The Decade of Vaccines Collaboration

By: Pedro Alonso and Chris Elias

The year 2011 will be remembered for at least two dramatic and opposing trends in global health – incredible progress in immunization and the episodic resurgence of vaccine-preventable diseases.
 
Progress was hailed in July, when a Sudanese infant became the first child in her country to be vaccinated against rotavirus, marking a milestone in the fight against a diarrheal disease that kills half a million children world-wide. Two months later, the GAVI Alliance announced that it would immunize children in 37 countries with rotavirus and pneumococcal vaccines. Then, in October, the world cheered new evidence of the potential of a malaria vaccine when interim data from an ongoing phase III trial showed that vaccine candidate RTS,S reduces risk of the disease by half in African children ages 5 to 17 months.
 
Meanwhile, health workers in many countries sought to hold the line against re-emerging, vaccine-preventable diseases. In Dadaab, Kenya, they worked feverishly to vaccinate children against measles and prevent its spread across the world’s largest refugee complex as refugees arrived – malnourished, weak and often sick. The virus made headway elsewhere as well – including in Europe, which reported 30,000 cases of the disease and eight deaths in the first 10 months of 2011. Polio also attempted a comeback in 2011, including in China, where it reappeared 10 years after the country was declared polio-free, prompting the massive vaccination of 4.5 million people.

These two opposing trends – progress in immunization and resurgence of disease – demonstrate the dynamic tension that underscores nearly every major vaccination effort in the world today. And while the balance is on the side of progress, substantial challenges remain as widespread poverty, population growth and climate change bring heightened vulnerability to disease. In addition, success itself can breed complacency. This is a unique moment in time for vaccines and immunization – one that we can seize to turn a moment into a global movement that improves the health of millions of people, reduces health disparities, and propels economic development in poor countries.

This sense of urgency is catalyzing a global movement to fully realize the potential of vaccines. In 2010, global health leaders joined a call by Bill and Melinda Gates for the next 10 years to be designated the Decade of Vaccines, to extend the benefits of immunization to all people. In 2011, the 193 countries participating in the 64th World Health Assembly approved the Decade of Vaccines’ vision for a global vaccine action plan.

In concert with these efforts, the Decade of Vaccines Collaboration is an unprecedented effort to pool collective expertise to develop a roadmap for the next decade on how best to save lives using vaccines. It will map a comprehensive effort to enable families, communities and nations to guard against both the most common childhood killers, as well as infectious diseases that can strike much later in life. It will build on considerable successes in immunization. Globally, between 1990 and 2009, diphtheria-tetanus-pertussis coverage increased from 75 to 82 percent, polio from 75 to 83 percent, and measles from 73 to 82 percent.

The time is right for a collaborative effort to chart a course for bold action. Vaccines are widely recognized as the best buy in public health. Already, immunization saves more than 2.5 million lives each year. Rotavirus and pneumococcal vaccines could ultimately save the lives of another million children each year. Future vaccines that protect against diseases such as malaria, HIV and dengue will not only save millions more lives, they will also save poor countries billions of dollars in health expenses and lost productivity, opening new possibilities for economic growth.

Indeed, wide-scale vaccination is a major component of economic growth. The medical savings alone are profound. Rotavirus vaccine, for example, can reduce hospital admissions for diarrhea by half. In addition to such cost savings, the economic benefits of vaccines flow from better cognitive development of children, higher educational attainment, improved labour productivity, and increased savings and investments. As economist David E. Bloom at the Harvard School of Public Health and others have documented, population health is a powerful predictor of economic growth, with increased life expectancy driving a small but significant growth of GDP. Vaccination itself has been shown to generate a sizable rate of return on investment, and a return on investment of 18 percent by 2020 has been projected through expanding vaccine coverage in GAVI Alliance eligible countries.

We know the value of vaccines, yet we also recognize that, in an immediate sense, their cost can be prohibitive in the world’s poorest countries, as well as in middle income countries where the per capita income remains shy of US$4,000 per year. That is why GAVI’s recent announcement of increased funding for two of the newest vaccines is so significant. Acknowledging the cost barrier in a world of many competing demands on development also highlights the need for further innovations: institutional, economic, technological, financial and social. The disturbing reality is that child mortality is an order of magnitude higher in developing countries than in their wealthy, industrial counterparts. Vaccination could dramatically narrow that gap. Ghana is a prime example. The country started its measles control program in 2002, and since 2003, no child in Ghana has died of measles.

Creativity is needed across all fronts and by all partners, as more than one-fifth of children, mostly in poor countries, lack access to the vaccines that families in rich countries have come to take for granted.

The Decade of Vaccines Collaboration brings together global health leaders and experts from every region of the world to develop a plan to stimulate the discovery, development and delivery of vaccines. Our planning efforts are overseen by a leadership council from the World Health Organization, UNICEF, the National Institute of Allergy and Infectious Diseases, the African Leaders Malaria Alliance and the Bill & Melinda Gates Foundation. A 19-member steering committee is responsible for developing the global vaccine action plan and driving the consultation process in four key areas of strategic content:

  • Expanding delivery of new and under-utilized vaccines
  • Achieving reliable global access to vaccines through private sector partnerships and market incentives
  • Strengthening research and development of new and improved vaccines; and
  • Activating public and political support for vaccines, empowering communities to advocate for policies that will improve their health.

Critical to the success of the plan will be the engagement of civil society, national governments, multilateral and bilateral organizations, industry, philanthropy, academia and others with a vital interest in vaccination and public health. This effort will ensure that the GVAP will be firmly rooted in the multi-faceted realities of implementing countries. In regional meetings, as well as sector-specific consultations, cross-cutting issues such as financing; vaccine supply and procurement; vaccine demand forecasting and costing; regulatory issues; policy change; and monitoring and evaluation are also explored in more detail.

Through these consultations we can learn from national and regional innovations, such as the Revolving Fund of the Pan American Health Organization and Progresa, program in Mexico that is reaching the last mile with vaccination. The Revolving Fund allows countries to collectively negotiate prices and bulk purchase vaccines. The Progresa program in Mexico linked immunizations to conditional cash transfers and has increased already high immunization rates by reaching children in rural and low-income areas. A multitude of initiatives across lower and middle income countries are identifying new ways to leverage technologies, from cloud computing to mobile phones, and new approaches to public-private partnerships.

One premise of the Decade of Vaccines Collaboration is the need for investment in new transformational approaches to vaccine delivery, development and discovery. From new tools for evidence-based decision-making to new R&D models, transformational approaches promise to accelerate the translation of new medical knowledge into widespread medical practice, and continue to close the gap between rich countries and poor countries in access to new vaccines and medicines.
The immunization community is poised to transform how vaccines are developed and delivered and the GVAP describes approaches to realise this potential. The timing could not be better. The pace of discovery, the accumulation of medical knowledge, and the tools available to help solve problems are all evolving. To make the best use of new knowledge, we must evolve apace: in our commitment, in our organizational flexibility, and in our willingness to boldly acknowledge and tackle the toughest of problems. In that way, we will realize the enormous potential of vaccines to save lives, and overcome the challenges before us.

Through the course of this decade, it is within our power to save 6 million lives; avert 400 million cases of disease; and save people, communities and countries $150 billion in costs. [2, 3]  Improved global health will contribute to a more stable and secure world. However, like any true vision, the Decade of Vaccines needs planning, passion and action to come to life. We urge the global health community to join us in making this vision for the decade a reality. 

REFERENCES

[1] Bloom DE, Canning D, Weston M. The value of vaccination. World Econ 2005;6(3):15–39.

[2] Ozawa S, Stack ML,  Bishai DM, Mirelman A, Friberg IK, Niessen L et al. During The ‘Decade Of Vaccines,’ The Lives Of 6.4 Million Children
Valued At $231 Billion Could Be Saved. Health Aff (Millwood). 2011;30(6):1010–20.

[3] Stack ML, Ozawa S, Bishai DM, Mirelman A, Tam Y, Niessen L, et al. Estimated economic benefits during the “Decade of Vaccines”: $6.2 billion in treatment savings, $145 billion in higher output. Health Aff (Millwood). 2011;30(6):1021–28.

Professor Pedro Alonso is co-chair of the Decade of Vaccines Collaboration and director of the Barcelona Institute of Global Health.
Christopher J. Elias, MD, MPH, is co-chair of the Decade of Vaccines Collaboration and president and CEO of PATH.

To learn more about the DoV Collaboration and consultation opportunities over the course of the next few months, please visit http://www.dovcollaboration.org or follow them on Twitter @DofVC

A very worthy cause indeed but….let us deliberately expand the scope of involvement of the Civil Society and Private Sector in these efforts, in order to effectively and efficiently realise our objectives and targets at the lowest costs; especially in resource-constrained communities and settings.

— Dr. Uzodinma Adirieje on 2011-12-23