10,000 Unite for Lifesaving Vaccines

?????????????????????????Last month GAVI proudly announced its partnership with the Global Citizen Festival, a social mobilisation project culminating in a free concert in New York on September 28. The Festival aims to convince world leaders into addressing the key issues related to extreme poverty, such as education, women’s equality and – you guessed it – global health and immunization.

And it’s already working. More than ten thousand global citizens have signed the petition to call for more immunization funding, giving us more than ten thousand new advocates for the power of vaccines. We are receiving more signatures every day, but we cannot stop here.

This September, heads of state and international decision-makers will convene in New York for the opening of the 68th UN General Assembly, and in the weeks and months beforehand we have a real chance to influence change.

The success of the End Polio campaign, which galvanized 22,000 US citizens to write to their politicians and effectively brought about a US Senate request for polio funding, has not only proven that people genuinely care about averting child deaths from vaccine-preventable illnesses, but importantly that their concern is politically powerful.

201307-kilinochchi-srilanka-colour-007_220We must learn from this example and seize this opportunity to raise awareness about the potential of vaccines to transform lives. One single shot given to a child can protect them from a disease over their lifetime, which is a cost-effective investment in the future. A child who has been immunized does not need costly drugs or medical care, and so is more likely to go to school, keeping money in the family and giving the parents time to work. The child and their family are more likely to lift themselves out of poverty and contribute to their community and local economy.

However, with more than 22 million children worldwide not receiving the full array of basic vaccines, we have some work to do.  And new powerful vaccines for the two largest killers of children—diarrhoea and pneumonia—are just being added to country vaccine programs and will add to the effects of these basic vaccines.

By prioritizing investment in immunization we can not only stop children dying from vaccine-preventable diseases, but, ultimately, we can help the 1.3 billion people living in extreme poverty to have a chance at a better quality of life.

Continue the Global Citizen momentum: work with the GAVI Alliance and the Global Poverty Project to build a future where all children are fully immunized.

Please sign the petition and add your voice to the call for greater investment in immunization.

This blog post is also featured on Global Citizen website.

A shot at a healthy future

In global health terms it is hard to find a more striking yardstick with which to measure inequality. Of the 275,000 women who die from the cervical cancer every year more than 85 per cent are in the world’s poorest countries. And yet the vaccine that could prevent 70 per cent of these deaths has not been available partially because of its high cost.

Indeed human papillomavirus (HPV) vaccines, which can cost as much as US$ 130 for each of the three doses needed to provide protection against this deadly form of cancer, have been part of routine immunisation in some wealthy countries since 2007. Meanwhile, women in the countries with the highest burden of disease, where women typically have no access to screening or treatment, and have no access to the vaccine even if they could afford it.

But that is now about to change. Today, we are on the cusp of addressing this gross inequity with a vaccination programme that will mark a transformational moment in women’s health. Thanks to its innovative market shaping strategy and close partnership with pharmaceutical companies, the GAVI Alliance announced this week at the World Economic Forum Africa Summit in Cape Town that it is now able to purchase HPV vaccines at an initial price of just US$ 4.50 a dose with further reductions based upon the volume of demand. This means that starting with demonstration programmes in eight developing countries in the coming months, we will make it possible for more than 30 million of the world’s poorest girls to be vaccinated by 2020.

However, not everyone thinks this is a good idea. HPV is a highly transmissible and common virus and the cause of virtually all forms of cervical cancer. But it is also sexually transmitted and because of this there are certain stigmas associated with it and the vaccine that can protect against it. Some critics say that since the vaccines is not given to infants and instead is provided to girls before they are sexually active – between the ages of nine and 13 – that this effectively gives tacit consent to engage in sexual activity, ultimately leading to increases in promiscuity. Others say that there is little long term data and inadequate surveillance to show that mass HPV vaccinations work.

Consider the evidence though. Certainly it is true that the two HPV vaccines so far approved by the World Health Organization (WHO) only target two of the 15 types of virus known to cause cervical cancer. But it is also true that these two types of the virus, HPV 16 and HPV 18, are by far the most prevalent cancer causing strains. In fact there is even research to suggest that with HPV vaccines there can be some cross-protection, providing immunity against HPV types not targeted by the vaccine.

Convincing evidence is now also emerging of the long-term benefits. Last year the medical journal the Lancet published a study involving more than 18,000 women and girls in Australia which showed a decrease in incidence of precancerous cells in women just three years after a mass vaccination programme, covering all women aged between 12 and 26 years, was introduced.

Similarly, numerous studies have found fears of increases in promiscuity to be unfounded. One recent study involving nearly 1400 girls was published at the end of last year in the journal Pediatrics. It found that after three years there was no difference between the degree to which vaccinated and unvaccinated girls sought pregnancy tests, chlamydia tests or birth control counselling – markers that in rich countries are considered surrogates of sexual activity.

The fact is HPV vaccinations work, which is why since 2009 the WHO has recommended that HPV vaccines be included as part of national immunisation programmes. Moreover this is a view that is clearly shared by the governments of countries that bear the disproportionate burden of cervical cancer deaths. For, since GAVI began accepting applications for HPV vaccine support in 2012 we have received unprecedented demand, with 15 countries applying last year and as many as 20 expected this year.

Most importantly, however, it is recognised by women in these countries, where screening is not an option and where the HPV vaccine is their only hope. They have seen too many women die a painful death from cervical cancer at the prime of their lives. For them, this programme is truly about changing lives, offering millions of women and girls a chance of a healthy future. And where women are empowered, families, communities and nations benefit.

How is health linked to development?

Over the weekend I will be making my way to Botswana to participate in the global thematic consultation on health in the post 2015 development agenda. This meeting brings together civil society, academia, private sector, youth representatives, governments, heads of international health and development agencies as well as members of the UN High Level Panel on the post-2015 development agenda. We will be tasked to consider the input and submissions from people and organisations from all over the world and ultimately make a recommendation to the UN Secretary General on how health should be prioritized in the next chapter of global development.

Post 2015 development agenda

I would love to hear your thoughts as I prepare to chair a discussion in Botswana on how does health fit in the 2015 development agenda?

We live in a world burdened with increasingly diverse and complex development challenges. As we begin the task of crafting a framework to respond to these challenges, the post-2015 agenda presents an opportunity to rethink what makes development that is inclusive, innovative and applicable to all people. It provides us with a platform to introduce new ways of delivering smart development.

A healthy population is a prerequisite for development. A child, who is borderline nourished, will tip into frank malnutrition if they contract an infectious disease such as measles. Evidence also demonstrates that minimising the burden of illness through health interventions such as immunisation will positively affect a child’s ability to attend school and attain high education levels.

Concurrently, development has a bearing on health. Approximately 25% of the global disease burden is due to modifiable environmental factors. Related effects of unsustainable development, notably outdoor and indoor air pollution are now major causes of global ill health. The greatest burden falls on the poorest population, women and children.

Development is surely about improving people’s lives. A population cannot progress if it is burdened with ill-health. Good health is the foundation on which communities and nations can and do flourish.

Addressing health in isolation of other development challenges such as environment, education and economic growth will diminish our chances of ensuring sustainable change. How can we clearly articulate and support the synergies between health and the other sectors? How can we devise shared solutions to drive people-centred, inclusive development?

What’s your view? Please leave a comment below.

TED Challenge: tracking & tracing vaccines in the GAVI Alliance supply chain

I’m heading to Long Beach, California this weekend for my annual participation in the TED conference – and this year, I’m looking for help, from TED and from you.

Malawi, November 2011 – Health workers transport vaccines in vaccine carriers to keep them cool, on their way to an immunisation outreach session at a remote village in eastern Malawi (Credit: GAVI/Doune Porter/PATH/2011)

Health workers transport vaccines in cold boxes to a remote village in eastern Malawi (GAVI/Doune Porter/PATH/2011)

To do our work at the GAVI Alliance, we need to make sure that vaccines are not wasted. Vaccines are a powerful technology, but must be looked after very carefully. They have to be stored at  a certain temperature and used within a fixed period of time, or they become non-viable. I’m making this the focus of a TED Challenge, asking the smart, innovative people who make up the TED community to help us find a better way to track vaccines. That could involve existing technology like 2D barcodes or RFID tags, or there may be a whole new approach that we haven’t yet thought of.  Of course, it requires not just technology, but also appropriate hardware, systems for data transmission, and the ability to scale it up in some of the most difficult places in the world.

I want to make sure we hear all the best ideas, so I’m also asking all of you to help. Are there smart technologies that can help, or better ways to use what we already have?

Click here to read more about the TED Challenge, then post your comments or questions below.

Valuing Vaccination

Last week’s announcement of the Minamata Convention on Mercury represents a huge step forward in international efforts to reduce the human health impacts of mercury. For GAVI what is most important about the global and legally-binding treaty is what was left out. The treaty made an exception for thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent bacterial or fungal contamination of multi-dose vials of vaccine.

The treaty exception represents a triumph of science over the politics of fear. The anti-vaccination lobby pressed hard to have thiomersal – known as thimerosal in the US – included in the treaty despite the scientific evidence that thiomersal poses no human health risk. Indeed, banning it would have disrupted vaccination programs in many developing countries, putting millions of children at risk from vaccine-preventable illness.

The anti-vaccine lobby has been successful in raising fears and doubts about the adverse effects of vaccination and the role of thiomersal in increases in developmental disorders and autism. With parents, scientists and even initially the American Academy of Pediatrics (AAP) weighing in, the United States implemented a precautionary reduction more than a decade ago. There is now a mountain of scientific evidence refuting any link between thiomersal and autism, and AAP reversed their 1999 position that called for elimination of mercury in vaccines. GAVI and AAP share a belief that scientific evidence should guide public policy, and the evidence on thiomersal is clear. It is a safe preservative used in multi-dose vaccines, and at this time there is no replacement for it. Good science and a good global policy.

At GAVI our goal is to reach the world’s poorest children with life-saving vaccines, and while we are pressing for innovations in vaccine delivery systems, the realities of the current cold chain and storage capacities in developing nations make multi-dose vaccines containing thiomersal a necessity. Without it the number of children receiving vaccines in in 120 countries, mostly in the developing world, would plummet. The World Health Organization estimates that thiomersal-containing vaccines avert at least 1.4 million child deaths every year by protecting children from fatal diseases, such as diphtheria, tetanus, and hepatitis B (1). By using multi-dose vaccines, we can reach more children, and we can save more lives.

It is encouraging to see that the treaty negotiators used good science to inform this important global policy. We need to build public confidence in vaccine safety, and reach the 22 million children who currently lack access to vaccines. As a doctor, an epidemiologist and a father, I know that childhood vaccination is a fundamental building block of health, and it gives me confidence to see that the treaty negotiators recognised that as well.


(1) The Lancet, Volume 379, Issue 9834, Page 2328, 23 June 2012

This blog post also appears on project-syndicate.org