Fact Sheet N° 189
HIGHLIGHTS OF THE CVI STRATEGIC PLAN
Polio -- Polio may cause up to 50,000 new cases of severe disability per year, but this is quickly falling due to the global eradication effort. The disease is still endemic in the Indian subcontinent and parts of Africa but was eliminated from the Americas in 1991.The World Health Organization estimates that $2.7 billion in resources would be needed to complete the global eradication of polio, with a target date of 2000. Some $800 million to $1 billion is needed from external sources for endemic countries. Once eradicated, some $1.5 billion would be saved annually, which is the current global cost of polio vaccination.
Measles -- The disease causes some 1. 1 million child deaths annually, with 400,000-500,000 of them in sub-Sahara Africa. Asia is the other continent with a major measles problem. A good control program has eliminated measles as a serious threat throughout Latin America. Measles has a direct medical cost of approximately $ 1.1 billion annually, much of it spent in four industrialized countries -- France, Germany, Italy and Japan --where measles is still a problem. Some $250 million annually is needed to achieve 90 percent coverage worldwide with 2 doses of a vaccine, with a total of about $4.5 billion required if eradication is eventually attempted.
Hepatitis B -- The disease causes 800,000 deaths per year among adults, mostly from infections received in early childhood. Approximately $20 million annually would be needed in low-income, mostly African countries to promote wider distribution of the HB vaccine. Before immunization started, Hepatitis B was primarily a problem in Asia and Africa. The vaccine is now being used in many, but not all parts of Asia. The biggest health problem with Hepatitis B stems from perinatal infections -- mother-to-child. The infant then has a higher probability of becoming a chronic carrier of Hepatitis B for the rest of his or her life, leading to cancer and cirrhosis of the liver.
Hib Disease (causing meningitis and pneumonia) -- This disease, caused by Haemophilus influenzae type b, results in 400,000-700,000 child deaths per year. The direct medical cost of the disease is some $750 million per year. The resources needed to distribute Hib vaccine to all children at risk is estimated at $1 billion yearly.
Rubella (German measles) -- This disease causes some 300,000 severe congenital malformations in newborns annually -- mental retardation, blindness, deafness -- stemming from infections developed by their mothers during early pregnancy. Wider use of rubella vaccine is suggested but strategies need to be carefully designed. The vaccine is currently used in some 75 countries, 29 industrialized and the rest in the wealthier developing countries.
Yellow Fever -- The disease causes up to 30,000 deaths annually, mostly in some 30 countries in sub-Saharan Africa. Outbreaks occur in other regions, such as in Latin America. The vaccine costs just 15 cents a dose for the poorest countries, but international agencies have not yet been able to assemble the money for a program to control yellow fever. A two-pronged program is likely to be necessary -- to vaccinate everyone in affected regions, and then to continue routine vaccination of infants. This would cost an estimated $17 million to provide catch up immunization on a one-time basis, and another $4.6 million for routine vaccination in the African at-risk countries.
Many of the following vaccines are considered Aimminent@ -- they are in the late-development or licensing phase. By 2000-2002, effectiveness trials in developing countries will be completed for many of them. If successful, wide rapid utilization is the aim of the Plan.
Rotavirus Diarrhoea -- It causes 400,000 to 600,000 child deaths annually, mainly infants under one year old. It is the most consistent cause of diarrhoea, responsible for about one-third of the most severe cases. It is a type of diarrhoea that hits industrialized countries as well as developing ones. Transmission does not come via contaminated water, like most other forms of diarrhoea, but probably from children coming into physical contact with other children. The death rate, from rotavirus diarrhoea is not high in industrialized countries -- perhaps as many as 100 child deaths per year in the United States, for example -- but the health care costs stemming from hospitalization are very high. The rotavirus vaccines that are being developed will protect children from the worst effects of diarrhoea, namely severe dehydration and death. The U.S. Food and Drug Administration held hearings in December, 1997, on whether to license the vaccine, being developed by an American company. Licensing could occur in early 1998.
Pneumococcal Pneumonia -- The leading cause of bacterial pneumonia, it kills some 1.2 million children annually, mainly five years old or younger. The current pneumococcal polysaccharide vaccine is only effective in children over the age of 2, so a pneumococcal conjugate vaccine effective in infants is being developed and could be licensed in the United States within 2-3 years. Vaccines to control rotavirus diarrhoea and pneumococcal pneumonia are in the final stages of development and could by themselves save up to 2 million children a year and prevent enormous treatment costs, says the CVI.
Meningococcal Meningitis -- This infection of the fluid membranes surrounding the brain and spinal cord kills at least 20,000 to 30,000 people annually, a toll that is higher during epidemics. The meningococcal conjugate vaccine is being developed by French and U.S. companies. The vaccine will be invaluable in the African meningitis belt.
Cholera -- The disease still kills some 120,000 people of all ages annually. Scientists are seeking to improve the already existing cholera vaccine, led by Swedish and Belgian effort. Cholera is spread via contaminated water, and is therefore prevalent in countries with poor sanitation. Children are most vulnerable from the ages when they move from their mother's milk to taking in water (6 months to a year), up to age 10.
RSV Pneumonia (viral pneumonia) -- It may kill 400,000 to 500,000 children annually, although some scientists believe the death toll is less. The disease, which mainly kills infants less than a year old, is most frequently found in developing regions.
Bacterial diarrhoea and typhoid -- These conditions lead to some 2 million deaths annually, mostly children, in high risk countries with poor sanitation, such as Bangladesh. The Shigella and the E. coli vaccines are the main diarrhoeal vaccine candidates. The typhoid vaccine is also scheduled to be improved.
Malaria - - Some 2.1 million deaths occur annually from malaria, including 1. 2 million children, most of them in Africa. Control of the vector -- the mosquito -- has not been fully successful, especially in the developing world. A malaria vaccine, then, could help free inhabitants of many low-income countries from the disease. A vaccine could be ready in 5-10 years. Much of the malaria vaccine work is being overseen by the U.S. National Institute of Health and the U.S. military, with some private companies and international organizations, such as the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, also involved.
HIV/AIDS -- At present, approximately 3-6 million people, mostly young adults, are newly infected each year with the HIV virus, which leads to AIDS. These individuals are likely to face premature death after lengthy and costly illness. Future annual new infections and deaths are difficult to estimate. A vaccine will probably not be available for at least 5-10 years. Much of the research is being carried out in the United States and Europe, and trial sites are being prepared in developing countries by the UN AIDS program.
Tuberculosis -- The infection causes 3 million deaths annually, mainly in Asia and Africa. The present TB vaccine, called >BCG= (bacillus Calmette-Guérin), prevents TB meningitis in young children. It does save about 200,000 children each year, but has no proven effect on
TB in adolescents or adults. New, improved vaccines are in early development, but will be difficult to test, and so may not be available for 5-10 years, at the earliest.
Other sexually transmitted diseases (syphilis, Chlamydia, Neisseria gonorrhea) -These infections, from chlamydia and gonorrhea and especially congenital syphilis, cause 200,000 deaths per year, and millions of cases of infertility. However, vaccines are not expected for at least 10-15 years.
Other parasitic diseases, including leishmaniasis and schistosomiasis -- These diseases cause a total of some 1 million deaths per year. The suitability of vaccine prevention versus other options must still be studied. Vaccines for these diseases are Aorphan vaccines@ because there would be little market for them outside the very poor countries where the diseases are prevalent. Therefore, companies have little incentive to invest large sums in searching for such vaccines.
For further information, please contact the Secretariat of the Children=s Vaccine Initiative, M233, 20, Avenue Appia, CH-1211 Geneva 27 Switzerland, tel.: 41 22 791 4799; fax: 41 22 791 4888; e-mail: email@example.com
All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http: //www.who.ch//