IVAC Blog

This article was originally posted on the Impatient Optimists Blog on January 9, 2018.

45 million children have access today, millions more expected to gain access to vaccine in 2018

When I started my career in the 1970’s, I saw children die every day from severe diarrheal disease. Today, diarrhea is still responsible for half a million deaths in children under 5 worldwide. That is far too many—acute diarrhea is both preventable and treatable.

Many of these deaths occur because our prevention tools have yet to reach the world’s vulnerable children. The leading cause of severe diarrhea globally is rotavirus, which countries have taken steps to address. After one of the fastest global rollout campaigns in history, 93 countries (home to 1/3 of the world’s children) now include rotavirus vaccines in their national immunization programs.

Introducing vaccines will not completely solve the problem—vaccine coverage must be improved, as must coverage of oral rehydration therapy and zinc supplementation to further reduce the number of deaths and serious illness. Yet, the progress has been remarkable.

Here are 5 reasons we have made it here today:

1. Political leadership in South Asia has been critical

In 2016, India was the first South Asian country to introduce rotavirus vaccines into its public program, using a phased approach. A year later, Pakistan followed suit. Once these programs scale up, the vaccine should reach over 30 million children annually.  Keeping with this trend, Afghanistan, Bangladesh, and Nepal plan to use Gavi support to introduce the vaccine in 2018 and 2019.  

2. African countries were early adopters and have been at the vanguard 

African countries have been the vanguard of rotavirus vaccine introduction, which began when South Africa introduced in 2009. Since then, the WHO Regional Office for Africa has found that rotavirus-confirmed diarrhea hospitalizations in children under five has declined by one-third. 

The progress does not end there. 33 African countries have rotavirus in their national vaccine schedule, many having received support from Gavi, the Vaccine Alliance. Several large countries here plan to introduce rotavirus vaccines in the next few years. These include Nigeria and the Democratic Republic of Congo, where more than 40,000 children died from rotavirus in 2013. 

3. Manufacturing developments are expanding choice, potentially reducing prices 

Many new vaccines are in development or recently licensed in Asian countries. Notably, two newly licensed Indian vaccines are soon expected to be prequalified by the WHO: ROTAVAC, from Bharat Biotech, and ROTASIIL, from Serum Institute of India. Once prequalified, UNICEF can supply these new vaccines in Gavi-eligible countries. Expanding choices between vaccine products can drive down market prices and avoid supply constraints. You can read more about this here.

4. Scientists and communicators on the frontlines have enabled progress

Scientific leadership can drive political will to improve child health. Take Bangladesh as an example, which once struggled with extremely high child mortality. Widespread use and excellent coverage of new vaccines helped reverse this trend. Pivotal figures, including my colleagues Shams El Arifeen, K. Zaman, and Samir Saha, published evidence spanning three decades about the toll of rotavirus and diarrheal disease on Bangladeshi children and families.

Still, challenges exist. Bangladesh must double the country’s cold chain capacity and cope with an influx of over 600,000 Rohingya refugees. Beyond this, we recently found that thousands of children were turned away from a pediatric hospital due to a lack of beds. If these children had been vaccinated against rotavirus, the hospital may not have been overburdened in this way.

5. Middle-income countries face unique challenges 

For middle income countries like Thailand and the Philippines, it remains to be seen whether expanding supply choices will impact pricing and decision-making. The Philippines began a phased introduction in 2012 but has yet to scale up use. In Thailand, a pilot introduction showed that rotavirus vaccine would be efficacious and cost-effective. However, the scientists calculated based on current pricing that to purchase the vaccine for all children would be equal to 45% of the current budget for Thailand’s entire immunization program. Fortunately, the expansion in supply may change this calculus.

What Now?

Even with all this progress, can we feel hopeful that still 2 out of 3 children in the world don’t have access to vaccines that developed nations take for granted?

 I am an optimist and I have seen seemingly impossible journeys come to fruition. Achieving vaccine equity is a marathon, not a sprint, and the global community should applaud the many countries taking this important step toward ensuring a healthy start for all children.

More Resources

• More Maps of Rotavirus Country Introductions
• Expanded Program on Immunization in Bangladesh 
• National Geographic Story on Bangladesh Impact: Here's Why Vaccines Are So Crucial

This image is courtesy of View-Hub

Welcome to the brand-new IVAC Blog! We’re pleased to launch this forum where experts, policymakers, advocates, students and other impassioned individuals can share ideas, thoughts and analysis on the latest in global health and vaccine access.

As students and practitioners of public health know well, delivering health interventions is often just as important as discovering them. Despite advances in science that allow us to prevent the world’s deadliest infections, those advances will never bear fruit in a majority of the world’s countries without the evidence base to prove the need, backed up by an advocacy effort that spurs decision makers to act. 

It was this compelling need that inspired the establishment of IVAC at Johns Hopkins Bloomberg School of Public Health just one year ago.

Simply put, IVAC is dedicated to ensuring that safe and effective vaccines reach those who need them most—like children in developing countries, where the disease burden is high and health interventions are tremendously scarce. Though great strides have been made in recent years to fund and improve vaccine delivery in the world’s last-mile communities, there is much work left to be done—and there are many barriers to implementation that remain stubbornly intact. 

Being housed at the Bloomberg School of Public Health allows IVAC to draw upon the tremendous expertise of the faculty as well as other scientific and policy leaders in building the credible case for expanding vaccine access. Our projects are made possible through grants from the Bill & Melinda Gates Foundation, the GAVI Alliance, the US Centers for Disease Control and others and we partner with international organizations, in-country advocates, industry leaders, civil society and others to ensure smart collaboration and accelerate progress. 

Thanks to the work of IVAC and our partners, nearly 50 developing countries have introduced Hib vaccines in the past decade, protecting millions of children and millions more will be protected in the years ahead from pneumococcal and other diseases. For us at IVAC, our aim is to do the same with other vaccines for diseases that claim the lives of children unnecessarily.

The IVAC Blog launches at a particularly important time for its mission. At Johns Hopkins Bloomberg School of Public Health, our third-annual Vaccine Day is tomorrow, Friday, October 29—and globally, the second-annual World Pneumonia Day will take place November 12. We invite you to participate in both events so that we can continue to find innovative and sustainable ways to deliver lifesaving vaccines to children who need them.

As any global health organization knows, the breakthrough in the lab is only half the battle. To be effective, we always need to know what works on the ground and what doesn’t. So please use the comments section to share your thoughts and ideas and highlight the topics and resources you’d like to read and discover in this blog.

--Dr. Orin Levine