DAKAR / GENEVA / NEW YORK, 20 November 2002 - The State of the World's Vaccines and Immunization report, released today warns that if urgent and strategic action is not taken to close the gaps in funding, research and global immunization coverage, the world will see the re-introduction of old diseases and the emergence of new infections. The report will be launched in Dakar, Senegal, at the 2nd Partners' Meeting of the Global Alliance for Vaccines and Immunization (GAVI).
Jointly produced by the World Health Organization (WHO), UNICEF and the World Bank, the report highlights remarkable achievements in immunization over the last decade and outlines the challenges for the future.
The report points out that while vaccines have saved billions of lives in the past century and are still the least expensive way of controlling the spread of infectious diseases, they are not reaching the populations that need them most.
"Vaccines are among the most cost effective public health interventions," says Carol Bellamy, Executive Director of UNICEF and Chair of GAVI. "Today, no child should die from a vaccine-preventable disease. We need to invest more - and more rationally - in vaccine coverage and research, and ensure access in all corners of the globe."
Currently, nearly three quarters of the world's children are being reached with essential vaccines but wide variations exist between North and South and within regions. Children in the developed nations now have access to additional, newer and more expensive vaccines to protect them against major childhood diseases including hepatitis and Haemophilus influenzae. But in sub-Saharan Africa only half of the children have access to basic immunization against common diseases such as tuberculosis, measles, tetanus and whooping cough. In poor and isolated areas of developing countries, vaccines reach fewer than one in twenty children.
"In wealthy countries we tend to take the absence of certain illnesses for granted," says Dr Gro Harlem Brundtland, Director-General of WHO. "But in many regions of the world it is more the rule than the exception for children to die of common childhood conditions such as measles, which alone causes about 700 000 deaths a year. We need to act fast and effectively to ensure that children and adults everywhere have access to life-saving vaccines. From a global perspective, this is the only way of avoiding major epidemics of new and old diseases."
The report cites low donor investment as one of the major reasons for the huge gaps in coverage. External aid to developing countries for immunization currently stands at approximately US$ 1.56 billion a year. With an additional investment of US$ 250 million a year, at least 10 million more children would be reached with basic vaccines. A further US$ 100 million a year would cover the cost of newer vaccines including hepatitis B and Hib vaccines. It is estimated that every year hepatitis B causes 520,000 deaths a year worldwide, and Haemophilus influenzae type B kills 450,000 children in developing countries.
Another factor cited for the low vaccination coverage is the low level of investment in immunization by developing countries. For instance, low-income countries spend as little as US$ 6 per person per year on health, including immunization. In such countries immunization coverage will not scale up without improving the health systems, reinforcing infrastructures, boosting health service delivery and developing managerial skills.
The report also states that inequity in access to new vaccines has increased over the past two decades, as most low-income countries cannot afford the cost of new life-saving vaccines such as hepatitis B, Haemophilus influenzae type B (Hib), yellow fever and rubella.
The low uptake of vaccines in developing nations in turn has impacted on vaccine research. The lack of a market in these countries does not provide sufficient incentives for companies to invest in developing vaccines for diseases that affect predominantly the poor. This affects vaccine development for diseases as Shigella dysentery, dengue, Japanese encephalitis, leishmaniasis, schistosomiasis and cholera.
The market situation in developing countries also affects the types of vaccines that are more suitable to developing country strains of global diseases. For instance, while a vaccine with some efficacy for HIV/AIDS is now seen as possibly achievable within the next ten years, only one clinical trial for this vaccine has been conducted in Africa, the continent that bears 70% of the world's HIV burden. A European, North American or Asian HIV vaccine may well not be appropriate for an African population.
The report underscores the urgent need for vaccines against malaria, and a new vaccine for tuberculosis (TB). Today, malaria kills approximately one million people a year, the majority of them African children. Most importantly, the most common and most accessible medicines for malaria are now ineffective as populations develop resistance to them.
Tuberculosis, an ancient scourge once thought to have been brought under control, is today a re-emerging disease, fuelled by the rising tide of co-infection with HIV (especially in Africa) and by increasing resistance to TB medicines. Between 1997 and 2000 there was a 9% increase in the number of TB cases. In 2000, 1.7 million people died from TB. Out of the 8 million new cases of TB each year, only 130 000 occur in industrialized countries. TB needs a more effective vaccine. The current one, BCG, creates an immunity that lasts at best up to adolescence, but not for a lifetime
"While new initiatives to fight killer diseases abound, it is the hard cash that is missing," says Dr Daniel Tarantola, Director of Vaccines and Biologicals at WHO. "The global campaign for access to medicines and vaccines needs to be backed with political and financial commitment if we want it to get beyond words and make a difference to people."
In conclusion, the report proposes simple solutions and strategies to address the gaps. These include:
Investing efforts in ensuring a fair return on investment in the research, development and production of vaccines, leading to a strong and healthy global vaccine industry.
Strengthening manufacturing quality in self-producing developing countries, along with the improvement of national regulatory controls
Improving skills and infrastructure in countries to better forecast and plan long-term vaccine needs, optimize the impact of vaccines and reduce wastage.
Ensuring creative and sustainable financing mechanisms to enhance vaccine security - the uninterrupted sustainable supply of affordable vaccines to developing countries
Advocating more equitable access to priority vaccines, both new and old, for children and adolescents who need them most.