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Johns Hopkins Bloomberg School of Public Health


Keyword: gavi

Next month, Dr. Orin Levine will leave his post as Executive Director of IVAC at Johns Hopkins Bloomberg School of Public Health to join the Bill & Melinda Gates Foundation as Director for Vaccine Delivery in the Global Development Program. Before he leaves, we asked him to reflect on the last 10 years and the changes he has seen in vaccine access and in the organization he helped build.

You started at Johns Hopkins with a single vaccine access project, GAVI’s PneumoADIP. Today, IVAC is a leader in vaccine access research and practice, with projects tackling a wide range of vaccine-preventable diseases across a mix of disciplines. What were your goals for the organization, and did you imagine it becoming anything like what it is today?

When we started PneumoADIP (Pneumococcal Vaccine Accelerated Development and Introduction Plan) we had no idea it would grow so quickly and evolve into what is now IVAC. And I know that because, when I took the job my wife and I had just had our first daughter and I told her, ‘don’t worry it’s just a three year grant, $30 million, a small team of about seven or eight people.’ Now, almost 10 years later, with a team of more than 30 people and the scope and breadth of what we are doing – it was almost unimaginable when we got started.

PneumoADIP was a really remarkable opportunity. One of the things the PneumoADIP team was really focused on was that this was the best chance we had ever had at making a really big difference on accelerating vaccine access. We were very focused on moving the needle, on getting pneumococcal vaccines out faster and more widely than ever before. So that team, that purpose, that mission, really came together all at once in a very special way.

Tell us about the evolution from PneumoADIP to IVAC.


Dr. Orin Levine speaking at the launch of the UK All-Party Parliamentary Group on pneumococcal disease prevention in 2007. (Photo Credit: Amit Lennon)

In retrospect, PneumoADIP occurred at a really exciting time in global health and global vaccine access. GAVI was new, the Bill & Melinda Gates Foundation was new, and people were asking questions about what is possible and raising their ambitions. At the same time all the architecture was also new and small. There was an incredible space for a team based at Johns Hopkins Bloomberg School of Public Health (JHSPH) to play a leading role in the effort to get new vaccines out in collaboration with GAVI and a lot of other players.

The team really embraced that. We were very focused on a handful of core strategic goals. We designed everything to be rigorous and collaborative. Those are qualities that have carried forward into IVAC. We saw a compelling injustice, that pneumococcal vaccines were being used here in the United States and not where they were needed the most. That injustice is what drove people here at IVAC – and still does – to get up and come into work and do what they do.

You often refer to the ‘summer that wasn’t’ in 2008. Can you tell us about that?

The summer of 2008 was pivotal for us at IVAC and one busy summer. At that time, it was apparent that pneumococcal vaccines were going to roll out in GAVI countries and we were ahead of any historical precedent with a new vaccine. They were poised to take off, but they weren’t yet in the countries. There was a feeling here at PneumoADIP, soon to be IVAC, that while we could take some legitimate credit for having built things to the point where the table was set for rollout, it hadn’t quite rolled out, and we were anxious that if we left the scene, for whatever reason, it wouldn't continue the way we had envisioned. So, we were in this moment where the success, the thing we had worked so hard for, was almost there but not quite. We wanted to be part of that next step - the sometimes messy process of getting to implementation.

The PnuemoADIP contract was coming to an end so we knew that to be part of the next phase we had to write a proposal. At the same time, we wanted to keep the team together not knowing what was going to happen. We were pretty busy writing proposals in the summer of 2008. We wrote two really big proposals, one for the follow on from PneumoADIP - AVI - and one for PERCH, the world’s largest pneumonia etiology case-control study in a generation.

We had this attitude that we would be happy working as a team on either grant and then we won both. That was a really big step for us. It helped us feel like we could continue on the pathway that we had started with PneumoADIP, but it also really said to us that people recognize what our team can do. From that time forward, we just continued to diversify our portfolio, building off that same core of teamwork and innovation in solving difficult problems.

So were you able to rest at all that summer? Was sleep on the agenda?

It was, but not much. As with everything at IVAC, it was a team effort pulling those proposals together but, as I always tell people, when you pack a printer for your vacation, it's a pretty bad sign the vacation won’t go how you planned. That was certainly true that summer. I remember it so well. We were packing up the car with towels and boogie boards and there was a box with a laptop and a printer in it.

What are some of the other highlights over the past 10 years?


Dr. Orin Levine in South Africa filming a documentary about pneumococcal disease for BBC in 2004. (Photo Credit: IVAC)

I'll give you a few because there were many, obviously with a team as talented as this one. One of the highlights was the very first strategic retreat of the PneumoADIP team. We got the PneumoADIP award in January of 2003 and by June, had identified, recruited and brought on campus everybody on the team. Together, with Thomas Cherian from WHO, we sat down for two days in Baltimore and built the strategic plan. Basically we mapped out the next few years of PneumoADIP on big sticky notes on the wall. It was really great to see everybody come together around this common vision and suspend disbelief for a couple days. You know it was pretty outrageous to believe in 2003 that we were going to accelerate access to the world’s most expensive vaccine for the world’s poorest countries, and yet they bought it and it has made a big impact.

The first IVAC video documentary we did was another highlight. We really put a face on pneumococcal disease, the problem and what could be done in a way that hadn’t happened before. I remember a few days after it aired on BBC World I got a phone call from a senior executive at a major vaccine manufacturer who said ‘That documentary was incredible. I watched it with my teenage kids and at the end they said to me, dad you need to get that vaccine for those kids in developing countries.’ With that I really came to appreciate the power of making the case with video and other multimedia. The case always starts with evidence, but using that kind of tool was really important.

We had a number of other highlights on the evidence side. It was a major accomplishment when our team built up pneumococcal surveillance in collaboration with WHO in more than 50 countries, then leveraged that data to generate disease burden estimates for the whole world, and then, in order to meet the needs of the $1.5 billion Advance Market Commitment, did the most incredible work on this project called the global serotype project. That's memorable because we had an incredibly tight turnaround. We got the final analysis and then had to summarize and submit back to GAVI and the AMC committee the night before it was due. I remember it was in August because it was Kate O’Brien’s birthday, and we spent her birthday as a team in her kitchen up until 3 a.m. writing that report.

So birthdays and vacations were often spent writing reports?

Definitely not, but I can see how it looks that way. [laughs] We have a team that knows how to celebrate as well as work hard and we shared many great times together. But when the team saw a $1.5 billion opportunity for pneumococcal vaccines, they made the sacrifices too.

Was there an especially memorable achievement for you over the years?

A really memorable moment was being in Rwanda for the launch of the first GAVI-supported pneumococcal vaccine program in 2009. I was there with the CEO of GAVI at the time, Julian Lob-Levyt, and seeing the expression of our work as kids getting vaccinated for the first time was a tremendously


Dr. Orin Levine speaking with a nurse in Rwanda at the launch of the first GAVI-supported pneumococcal vaccine program in 2009. (Photo Credit: Thomas Rippe)

memorable experience. We had an event in Rwanda where kids got vaccinated and then we arranged a conference call back to Baltimore with the whole PneumoADIP team. The GAVI CEO joined me for that call and thanked the team for their work over the years to make this launch possible. Even though I wasn’t in Baltimore, you could feel, even over the phone, the pride that was coming from the team at having made a really big contribution to that achievement.

Wow, it must have been amazing to hear people say we need to fix this problem and then just a few years later see children being vaccinated.

Yes, it was, for the whole team. I think the thing that pulls people to work at IVAC more than anything is the mission. It's a mission-driven group, they are committed to the notion that we can do something about vaccine access. And when we do, it makes a difference in peoples lives and communities. There are lots of organizations that talk about that, and here we have the privilege and benefit to actually deliver on it. That’s one of the things that make IVAC special.

While we are talking about the mission, what do you envision in the future for IVAC?

IVAC is in a terrific position. The number one strength of IVAC is its team. We have incredibly talented people here who are going to carry the mission forward for years to come. You know, I see many opportunities for IVAC in the future. Really the question that IVAC probably will face is, out of so many opportunities, which do they choose to focus on? It’s a good problem to have.

What are the things you value most about the team here at IVAC?

One of the things that make it hardest to leave is the team. There are a few people who have been with me shoulder-to-shoulder from the beginning, like Kate O’Brien, Mathu Santosham and Maria Knoll, and others like Dagna Constenla, Danny Feikin and Lois Privor-Dumm, who have come on board later. What is really remarkable in many ways is that as we grew we retained a core set of ambitions: a sense that we didn't want incremental change, we wanted that big change, and that it was possible; a willingness to question things, not in an arbitrary or personal way, but in a very results-focused way;


Dr. Orin Levine and members of the PERCH Expert Committe at a meeting in Baltimore in 2012. (Photo Credit: IVAC)

and an innovation-centered approach, that idea that if it was easy it would have been done already, so let’s try something a little bit different. Those are some of the things that IVAC is going to carry forward, especially this sense of bringing innovation to difficult problems and the willingness to experiment and fail, which is integral to making a difference.

What’s your vision for vaccine access in general? What changes do you think we will see in the next 5-to-10 years?

It’s an exciting time to be working on vaccine access. There are some really important trends that are going to impact vaccine access in the years to come. From my perspective, one trend is going to be an emphasis on more and more country-driven immunization programs. Countries are going to be less reliant on donors and international agencies and more self-reliant. That's a great opportunity and it requires shifting towards a policy dialogue model. I also think we are moving to a more integrated approach to delivering interventions within health and even between health and other sectors. So you are seeing things like financial services and health connecting. And then the last area that I think is going to be really exciting is improving service delivery. We have improved our vaccine introduction and accelerated that more in the last decade than we have improved coverage or service delivery. We made big gains by narrowing the time-lag in access to new products, but the next big step is going to have to be boosting us to universal coverage in every community.

So what excites you the most about your new position?

I think working at the Bill & Melinda Gates Foundation will be exciting because of their results-based approach to tackling problems. The foundation brings to bear great minds, substantial resources, and a prolonged focus.

And you are moving to Seattle. What are you looking forward to about that? Aside from the rain...

Well, the well-known weather patterns of Seattle are certainly a draw. The city itself is really beautiful and, for me and my family, who really enjoy the outdoors, there is just tremendous opportunity to enjoy the Seattle environment. I think we – me professionally and hopefully my family too – both literally and figuratively, will have new hills to climb that will make us stronger and bring us new rewards.

By Dr. Chizoba Wonodi

Dame Prentice at Nigeria's National Vaccine SummitNearly two years in the making, Nigeria’s plan to convene a National Vaccine Summit came to pass in April. More than 1000 delegates from all walks of life - from political big wigs to orphan children – assembled in the majestic International Conference Centre Abuja.

The colorful atmosphere and vibrant mood belied the somber reason for holding the Summit in the first place – that far too many children were dying every year from diseased that can be prevented by vaccines; the country needed to do better.

As the demographic powerhouse of Africa, when Nigeria sneezes, Africa catches a cold. One in 5 children that die in Africa is Nigerian. Sadly, in 2010, more than 800,000 Nigerian children did not live to see their fifth birthday. A quarter of these kids died from vaccine preventable diseases such as diarrhea, pneumonia, meningitis and measles. With the potential of vaccines to save so many lives, it is not acceptable that nearly 1 million Nigerian children remain unvaccinated every year.

That is why the Summit is timely and relevant. It was a rallying cry by the broadest coalition ever assembled on vaccines in Nigeria. More than 20 organizations came together to find solution to the problems. IVAC is proud to be on the roll call that included government, international partners, civil society and the private sector. Our mission was to grab the attention of political leaders and energize the public to take action on routine immunization.

If the attendance at the Summit is any thing to go by, we succeeded. The Secretary to the Federal Government, Senator Pius Anyim, declared the event open. The Minister of State for Health, Dr. Muhammad Pate, gave the keynote address and Sir. Brian Greenwood of the London School of Hygiene, gave a special guest lecture. It was a rare honor to have Sir Greenwoood and indeed a homecoming for him, having started his public health career in Nigeria.

Attendees at Nigeria's National Vaccine Summit

After two days of deliberations and presentations, the messages that emerged were clear and consistent – vaccines are cost effective, governments, partners and private sector must do more to finance vaccine programs, every child must be vaccinated to attain their full potential. It is their right.

Nothing brought these messages more poignantly alive than when the orphans sang "we are the children, we are the future, please don’t let us down". I was moved to tears. Through misty eyes, I looked around me and saw grown men and women crying.

Now the Summit is over, the tears have dried and the cheers have died; the question on everyone's lips, including Mrs. Melinda Gates, who tweeted a shout out to us, is "what next?”

We find ourselves at a crossroad. On one hand is an ambitious agenda that calls for universal vaccine coverage and sustainable financing by 2015. On the other hand is the stark reality that without a concrete plan, money and momentum, it will remain business as usual.

Leaders at Nigeria's National Vaccine SummitThere is however reason for optimism, because we have powerful allies on our side. The First Lady, Dame Patience, who hosted delegates to a dinner at the Presidential Villa, was decorated as an ambassador for immunization. Your excellency, we will be calling on you soon to perform your ambassadorial duties. As the mother of the nation, nobody is better placed than you to be an advocate for children.

To my mind, the main theme that emerged from the Summit is a call for Nigerians to look inwards and find support for immunization. Dame Patience called for NAVI (think Nigerian GAVI) and the Health Reform Foundation of Nigeria (HERFON) called for the well-meaning and well-placed in society to volunteer as vaccine ambassadors in their communities. These are interesting ideas.

The biggest challenge now is to follow through. In this Decade of Vaccines, we have an unprecedented global momentum to propel this national awakening. We need to take action now to build the future we desire. What a wonderful future we will build if in the next ten years, we can scale up coverage of key vaccines against Hib, pneumococcus, rotavirus, measles and pertussis, to 90%! We can save over 600,000 lives and avert 17 billion dollars in cost and productivity loss. Come on, one and all, let’s rally for vaccines.

Dr. Chizoba Wonodi, MD PhD, is an Epidemiologist at The International Vaccine Access Center

By Dan Thomas

Have you ever been to the movies and seen a trailer for a film that you previously had no interest in seeing and then suddenly thought to yourself “That is a film I CANNOT MISS”?

That was the idea behind GAVI’s most recent production. It’s a three-minute film by a talented young American film maker called Ryan Youngblood that I stumbled across in Kigali one day and I think he and producer Doune Porter more than fulfilled their brief.

On April 26, during WHO’s first-ever World Immunization Week, Ghana will introduce not just one but two new vaccines into its immunisation programme.

The pneumococcal and rotavirus vaccines will protect infants against the leading causes of the two biggest killers of children in Ghana and throughout the developing world – pneumonia and diarrhea.

The GAVI Alliance and our partners UNICEF andWHO are working with Ghana’s Ministry of Health to plan a massive celebration in Accra at which the first children will be vaccinated.

On the same day, halfway across the world in Atlanta, Georgia, USA, our friends at the UN Foundation will be launching the Shot@Life campaign to encourage the American public to champion vaccines as one of the most cost-effective ways to save children’s lives around the world.

It’s such an exciting time to be working in global health and, as more and more power brokers embrace the value of investing in people’s health, we are literally seeing progress across the world on a daily basis.

As you can imagine, back in Ghana our colleagues are feeling more than a little pressure and this film brilliantly captures the careful, methodical planning process that is involved in introducing new vaccines into the national health programme.

It also portrays the skill, wit and energy that Ghanaian health professionals are investing in this extraordinary initiative.

Like the best movie trailers, our little film has all the right ingredients to get you interested in wanting to know what happens next:  handsome men, beautiful women, tragedy, suspense, despair, hope and raw determination!

Watch it now, you won’t be disappointed. (It's also available in French and German)

Dan Thomas is Head of Media and Communications at the GAVI Alliance, a public-private partnership which aims to save children’s lives and protect people’s health by increasing access to vaccines in the world’s poorest countries.

By Lois Privor-Dumm

This is a moment we have been cautiously optimistic about. Was today going to finally be the day? Friday the 13th is not an unlucky day this year – it is the day that India has gone one year without a single new case of poliovirus!  Every time I look out the window as I’m driving around India, I witness the all-too-common sight of someone suffering the debilitating effects of the disease.  That image is a reminder about how horrible this disease is and that polio’s impact is not just on the individual, but a whole nation.

A man who contracted polio walks on crutches in the village of Kosi, 113 miles from Patna, India. Photo by Altaf Qadri / AP.

The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, there was just a single new case in 18-month old named Rukhsar from West Bengal. It was a heartbreaking occurrence, but efforts persevered.

I am struck by the level of effort committed to this goal: government, civil society and international organizations including WHO, the National Polio Surveillance Project (NPSP) based in Delhi, UNICEF, CDC and Rotary are all laser-focused on making sure that kids even in the hardest to reach places were immunized. The Bill & Melinda Gates Foundation is also instrumental in these efforts. It was no easy feat, as we’ve seen in other polio-endemic countries including Nigeria, Pakistan and Afghanistan. India was considered one of the toughest countries to tackle, making this effort all the more impressive.

History of Polio Case Numbers in India

The infrastructure requires an enormous amount of coordination with stakeholders who were not part of the government or its partners. Civil society, including community and religious leaders, NGOs and others all needed to be engaged. The outcome of polio eradication efforts is not just the achievement of interrupting transmission, but the commitment that is gained by those involved in disease prevention efforts. I don’t work directly on polio, but I recognize the benefits of building an understanding of the value of vaccines, creating a system that can handle the supply chain, monitoring and evaluation and constant communication. On a recent GAVI consultation visit to India, I was very happy to hear that the discussion was about how we can leverage the infrastructure created by the polio efforts.

It is important that we learn the lessons from polio and leverage the best practices, not only in India, but in other large countries like Nigeria, where stopping Polio is also within reach. One of the biggest lessons is that there are a lot of stakeholders that contribute to a successful vaccine program – it takes a village. The government plays a big role, but it is the community, that will directly determine success. 

Building an understanding of what can be achieved, and helping to implement the strategies that can lead to that success, are ways that the IVAC team is privileged make contributions. We are all working towards the goal of improved health for people in countries like India and Nigeria. Today’s milestone inspires others to act in ways that can help not only polio eradication efforts, but disease prevention and control efforts more broadly. One year without a new case of polio in India is an important milestone, but as we continue to make great strides around the world, our best years are ahead of us.

Lois Privor-Dumm is the Director of Alliances and Information at IVAC.

By Dr. Mathu Santosham

The first baby to be vaccinated today is a young girl named Ardra. Pentavalent vaccine launches were organised in all the 14 districts of Kerala today. About 500 to 600 babies were vaccinated per district. Photo courtesy of Mercy Ahun.


As a pediatrician who has dealt with Haemophilus influenzae type b (Hib) disease for over 40 years, it is heartening to see that the Hib vaccine will soon be available to the poorest children in at least two states in India.

I have seen the devastating consequences of Hib pneumonia and meningitis - Hib is estimated to cause 20% of all severe pneumonias in children. If untreated or if treatment is delayed, there is considerable risk of the child dying. Hib vaccines have been available in affluent countries for over 20 years. They have also been available for children from affluent families in India for several years, but until recently have not been available to the poorest children. Unfortunately, it is the poorest children who are at highest risk for death from this disease because of poor access to health care. It is wonderful to know that at least some of the poor children in India will soon have access to this vaccine.

In addition to pneumonia, Hib also causes meningitis. As a pediatrician, I have cared for many children with this disease. Prior to the availability of Hib vaccines, meningitis was one of the diseases feared most by pediatricians in the western world. In addition to causing death in up to 50% of infants with the disease, meningitis can cause severe neurological problems such as paralysis, deafness, and blindness in approximately 40% of cases. The consequences of meningitis can take a major toll on the social and financial wellbeing of the child as well as the family.

The Government of India has many competing priorities to consider in allocating money for health care of the over 26 million children who are born each year. It is commendable that the Indian Government has made the prevention of this dreadful disease a major priority through the use of the Hib vaccine. It is my sincere hope that this vaccine will soon be available to all children in India.

Dr. Mathu Santosham is the Director of the Center for American Indian Health