For girls in developing countries, good health in childhood and adolescence is a key to a bright future. When girls grow into healthy women, nations and communities benefit. Everybody benefits.
In GAVI we are committed to giving all children a good start in life by delivering life-saving vaccines including against two leading killers, pneumonia and diarrhoea, to the developing world.
While globally there is little difference in immunisation coverage rates between boys and girls, in countries where families prefer having sons over daughters, more boys than girls get immunised. Where women have low status, their children – both girls and boys – are less likely to be immunised. So we work with these countries to overcome gender-related barriers to immunisation. Countries identify the barriers to immunisation and GAVI provides health systems funding support to help reach those who are excluded.
Vaccines protect the health of women and mothers. With UNICEF we have reached more than 40 million women with maternal and neonatal tetanus vaccines, which protect against a lethal consequence of unclean deliveries.
Now, GAVI is supporting two more vaccines which can benefit the health of women and girls: human papillomavirus (HPV) vaccines against cervical cancer and rubella vaccines against congenital rubella syndrome.
Worldwide, over one quarter of a million women die every year from cervical cancer. The vast majority of those deaths occur in developing countries. In Asia and Latin America, deaths from cervical cancer even outnumber those from pregnancy-related causes. So in the global fight to reduce mortality among women of reproductive age we have a new weapon: HPV vaccines that can prevent 70% of cervical cancer cases.
HPV vaccines are critically important to developing countries as cancer screening and treatment services are often unavailable. So in response to the enormous demand from countries, GAVI is working to ensure that HPV and other vaccines are affordable to the countries that need them the most. Last year, a vaccine manufacturer offered an indicative price for HPV vaccines to GAVI countries at US$ 5 per dose, a two-thirds reduction on the lowest public price. GAVI continues to work with vaccine manufacturers to achieve acceptable price commitments.
We are working with cancer, reproductive health and women’s organisations to help countries deliver HPV vaccines cost-effectively. We know how important it is to make sure that vaccination is delivered in an integrated way, with other important interventions for girls such as adolescent reproductive health, HIV prevention, nutrition, family planning and safe motherhood. Our goal is that by 2020, over 28 million girls will be immunised with HPV vaccines.
The other good news for women is GAVI’s support for rubella vaccination. Every year, 90,000 children are born in GAVI-eligible countries with severe birth defects just because their mothers were infected with rubella virus during pregnancy. This is totally preventable through the power of vaccines. GAVI will now support combined measles-rubella (MR) catch-up campaigns in countries immediately introducing MR vaccine into their routine immunisation programmes. By building on the momentum of accelerated measles control activities we believe that one billion children can be immunised against measles-rubella by 2020.
New vaccines, new delivery systems and affordable prices for new vaccines. GAVI is committed to delivering on its promise for women and girls – their right to a healthy future, no matter who they are, no matter where they live.
As 2011 draws to a close, it’s a good time to reflect on what an extraordinary year it’s been for GAVI and for this Alliance’s mission to ensure life-saving vaccines reach all the world’s children regardless of whether they are born in a poor country. Those of you who know me from my time as CEO of the International AIDS Vaccine Initiative will be familiar with my end of year letters and it’s a tradition I would like to introduce at GAVI.
Over the past five months, I have enjoyed getting to know better how the Alliance works: its members, its mechanisms and, most of all, the magical formula that ensures our partners deliver more together than alone. This learning process culminated in the recent GAVI Alliance Board meeting in Bangladesh, where it was great to see Geeta Rao Gupta, Deputy Executive Director at UNICEF and a leading champion of immunisation, appointed vice-Chair of the GAVI Board.
Without a doubt, the high point of the year was the June pledging conference in London when donor governments pledged funding which the Alliance will use to immunise close to a quarter of a billion children against life-threatening diseases by 2015. At a time when the economic outlook is uncertain, that represented an exceptional vote of confidence – not just in our Alliance but also the cost-effectiveness of vaccines and their ability to make a difference.
The level of political commitment was extraordinary. The Prime Ministers of the UK and of Norway, the President of Liberia, and Bill Gates and many many other leaders together brought the focus on immunisation to a whole new level. That political commitment came from implementing countries too, with the countries reaffirming their commitment to co-finance vaccines, which they continue to do. And in the approach to the conference, vaccine manufacturers made offers of significant price reductions for key vaccines.
As the chair of the GAVI Board, Dagfinn Høybråten, said recently, it was a great GAVI moment; and we need more moments like that.
Prior to the conference, pneumococcal vaccines were already reaching developing countries in record time thanks to GAVI support; in February, Kenya’s President, Mwai Kbaki, marked the introduction of pneumococcal vaccines into the national immunisation programme with a special event to celebrate the global rollout. Now, the pledging conference has given us an enormous opportunity to accelerate the rollout of both pneumococcal and rotavirus vaccines against the leading causes of pneumonia and diarrhoea deaths respectively. By 2015, some 40 countries are expected to gain access to these vaccines through GAVI funding and the work of countries and our other partners in countries.
We recognise that a number of countries eligible for GAVI support do not have the immunisation infrastructure in place to deliver all of the new antigens. Funding the introduction of new vaccines is only part of GAVI’s vision. Immunisation programmes also need to be sustainable so vaccines do not protect only one birth cohort. Working with our partners on the ground to build countries’ systems and figure out their needs will be a critical part of what we have to do in the immediate future.
As an innovative Alliance, GAVI never stands still and, last month, we were pleased that our Board meeting in Bangladesh took the first steps to opening windows of support for the introduction of vaccines against human papillomavirus (HPV) - the second human cancer vaccine - and rubella virus in developing countries. Both have a huge potential impact. If negotiations to secure a sustainable price for the vaccine from manufacturers are successful and countries can demonstrate their ability to deliver them, up to two million women and girls in nine countries could be protected from cervical cancer by 2015. Over the same period, the rubella vaccine has the potential to reach 588 million children.
Opening an HPV window does bring its own set of new challenges. While we will be able to build on the same cold chain used for other vaccines, the vaccine needs to be provided to adolescent girls, which is a new age group for GAVI.
However, our Alliance allows us to bring together an enormous number of talented people to accomplish more than our individual capacities alone. In 2012, we will be looking to build new partnerships with reproductive health groups, family planning groups, ministries of education, nutrition and maternal child health and others, and these will help to provide opportunities to link the introduction of HPV vaccine with other additional steps to improve girls’ and families’ health.
If we lift our eyes to the horizon, there are many new opportunities in prospect. The research and development effort on vaccines is currently very rich. In 2011, phase three trials of a malaria vaccine delivered exciting early data. And in addition to the traditional multinational pharmaceutical companies, there is the R&D work being done by Public-Private Product Development Partnerships as well as the beginnings of work being done by developing country manufacturers.
The Alliance needs to be a big tent where all of the major players in immunisation can meet. So we need to rethink our links to the polio eradication campaign, which is continuing to have success and is beginning to think about the end game for this terrible scourge of mankind. Similarly we need to look at how we can strengthen our connection with those working on measles elimination. Our work here is aligned with and part of the Decade of Vaccines and our goal of ensuring vaccines are a higher public health priority.
As I noted above, we received significant new commitments from vaccine manufacturers on prices in the approach to the pledging conference. We need to continue to work to create a healthy vaccine market, with secure supply, as much competition as possible, assurance of high quality and sustainable prices. Under our new supply and procurement strategy, approved at the November Board meeting, we will look at each vaccine market in turn and take a tailored approach to each.
With these challenges ahead, and the success of the June replenishment notwithstanding, it is critical that GAVI constantly thinks about how to renew resources and diversify its funding base, especially in the current economic climate. We were delighted this year to have two donor governments, Brazil and Japan, make their first grants to GAVI. The Matching Fund initiative, launched by the UK and the Gates Foundation, is also attracting new private sector champions to our cause.
Such generosity puts the emphasis on being accountable to our donors. Last month’s Aid Effectiveness conference, which I attended in Busan, South Korea, emphasised the importance of data transparency. In 2011, GAVI published all its key performance indicators on www.gavialliance.org. In 2012, we will strive to improve immunisation impact data by working with our partners and also give access to more timely information on vaccine rollouts.
Finally, I take inspiration from the memory of a Dhaka schoolgirl Saleha Akhter, presentor of a video shown to the GAVI Board last November and a reminder of why GAVI exists.
In six significant minutes, Saleha describes the vital role of governments, UN agencies, civil society organisations, vaccine manufacturers and donors in delivering vaccines to her fellow Bangladeshi schoolchildren. All are critical members of our extended family. Without these combined talents, neither Saleha nor 90% of her fellow Bangladeshi schoolchildren might ever have had the chance to fulfill their life’s potential.
As always, we thank you for your interest in GAVI’s work and look forward to working with you next year to continue to increase our impact on the lives of so many. If there are any questions, please let us know.
With best wishes for you and yours for the holiday season.
A decade ago, China had one of the world’s highest incidences of hepatitis B, a viral infection that is the primary cause of liver cancer.
Today, less than 1 percent of China’s children are carriers of hepatitis B – and as they age, the deadly liver cancer, once a leading killer in China, is becoming increasingly rare.
How was this achieved? From 2002-2010, my organization, the Global Alliance for Vaccines and Immunisation, or GAVI, worked with the Chinese Ministry of Health to immunize 25 million newborns against hepatitis B in some of the poorest and most remote provinces in the country. The campaign helped avert hundreds of thousands of cancer-related deaths, and its success led the Chinese Government to add the hepatitis B vaccine — the first immunization known to prevent any form of cancer — into its national immunization programme.
Though their causes are viral, cancers such as liver and cervical cancer, are often described as part of the group of “non-communicable diseases” (NCDs) that also include diabetes and heart disease. The viral origins of these two cancers raise the question of whether “non-communicable” properly defines this group of diseases. We know that almost a fifth of cancer cases worldwide are caused by infections, and there are indications that a number of other chronic diseases are caused by infections, which might one day also be prevented by vaccines.
Vaccines are critical preventative tools to curb liver and cervical cancer, particularly in poorer countries where the burden is highest and health services are often limited. And they’re a good investment – the World Health Organization (WHO) ranks vaccines such as hepatitis B a “best buy” in preventing NCDs.
Considering the important role that these existing vaccines have and the potential for new vaccines, any global strategy that aims to tackle non-communicable diseases should include the power and potential of vaccination.
And so much more can be done. China is just one success. GAVI plans to reach 230 million more children with hepatitis B vaccination. And we’ve set our sights on cervical cancer too, the second most common cancer in women. While it is a global public health threat, nearly 90 percent of cervical cancer deaths are found in developing countries. GAVI’s aim is to replicate the important progress achieved in the fight against liver cancer by supporting the introduction of vaccines preventing human papillomavirus (HPV), which causes virtually all cervical cancer cases. Some, for political purposes, have questioned the value and importance of HPV vaccines. Let’s be absolutely clear – the science supports the use of this life-saving vaccine.
If the GAVI Board approves HPV vaccine funding at its November meeting, countries will be invited to apply for support. Ensuring a sufficient supply of affordable HPV vaccines will be key to our efforts and GAVI is already working with manufacturers to lower vaccine prices for developing countries.
On September 19 and 20, the global community will come together at the UN General Assembly for the first-ever high-level meeting on non-communicable diseases. The UN Secretary-General Ban Ki-moon has described the meeting as “our chance to broker an international commitment that puts NCDs high on the development agenda where they belong.” Effectively knocking out non-communicable diseases and the chronic infections that cause many of them will require a comprehensive effort, and immunization belongs at the very heart of such an approach.