GAVI Alliance: the success continues

One of the most impressive speakers I’ve had the pleasure of hearing is Seth Berkley.

Seth is CEO of the GAVI Alliance. The incredible life-saving machine known as “the GAVI model” has prevented over 5 1/2 million future deaths through the immunisation of 370* million children since 2000.

* – May 2012 projection

GAVI’s mission encompasses a bold, compassionate vision, effective strategies, education and commitment. GAVI has pulled together very specific dynamics of international development, finance organisations, donor governments, the pharmaceutical industry, developing countries, WHO, UNICEF, Bill and Melinda Gates Foundation and the World Bank into a single “decision-making body”.

This uniquely complex approach allows the central part of the GAVI vision to be realised:

Saving children’s lives and protecting people’s health by increasing access to immunisation in poor countries

GAVI has every right to be proud that its model has permitted “a single-minded focus to the urgent task of closing three critical gaps in the provision of vaccines”:

  • between children for whom immunisation is a given and the 19 million children worldwide with no access to vaccines;
  • between the introduction of a new vaccine in rich countries and the average 10-15 years required for the same vaccine to reach low-income countries;
  • between the need for new vaccines in developing countries and the lack of research and funds to provide them.

In 2009 UNICEF reported that more children are being immunised than ever before and this is “directly attributable” to the success of the GAVI model. With the support of GAVI, 18 developing nations had begun to introduce the pneumococcal vaccine by mid-2012. Better still this vaccine will soon be part of routine programmes in half of GAVI-eligible countries. Pneumonia is the cause of 18% of child deaths in developing nations.

Another 18% of deaths in children is due to diarrhoea, primarily caused by rotavirus. By the end of last year 20 GAVI-eligible countries had been approved for support in implementing vaccines against rotavirus. It’s wonderful that by the end of last month Sudan was joined by Rwanda, Malawi and Ghana as the first African nations to see GAVI help roll out rotavirus vaccines.

Consider for a moment, Ghana. The first GAVI supported country to introduce both rotavirus and pneumococcal vaccines together, Ghana can now directly address and prevent the cause of 36% of childhood fatality.

GAVI have excelled in meeting demand. In the middle of 2011 more applications than ever before were made to GAVI for both new and underused vaccines. Late last year two thirds of GAVI programmes met demand for both rotavirus vaccine (representing a nine fold increase) and pneumococcal (representing a doubling of demand). The diagram below indicates how GAVI commits funds to specific purposes.

Meanwhile in the developed world we continue to enjoy the luxury of faux “vaccine injuries” and other hoax reasons proffered as cause to deny children immunisation. This itself is an indicator of, and direct result from, the success of mass immunisation. Vaccine induced immunity and herd immunity protecting the unvaccinated, remains out of reach in poorer nations wherein one child dies from a vaccine preventable disease every 20 seconds.

Where vaccination regimes have been successful such tragic suffering is forgotten. Indeed, subtracting the impact of vaccine denial, there’s virtually no evidence of it in our midst. But this does not mean we may have cause for complacency – no matter how strong both specific and herd immunity might be. Influenza pandemics remain a serious threat to humanity. It’s been estimated that the likelihood of such a Massively Fatal Discontinuity, able to kill up to 100 million people in the next 50 years, is 100%.

Back in February 2010 Seth Berkley looked at the importance of vaccines to human health, and our survival.

Wise words.

HIV and flu — the vaccine strategy (TED Talks)

Source – GAVI


Australian Vaccination Network crashes and burns on seminar tour

As many know, Australia’s leading anti-vaccination lobby group, the deceptively named Australian Vaccination Network recently finished it’s “tour” of Western NSW.

The tour itself was an abysmal failure. Billed Vaccination and Health Rights – a seminar for parents and health professionals it attracted mainly aged hippies and conspiracy theorists. The most compelling development was rumoured to be Greg Beattie shouldering Meryl Dorey out of the spotlight.

Subtracting the obligatory four heads of the Doreys and Beatties, attendance was likely anything from 4 to 15 across various venues. This silliness may have cost over $7,500 if food, fuel and dodgy accommodation is included. To the surprise of many it cemented the disgust which with Meryl Dorey, Greg Beattie and the other misguided members of the antivax movement are regarded.

The “fury” expressed by residents of Tamworth appears typical of the reception the AVN received. The vicious online reception that the public of Tamworth laid out and the pummeling the AVN received in the comments attached to that article ensured Tamworth attracted the highest attendance.

Another piece, Controversial AVN vaccination group in Tamworth briefly covers the event. It includes the grab for money the AVN is known for;

Participants paid $12 to attend the meeting and were given information on the AVN legal fighting fund appeal where they can donate money to help the AVN fight their own pending legal cases and also to support the “fighting fund for non-vaccinating partners.”

The group says it helps parents in court proceedings fight their ex-partners or spouses who seek orders of the court to vaccinate their children.

Sounds darn tootin’ except “the group” has never done any such thing. Nor do they have any pending legal cases. This is a bald faced lie and an outright scam. I can be no kinder.

So, their largest turnout included critical journalists and the “ninja academic”, Scotty Harrison. Scotty is an Armidale local and PhD candidate in Health Economics. Scotty – the most qualified individual on the entire tour – took the stage and worked his way quickly to evidence based figures on the history of vaccines. Within 12 minutes he had demolished the thrust of a life time of deception from Greg Beattie (video below).

Greg Beattie: His antivax lies were demolished before his eyes

Scotty didn’t just lay bare the lie that decreases in mortality before vaccination, supposedly refute the efficacy of vaccination. Improved living standards led to increased recovery – but not reduced incidence of disease. He also raised the reality of vaccine preventable disease-induced disability. Then furthermore spoke of his own struggle with ADD, asthma, allergies and eczema. There is no evidence they are due to the vaccines he received as a child, he concluded.

He makes it quite clear vaccines brought about the elimination of the incidence of disease. When pre-vaccine recovery meant a lifetime of scarred lungs or severe brain damage or being bed ridden with multiple organ damage, the onus is upon people like Beattie to convince us just how vaccines are supposedly useless. As seen below the video, even in the present day (wherein no changes in living standards have occurred) the impact of vaccination on disease is striking.

Delightfully, Dorey and Beattie didn’t expect any presentation that might be in dissent to their theme. They refused Scotty’s invitation to return the next night. Keep an ear out for the spontaneous applause on Scotty’s point on how poorly the vaccination “debate” is being conducted. Strange then that this enthusiasm vanishes once his content is known.

As much as one may want to support the AVN in their quest for legitimacy, “because every story has two sides”, I’m afraid that’s presently impossible.

This trip was an unmitigated disaster.

Over to Scotty…

Impact of vaccination on measles and Hib incidence in recent and very recent times


Measles control & genotypes in Victoria Australia

(Above) Hib vaccine introduced to Australia

(Above) Hib Vaccine introduced to Kenya, Kilifi district

Impact of vaccines 1,2,3 & 4 decades post introduction in Australia

(Above) Impact of diphtheria, pertussis & tetanus vaccines on mortality 1,2,3, & 4 decades after their introduction to Australia

Hepatitis B Vaccination: A Chinese Success Story

The vaccination effort against Hepatitis B, especially to protect newborns, will not stop

– Dr Yang Wei Zhong, Deputy Director General of the China CDC –

Australians are unfamiliar with the impact of large scale infection from Hepatitis B virus [HBV].

Ways of controlling the spread of infection include vaccination of health care workers against HBV, that infection with HBV is a notifiable disease, the quarantine of patients suspected of having HBV, ongoing quarantine procedures for patients diagnosed with HBV, extensive education and follow up of patients upon discharge and Harm Reduction initiatives.

So successful have these measures been that many Aussies erroneously believe HBV is exclusively a problem for high risk demographics such as IV drug users or sex workers. This misconception itself is as dangerous as high risk behaviour because it leads to the belief that protection from infection is linked to how one identifies oneself.

Indeed, IV drug users and sex workers are often highly educated about the risk of HBV infection and implement safe injecting and safe sex practices. Many seek out or are offered the HBV vaccine by their own or any GP. The fact is everyone is susceptible to infection with HBV or any blood borne virus.

Tragically the antivaccination lobby has done much to mislead some Aussies into what could almost be termed lethal complacency. By both dehumanising high risk demographics and falsely linking the HBV vaccine to injury and death, they have propagated ignorance and fear, condemning many to premature death from liver failure. In some cases the virus will be cleared over time, but there is no way to manufacture this outcome.

HBV positive individuals who would not exist but for antivaccination propaganda, can transmit the virus for many years post infection, completely free of symptoms.

The WHO observe:

HBV may be the cause of up to 80% of all cases of hepatocellular carcinoma (liver cancer) worldwide, second only to tobacco among known human carcinogens. […]

One should not judge by appearance: most infected people look perfectly healthy and have no symptoms of disease, yet may be highly infectious.

As Australia’s population changes rapidly through immigration and we travel more readily our risk of HBV infection steadily increases. At no time in our history has vaccination against HBV been more important. This will be true tomorrow, next week, next year and next decade. For this reason HBV vaccination is available to newborns.

It’s safe to say that everyday in Australia new lives not only begin, but are in many cases saved and protected from infection through this initiative. In the USA at least eight people per day die from HBV related complications. 25% of carriers world wide – over one million people – die each year from chronic hepatic insufficiency, cirrhosis and liver cancer brought on by HBV infection.

The protective effect of vaccination rolls on for newborns, toddlers and children. Children not born to a HBV positive mother are still protected from the many modes of infection as they grow and go about their lives. There are more concerns than sexual behaviour or the sterility of drug administration. Blood borne is invisible. Only a tiny scratch or cut to the skin or oral mucosa is enough to allow the HBV virus to infect.

It can remain viable for up to a week in blood stains on razor blades, nail clippers, nail files, table tops and can be transferred to a tiny wound by moistening dried, viable blood stains on bedding. We can extrapolate from that to see potential risk comes from any sharp surface or object or textile that children play with and chew on.

It would appear that if complacency was to be justified it is in the parents whose children are vaccinated at birth.

Fortunately antivaccination lobbying and planned fear mongering is not the global norm. At the same time we can celebrate the truly life changing roll out of Hepatitis B vaccination in China.

In 2004 The Association for Asia Research reported 690 million people in China were infected with HBV:

According to the Xinhua News Agency, April 25 is Children’s Immunization Day in China. China’s health department has named this day with the theme of “vaccination prevents hepatitis B” this year. They want to draw the public’s attention to the importance of vaccinating children for hepatitis B vaccination to stop further spread of the disease in China.

A recent study showed that about 2 billion people in the world are infected with hepatitis B; 690 million of them live in China. The chronic hepatitis B carriers in China number about 20 million. An average of 280,000 deaths annually are caused by hepatitis B and related liver diseases.

Still today in China HBV infection carries stigma much like HIV which, in what should be a wake up to Australian and USA antivaccination mobs, prevents middle and upper class individuals from seeking blood tests. Despite HIV awareness being much greater, as recently as 2007 the HIV to HBV infection ratio in China was 1 to 200.

In 2005 the GAVI Alliance began to work with Chinese officials in combating HBV through the vaccination of newborns. GAVI had already made significant inroads in developing nations. In 2004, 22 years after HBV vaccination was introduced to Italy, 50% of low income nations had included the vaccine in immunisation schedules.

What’s truly impressive about GAVI’s impact, is that this was only six years after the 50% mark was reached for high income countries. Over 75% of that catch up followed the launch of GAVI.

In 2001 10% of China’s population were chronic carriers of HBV, which was responsible for hundreds of thousands of deaths from cirrhosis and liver cancer annually. In 2004 this was estimated to be 280,000 deaths. Less than 40% of children in poor areas were being immunised.

In 2002 the Chinese Centre for Disease Control, the Chinese Government and GAVI formed a partnership to co-fund HBV vaccines. This lasted until the end of 2010 and produced a concerted effort to fight infection. Over 25 million newborns in remote and poor regions of western and central China were given free HBV vaccines.

As many women traditionally gave birth at home, raising awareness as to the value of immunisation and encouraging mothers to give birth in hospital became a crucial part of the programme.

In 2005 the Chinese government added HBV vaccines to the national immunisation schedule. At the beginning of the project 64% of children were immunised with the first dose at birth. Now this level is over 90% in the majority of these remote regions. Today, less than 1% of children aged under 5 are carriers of HBV.

Dr Mark Kane, a GAVI Alliance founding Board member states:

The success of the introduction of hepatitis B vaccine is a model, showing us what we need to do and what can happen as we embark on efforts to introduce important new vaccines against pneumonia, diarrhoea and cervical cancer.

China remains a country where vaccines are not a victim of their success. 25 million newborns have been given a start in life that many of their parents could only dream of. Australia’s most vocal antivaccination identity claims Chinese herbal medicine has been shown “to clear Hep B from the system… there are peer reviewed studies on this”.

It appears the Chinese themselves would, and can, disagree without saying a word. There is no cure. The virus can and does clear of it’s own accord in some cases, which might easily be the subject of poorly controlled studies.

However the ravages of Hepatitis B infection in China is a matter of recorded history. I wish them all the best for the future.

Because after all as we can see yet again, vaccination saves lives.

Australia’s role on the global vaccine stage

Last Thursday evening The University of Melbourne’s Spot Theatre hosted a unique and impressive event.

Australia’s Role In The World is an initiative of UN Youth Australia, the Australian Institute of International Affairs and the University of Melbourne. It’s purpose is to “engage young people, academia and the wider public in debate
about major global issues”. The official launch of the initiative was a forum entitled Vaccines To Change The World and made for a perfect Live @ Melbourne event.

The panelists were Dr Seth Berkley, CEO of the GAVI Alliance (formerly the Global Alliance for Vaccination and Immunisation), Tim Costello, CEO of World Vision Australia, Sir Gustav Nossal, University of Melbourne and Dr Kate Taylor from the Nossal Institute for Global Health. ABC Correspondent, Ben Knight having just returned from the Middle East made for an appropriate and excellent moderator.

When it comes to funding vaccination in developing nations and contributing to vaccine research and development, “Australia punches way above it’s weight”, Seth Berkley informed a large audience shortly into his address. Given the global challenge, and the positive impact of these programmes, this is something to feel good about.

Presently one child dies every 20 seconds from VPD. 270,000 women die annually from HPV related cancer with 85% in developing nations. More so, the percentage of mortality to cervical cancer incidence is disproportionally high in low to middle income nations. HPV vaccine coverage is least in these nations – something GAVI is working to address.

Lower income nations experience higher incidence and mortality from HPV related cancer

With pneumonia and diarrhea the top killers it’s satisfying to know Aussies contribute significantly to the “huge task” of rolling out of Pnuemococcal and Rotavirus vaccines. Along with Hepatitis B, DTP3 and Hib, GAVI has slashed the cost of access. In the case of the Pneumococcal vaccine market GAVI fund 97% of cost as compared to the USA market.

Pneumococcal and Rotavirus vaccines directly target two major child killers

However with 19 million children still missing out on immunisation and 15.4 million of those in GAVI eligible nations, one can appreciate the significance of GAVI’s mission and goals. Along with the mission to save lives and improve health via access to immunisation, GAVI seek to accelerate the uptake and use of underused and new vaccines. Helping strengthen the capacity of integrated health systems will be crucial in achieving this.

One child dies every 20 seconds from a VPD. Of 19 million missing out, 15.4 million are GAVI eligible

Increasing the predictability of global financing and improving the sustainability of national financing for immunisation, along with shaping the vaccine market are GAVI’s final two goals. GAVI also aim to drive equity in vaccine access across the globe. An impressive example of this is the uptake of the Hepatitis B vaccine in the decade from 2000.

High income nations increased uptake from 60% to around 77%. Low income nations shot from just over 5% to 98%. The impact of the consequential lowering of liver cancer incidence, particularly in China which experienced epidemic levels, cannot be understated.

“Only good for junkies and hookers” – anti-vaccination slurs of the HBV vaccine reflect pop culture mentality

This brings into focus how important immunisation is not only in preventing disease but in sustaining economies, and earning potential in adults. Immunised children maintain the health to attend and complete school. Reaching adulthood they have the potential to earn a competitive wage and thus contribute significantly to family income.

Parents need not produce large families to combat childhood sickness and death, or to meet the need for labour and their own care in old age. The cost of a disabled child or adult added to the tragedy of a deceased parent is a reality for many in developing nations. It’s estimated a one year increase in life expectancy equates to increased labour productivity of 4%. In this light it’s been estimated immunisation programmes have a rate of return between 12.4 – 18%.

One study cited by Seth Berkley noted that a fully immunised 11 year old would present with increased IQ, language skills and math testing results. Over time the “democratic dividend” is to invest more in fewer children. Thus we can see that by ensuring healthier children and smaller populations immunisation can pull families, villages, districts and  entire nations from poverty. According to Dr. Kate Taylor 100 million people per year are driven back into poverty due to illness.

Hib meningitis in Kenya’s Kilifi region fell 88% in three years following vaccine introduction

Results from immunisation are undeniable. With a 54% increase in population from 1980 – 2010 came a 95% reduction in diptheria and tetanus cases, a 92% reduction in measles and pertussis and a 97% reduction in polio. $1.3 billion per year is saved due to the absence of smallpox, which is over ten times the cost of the 1979 eradication programme.

When the Global Polio Eradication Programme was launched in 1988, 125 countries were endemic and 350,000 children were paralysed annually. Today only three countries remain endemic. India is an example of strong political will and determination in that two years ago it had the largest number of cases, yet today has been free of polio for a full year.

Rolling out new vaccines to close the immunisation gap is a major GAVI priority

Future challenges for GAVI will be expanding it’s reach and overcoming political apathy to make the most of emerging new vaccines and to roll out those yet to hit the market. The newer the vaccine the higher the percentage of those unimmunised. Poor political will is an obstacle. Part of the answer is to get the public and the global community to care, without placing excessive reliance on ministries of health by also including financial and planning ministries.

Australia is presently the sixth largest supporter of GAVI. Recently, thanks to Kevin Rudd, our commitment rose from $6 million to $250 million in the lead up to 2015. Kate Taylor underscored that private individuals with enormous wealth had dramatically also changed the landscape in securing funding dollars.

As competition drives down vaccine prices quality control in emerging markets is vital

Focusing on two research initiatives Sir Gus Nossal declared, “The future is bright”. Australia is contributing strongly to the “second generation” malaria vaccine, which given that the RTS,S is 56% effective in toddlers, is an essential avenue of pursuit.

Closer to home he mentioned emerging research into a vaccine for Group A Streptococcus. This disease has given Australia the unenviable status of having the highest incidence of rheumatic fever and rheumatic heart disease in remote indigenous communities.

Tim Costello reinforced that Australia and AusAID is committed to 0.5% of Gross National Income. Presently Australia has no billionaire analogues to the Bill Gates’ of this world. Letting no-one off the hook, Tim pointed out that, per capita, W.A. also donate the least to charity despite their expanding wealth. Aussies donate 35 cents per $100 of tax payer monies to global charity.

Over 90 or so minutes a fascinating account of Australia’s role in the World was presented by some rather heavy hitters in global charity and health.

Aussies can be proud that an unmistakable message is that when it comes to global vaccine equity, our nation is an accomplished heavy hitter also.

How can anyone doubt? Vaccination Saves Lives.

All slides © GAVI