or country-readiness issues have jeopardised the achievement of coverage goals in the short term.
Pentavalent vaccine, 3rd dose
Coverage (%)WHO/UNICEF Estimates of National Immunization Coverage, 2012
Pneumococcal vaccine, 3rd dose
Rotavirus vaccine, last dose
A record total
A record total of 30 new introductions and campaigns took place across GAVI-supported countries in 2012 alone.
During the year, GAVI support enabled eight countries to introduce pneumococcal vaccine, seven to roll out rotavirus vaccine, six to provide the second dose of measles vaccine and five to launch the pentavalent vaccine. In addition, four countries initiated meningitis A vaccination campaigns for the first time.
An important milestone was the first-ever dual introduction of pneumococcal and rotavirus vaccines in Ghana in April, followed by another dual launch in Tanzania later in the year.
WHO estimates that, by the end of 2012, the world’s poorest countries had collectively immunised an additional 370 million children with GAVI-funded vaccines – preventing more than 5.5 million future deaths.
Country demand continues to grow
The number of applications for vaccine support remains high. In 2012, the Independent Review Committee (IRC) reviewed 57 applications for vaccine support from 41 countries.
By the end of the year, a total of 67 countries had been approved for pentavalent vaccine support*, 46 for pneumococcal vaccine, 28 for rotavirus vaccine, 17 for routine yellow fever immunisation, 11 for measles second dose vaccine and 10 for meningococcal A vaccine.
An additional 30 vaccine applications have been recommended for support by the IRC.
Cumulative number of countries APPROVED AND RECOMMENDED FOR NEW VACCINE SUPPORT
* An additional five GAVI-supported countries have introduced the pentavalent vaccine independent of GAVI support.GAVI Alliance, 2012
shows early impact of pneumococcal vaccine
Just two years after its nationwide introduction, pneumococcal vaccine is making a significant difference in Kenya. One district hospital where detailed surveillance records are kept has experienced a dramatic drop in the number of cases of invasive pneumococcal disease in children.
In 2010, 38 children under the age of five years were admitted to the Kilifi District Hospital with invasive pneumococcal disease. In the following year, when the pneumococcal vaccine was introduced, the number of admissions was reduced to 11. In 2012, there were only four confirmed cases of invasive pneumococcal disease among the under-fives in the whole district.
The Kilifi District Hospital serves a population of approximately 260,000 people. It is also home to the KEMRI-Wellcome Trust Research Programme, a medical research collaborative known for its work on malaria and bacterial and viral childhood infections.
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Admissions of children UNDER FIVE YEARS WITH INVASIVE PNEUMOCOCCAL DISEASE, KILIFI DISTRICT HOSPITAL, 2003–2012Anthony Scott, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, 2012
Pentavalent, pneumococcal and rotavirus
Pentavalent, pneumococcal and rotavirus vaccine introductions:
COUNTRIES AND RESPECTIVE NUMBER OF NEWBORNS (MILLIONS), 2012
GAVI Alliance and UN DESA, Population Division, 2011: World Population Prospects, the 2010 revision. New york, United Nations, 2010; (surviving infants)
Preventing the main child killer disease with pneumococcal vaccines
Pneumonia, a severe infection of the lungs, is the leading cause of child mortality. Each year it kills an estimated 1.6 million children under five across the world, accounting for 20% of all child deaths. Infection with the pneumococcal bacterium is the main cause of fatal pneumonia.
By the end of 2012, 24 of the world’s poorest countries had introduced the pneumococcal vaccine, which also provides protection against meningitis and sepsis, with support from GAVI. WHO estimates that to date more than 10 million children worldwide have been protected against pneumococcal disease with GAVI-funded vaccines.
WHO and UNICEF recommend an integrated approach to preventing and treating child pneumonia that includes promoting exclusive breastfeeding and improved nutrition, routine use of Haemophilus influenzae type b (Hib), measles, pertussis and pneumococcal vaccines, and treatment with appropriate antibiotics and oxygen when necessary.
Five-in-one vaccine accelerates protection against Hib and hepatitis B
Hib is another common cause of severe pneumonia and meningitis in young children. Although the number of deaths from Hib disease has decreased significantly since the vaccine was introduced into developing countries, Hib disease still kills approximately 200,000 children under five every year.
The hepatitis B virus also causes hundreds of thousands of deaths every year through acute and chronic diseases, including liver cancer and cirrhosis. The hepatitis B vaccine is 95% effective in preventing infection and its chronic consequences, and is the first vaccine to provide protection against a major cause of cancer.
Developing countries are increasingly offering hepatitis B and Hib vaccines as part of their routine immunisation programmes, mainly through use of the five-in-one pentavalent vaccine which also protects against diphtheria, tetanus and pertussis.
It is anticipated that by early 2014, all 73 GAVI-supported countries will have introduced the pentavalent vaccine into their routine immunisation programmes.
Post-earthquake immunisation success
In April 2012, just two years after the devastating earthquake that claimed 230,000 lives and left the public health system in tatters, Haiti marked World Immunization Week by launching a nationwide immunisation campaign against measles, rubella and polio.
The campaign was followed by the roll-out of the five-in-one pentavalent vaccine, with the support of GAVI, WHO, the Pan American Health Organization (PAHO), UNICEF and others.
“Vaccination is a great and simple tool to save lives and ensure the well-being of Haitian society,” said Dr Florence Guillaume, Haiti’s Minister of Public Health and Population.
It is estimated that more than 200,000 Haitian children will be immunised with pentavalent vaccine during the first year of the roll-out.
GAVI has provided support to Haiti for more than 10 years to help bolster its immunisation services and safe injection practices. The country has also been approved for support for pneumococcal and rotavirus vaccines.
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Rotavirus vaccines combat the main cause of fatal diarrhoea
Rotavirus is the leading cause of serious diarrhoea in children aged under five worldwide, killing more than 450,000 children each year and hospitalising millions more. More than 95% of all rotavirus deaths occur in developing countries.
Nearly all children are at risk of rotavirus infection, although poor hygiene practices and limited access to clean water can increase that risk. Since rotavirus cannot be treated with antibiotics or other drugs, vaccination offers the best hope for reducing the death toll from severe rotavirus disease.
Immunisation against rotavirus provides the opportunity to promote a comprehensive approach to the prevention and control of all causes of diarrhoea. This includes improving water quality, sanitation and hygiene practices and providing better access to oral rehydration solution and zinc supplements, as well as improving overall case management.
By the end of 2012, a total of 28 countries had been approved for rotavirus vaccine support from GAVI, of which 12 had already introduced the vaccine. According to WHO estimates, GAVI has contributed to the immunisation of four million children against rotavirus.
The Democratic People’s Republic of Korea
The Democratic People’s Republic of Korea
introduces five-in-one vaccine
By introducing the pentavalent vaccine into its routine immunisation programme, the Democratic People’s Republic of Korea hopes to protect hundreds of thousands of boys and girls against Haemophilus influenzae type B (Hib) as well as four other diseases.
“The introduction of pentavalent vaccine in DPR Korea will mean that around 350,000 children will be vaccinated every year against Hib in addition to other vaccines,” said Bijaya Rajbhandari, UNICEF’s representative in the Democratic People’s Republic of Korea.
Working closely with WHO and UNICEF, GAVI has supported the Democratic People’s Republic of Korea since 2001. It has helped the country strengthen its immunisation system and has supported a major upgrade of the cold chain system to ensure that vaccines are kept safe and effective.
The Government will continue to co-finance the cost of its GAVI vaccines, contributing approximately US$800,000 in the period between 2012 and 2015.
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Working with partners
Working with partners to alleviate supply constraints
Country demand for pneumococcal and rotavirus vaccines is higher than ever. While this is undoubtedly positive, it has led to some short-term supply constraints for particular products and vaccine formulations.
Working in close partnership with suppliers and implementing countries, GAVI was able to ensure sufficient overall supply of the pneumococcal vaccine for 2012. However, two countries postponed their planned 2012 introductions as their preferred product presentation was not available. In five other countries, introductions were delayed due to either challenges related to country readiness, or a combination of readiness issues and limited supply of their preferred product.
Supply constraints have also delayed the introduction of the rotavirus vaccine. Of the eight countries approved for 2012 introduction of the rotavirus vaccine, one had to postpone to 2013 due to insufficient supply of the preferred two-dose schedule vaccine.
GAVI continues to engage with suppliers to secure additional doses, while proactively monitoring demand and supporting countries in their implementation planning based on product choices.
GAVI revamps support
GAVI revamps support for vaccine roll-out preparations
GAVI’s vaccine introduction grants are designed to assist countries with the costs of preparatory activities for new vaccine introductions. Such activities typically include health worker training, information dissemination, education and social mobilisation, expansion of the cold chain and technical assistance. The grant is a one-time investment, which does not cover recurrent costs and cannot be used for vaccine co-financing.
GAVI has provided introduction grants since 2001. In 2012, the amounts were reviewed and adjusted to better reflect the actual cost of preparatory activities and country needs. The revised policy for vaccine introduction grants takes into account the size of the birth cohort in each country, and differentiates between vaccines given to infants and adolescents.
The revised policy also increases GAVI support for operational costs during large-scale campaigns, to ensure that campaigns are not delayed and social mobilisation activities are not compromised.
Total number of children immunised
AS OF 31 DECEMBER 2012 (PROJECTED INCREASE RELATIVE TO THE END OF 2011)WHO-UNICEF coverage estimates for 1980-2011, as of July 2012. World Population Prospects, the 2010 revision. New York, United Nations, 2010; (surviving infants). GAVI Alliance, 2013
Beyond saving lives: the broader impact of vaccines
Vaccines do not only prevent sickness and save lives. Immunisation also helps children and their families to lead better and more prosperous lives in many other ways. For instance, boys and girls who are healthy are more likely to attend school and to do well in their studies, and thus become more productive as adults.
Parents who do not have to spend money on their children’s healthcare can use it for other purposes, such as investments that spur economic growth. Furthermore, by reassuring parents that their children have a greater chance of surviving, vaccination can contribute to lower fertility rates. This promotes an age distribution that is more favourable to economic prosperity.
Society as a whole also benefits. A high proportion of vaccinated, healthy children in the population confers greater herd immunity, whereby protection extends to non-vaccinated people.
GAVI-supported countries gear up for HPV vaccine introduction
In a bid to protect millions of women from the devastating consequences of cervical cancer, GAVI opened a funding window for human papillomavirus (HPV) vaccines in April 2012.
HPV, which is highly transmissible, causes an estimated 275,000 cervical cancer deaths each year. Approximately 85% of these deaths occur in developing countries. Safe and effective HPV vaccines can prevent 70% of all cervical cancer cases.
Countries with demonstrated experience in reaching adolescent girls with vaccines can apply for GAVI funding to support nationwide introduction of the vaccine. Others are eligible for support for smaller-scale demonstration projects, which allow countries to gain the experience needed for a national introduction.
GAVI aims to support the vaccination of one million girls by 2015, scaling up to reach over 30 million girls in more than 40 countries by 2020.
Campaigns and routine immunisation protect millions against yellow fever
Yellow fever is an acute viral haemorrhagic disease that, in the absence of prompt treatment, can kill up to 50% of those severely affected. There are approximately 200,000 cases of yellow fever every year, resulting in 30,000 deaths.
GAVI supports yellow fever vaccines for use both in routine immunisation programmes and vaccine campaigns in countries at high risk of outbreaks.
WHO estimates that, by the end of 2012, close to 64 million children had been vaccinated against yellow fever as a result of GAVI-supported routine immunisation programmes. Of these, nine million were immunised in 2012 alone.
Two countries – Côte d’Ivoire and Ghana – completed the second phase of their yellow fever vaccine campaigns during the year, immunising an estimated eight million people against yellow fever.
Meningococcal A vaccine
Meningococcal A vaccine introduced in 10 countries in the meningitis belt
Seasonal meningitis A epidemics threaten the lives of the 450 million people in the meningitis belt, which stretches across 26 African countries from the Gambia in the west to Eritrea in the east. The disease causes a painful inflammation of the lining around the brain and the spine, and can kill within 24 to 48 hours of infection. Those who survive often face learning difficulties and deafness, and severe cases can result in gangrene and limb amputation. Children and young adults are most at risk.
GAVI-funded meningitis A campaigns
AND ESTIMATED NUMBER OF PEOPLE REACHED (IN MILLIONS), 2012WHO-AFRO, 2013
A new meningococcal A vaccine was developed in 2010. Together with partners, GAVI is helping to support the introduction of this vaccine, which has the potential to eliminate one of the leading causes of meningitis epidemics, in all countries in the meningitis belt.
In 2012, 7 countries conducted vaccination campaigns against meningitis A, targeting close to 50 million people between 1 and 29 years of age. This brings the total number of countries that have initiated campaigns against meningitis A to 10.
Measles-rubella vaccine to safeguard the health of mothers and children
The 2012 application round gave countries their first opportunity to apply for rubella-containing vaccine. This vaccine has the potential to protect hundreds of millions of babies and mothers in GAVI-supported countries over the next few years.
Maternal infection with the rubella virus in early pregnancy puts babies at risk of congenital rubella syndrome, which can cause severe birth defects and life-long disabilities. Every year, approximately 90,000 babies are born with this syndrome in GAVI-supported countries. The rubella virus can also cause miscarriage and stillbirth.
By supporting the measles-rubella combination vaccine, GAVI is simultaneously helping to combat measles, a viral infection which can lead to serious illness, life-long disability and even death. While increased routine immunisation led to a 74% drop in measles mortality between 2000 and 2010, recent years have seen a stalling in the reduction of the number of measles deaths. Seven applications for GAVI support for the measles-rubella vaccine were recommended for approval in 2012.
In addition, GAVI continues to support countries with the roll-out of the second dose of measles vaccine. To date, GAVI has helped 8 countries to deliver the measles second dose vaccine to an estimated 11 million children. GAVI became an official partner of the Measles-Rubella Initiative in 2012.la syndrome occur in GAVI-supported countries.