Immunization, Vaccines and Biologicals

Immunization highlights: 2011

Reaching more people with existing vaccines

The Measles Initiative vaccinates one billion children in the first decade

S. Ramson / UNF

In August 2011, the Measles Initiative announced that it has helped vaccinate one billion children in more than 60 developing countries since 2001 and routine measles vaccination coverage reached its highest level at 85% in 2010, making significant gains in the fight against measles. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. With accelerated immunization activities spearheaded by governments and the Measles Initiative, global measles deaths dropped by 78% from 733 000 deaths in 2000 to 164 000 in 2008. Reductions in measles-related deaths during that same time period accounts for nearly a quarter of the overall decrease in childhood mortality, representing significant progress towards Millennium Development Goal 4.

But governments and the global health community should not rest or redirect their efforts and resources elsewhere at the expense of tackling measles. Because of the decline in deaths, measles is no longer perceived to be a threat by many and must compete for funding with programs aimed at other diseases. Since 2009, widespread outbreaks affecting 30 countries in sub-Saharan Africa, including the Democratic Republic of the Congo and Ethiopia, have resulted in more than 320 000 new measles cases and more than 2400 reported measles deaths in Africa alone. In the past year, several European nations have faced their worst measles outbreaks in more than 10 years, with more than 26 000 cases in 36 European countries from January-October 2011, with more than 14 000 of those in France. These outbreaks have caused nine deaths, including six in France, and over 7000 hospitalizations. The U.S. is also experiencing its largest measles outbreak since 1996, with more than 150 reported cases.

Measles outbreaks are extremely costly to control. A well-documented 2008 outbreak in Arizona of seven measles cases, traced to a traveller from Switzerland, affected two hospitals, caused significant disruption, and cost US $800 000 to respond to and contain. That same amount of money could purchase about 2.5 million doses of measles vaccine for developing countries.

The Measles Initiative

The Measles Initiative is a partnership spearheaded by the American Red Cross, United Nations Foundation, U.S. Centers for Disease Control and Prevention, UNICEF and WHO. The Measles Initiative continues to advocate with governments and appeal to donors around the world to maintain an aggressive vaccination schedule, and improve routine immunization and disease surveillance in developing countries. The support of other nations, paired with financial and technical support from the Measles Initiative, has proven to be influential among those countries whose immunization programmes have not kept pace.

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Progress towards eliminating maternal and neonatal tetanus

People participating in a survey
J. Vandelaer

Maternal and neonatal tetanus kills tens of thousands of newborns each year, most of them in developing countries. Yet, tetanus is preventable through hygienic birth practices and immunization of women of childbearing age with tetanus toxoid vaccine.

In 2011, Ghana, Liberia, Senegal and Uganda were validated as having eliminated maternal and neonatal tetanus. This brings the number of countries that have eliminated the disease to 23 out of 59 countries where maternal and neonatal tetanus persist as public health problems. In addition, Ethiopia, 15 states out of 33 in India and 29 provinces out of 33 in Indonesia have eliminated maternal and neonatal tetanus.

As of the end of 2011 eight additional countries have completed tetanus toxoid supplementary immunization activities: Burkina Faso, Cambodia, Cameroon, Côte d’Ivoire, Iraq, Mauritania, Tanzania and Timor Leste. Other countries such as China, Equatorial Guinea and Gabon have also made remarkable progress towards achieving elimination.

The maternal and neonatal tetanus elimination initiative ― a partnership launched in 1999 by UNICEF, UNFPA and WHO ― continues to gain momentum with commitments to meet the funding gap being spearheaded by Pampers and Kiwanis International. The partnership is now at a critical stage, with only three years remaining before the 2015 elimination deadline and with 36 countries where maternal and neonatal tetanus persist as public health problems.

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Polio eradication - a programmatic emergency for global public health

A young Pakistani child receiving oral polio vaccine
Global Polio Eradication Initiative

Following the launch of a new Strategic Plan in 2010 to eradicate the remaining 1% of polio in the world once and for all, 2011 has brought evidence that the approaches work when thoroughly applied. Nowhere is this demonstrated more clearly than by the absence of polio cases in India (since January 2011), one of the most technically challenging places from where to eradicate polio.

However, the Independent Monitoring Board (IMB), set up at the request of the World Health Assembly (WHA) to independently monitor progress towards a polio-free world, warned that eradication efforts could yet fail in Nigeria, Pakistan and Afghanistan – which have never stopped polio – and in Angola, Chad and the Democratic Republic of Congo, which previously were polio-free but have since seen imported poliovirus re-establish transmission. This view was shared by the Strategic Advisory Group of Experts (SAGE) on immunization, which in November 2011 concluded: "Failure would lead to a major resurgence of the disease with many children crippled for life again every single year. At the same time, it would also represent the most expensive public health failure in history, with far-reaching consequences on overall global immunization efforts, seriously undermining the credibility of public health efforts with donors and stakeholders." The SAGE concluded that failure is not acceptable under any circumstances, and that polio eradication should be the concern of every individual, group or organization working on immunization.

Given the stakes, the Executive Board in January 2012 declared the completion of polio eradication a 'programmatic emergency for global public health', requiring the full implementation of current and new eradication strategies and the institution of strong national oversight and accountability mechanisms. At the same time, the new measures would see the full application of vaccination recommendations for all travellers to and from polio-affected areas. The Executive Board's decision is expected to be considered by the WHA in May 2012.

In response to the declarations by the Executive Board, the Global Polio Eradication Initiative (GPEI) is urgently finalizing an Emergency Action Plan for 2012-2013. This Emergency Action Plan is building on the successful experiences of India's eradication effort, and new measures to concentrate and coordinate resources across the partnership, promote innovation in managerial and tactical processes, and ensure faster risk identification and correction in key infected areas. The core strategies of the new Emergency Action Plan are already being urgently implemented in key countries, particularly in Nigeria and Pakistan, which in late 2011 launched national emergency plans with oversight by heads of state.

Failure to eradicate polio would results in hundreds of thousands of new cases occurring again within the next ten years. The achievement of polio eradication, on the other hand, would have substantial humanitarian and financial benefits. More than 7 million people are today walking, who would otherwise have been paralysed, as a result of the GPEI efforts. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of Vitamin A during polio supplementary immunization. The health economic benefits are significant: more than US$50 billion would be saved, through 2035; 80% of these savings would be in developing countries.

Most importantly, success would mean that no other child will ever again be affected by life-long paralysis from this terrible disease.

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