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This article was originally published on the Dengue Vaccine Initiative website and is cross-posted here with permission. IVAC is a member of the Dengue Vaccine Initiative (DVI). 

On December 9 2015, Mexico approved Sanofi Pasteur’s dengue vaccine marking the first time a dengue vaccine has been licensed for use in a country. Called Dengvaxia® and developed by the French pharmaceutical company, Sanofi Pasteur, the vaccine was approved for people aged 9 to 45 years in areas that are highly endemic, with a dengue seroprevalence of more than 60 percent.

The Dengue Vaccine Initiative (DVI) views Mexico’s licensure of Dengvaxia® as an important milestone in the fight against dengue. Recent studies have demonstrated that in children and adolescents aged 9 years and above, Dengvaxia® reduces dengue cases overall by approximately 65 percent; dengue cases requiring hospitalization by 81 percent; and severe dengue cases by 93 percent. The vaccine’s efficacy was most apparent in individuals with evidence of prior dengue virus exposure. In children below the age of 9 years and in those with no evidence of prior dengue, the vaccine’s efficacy was substantially lower. There was also an increased risk of cases requiring hospitalization during the third year after vaccine initiation in children under 9.

These results suggest that Dengvaxia® may have significant public health impact in reducing dengue disease burden for people 9 years of age and older, especially in areas with existing high infection rates of dengue. Questions remain regarding Dengvaxia®, including duration of protection, price, and impact on overall dengue virus transmission given that the youngest age groups will not be vaccinated. These and other issues will have to be closely followed in order to ascertain the ultimate impact of this vaccine.

Dengue, also known as “breakbone fever,” is caused by a virus transmitted by Aedes mosquitoes, the same mosquitoes that can transmit chikungunya and Zika virus. Dengue virus causes approximately 400 million infections globally each year. In the Americas alone, dengue’s economic burden has been estimated to cost $2.1 billion dollars a year.

DVI believes that this first vaccine licensure in a dengue-endemic country may pave the way for other countries considering new technologies to fight dengue, but stresses that the decision to introduce a dengue vaccine should follow scientific evidence. Following registration, ministries of health will still face important decisions about whether and how to introduce the vaccine into national programs. These decisions may vary according to the specific demographic characteristics, dengue epidemiology and the capacity of public health systems of each country. Therefore, DVI continues to strongly support increasing efforts to improve endemic countries’ access to the evidence needed to inform vaccine introduction decisions.

DVI also welcomes the decision by Mexico as an opportunity to increase our understanding of the questions raised above, as well as the effectiveness of the vaccine in field conditions. DVI recognizes the importance of effective integration of dengue prevention and control strategies, notably vaccination and vector-control approaches, to comprehensively reduce dengue. DVI also encourages the global health community to facilitate and support mechanisms for regional knowledge transfers and information sharing among endemic countries to collectively fight dengue and other vector-borne diseases that are also on the rise. We hope this development spurs other vaccine candidates currently in clinical development to continue to progress in the pipeline.

About the Dengue Vaccine Initiative
The Dengue Vaccine Initiative is an international consortium of the International Vaccine Institute, the World Health Organization Initiative for Vaccine Research, the International Vaccine Access Center at the Johns Hopkins University Bloomberg School of Public Health and the Sabin Vaccine Institute that specializes in research, health economics, policy and advocacy to equip countries with objective information and scientific evidence to fight dengue fever. The Initiative is supported by the Bill & Melinda Gates Foundation.

This article was originally published on Global Health Now and is cross-posted here with permission.

By: Dr. Mathuram Santosham

A healthy child in Uttar Pradesh, India, 2010 © Gates Foundation

World Immunization Week provides a moment to reflect on the tremendous progress in reducing one of the world’s leading killers of children—diarrhea.

While oral rehydration solution has significantly reduced diarrheal disease mortality since its adoption in 1978, diarrhea continues to be a major cause of childhood illness and death globally. Rotavirus, the most common cause of severe diarrhea, is responsible for approximately 40% of all diarrhea hospitalizations and hundreds of thousands of deaths in children under 5.

Rotavirus vaccines offer the best protection for children and are an essential part of comprehensive diarrhea control. While the WHO recommends that all countries introduce rotavirus vaccines, only 77 have done so, 34 of which are Gavi-eligible countries where many of the deaths occur. Unfortunately, some of the most vulnerable children and communities do not have access to the vaccine.

In particular, Asia has lagged in introducing rotavirus vaccines, even though it accounts for more than 40% of global rotavirus deaths. To date, no country in the region has introduced the vaccine into its national immunization program.

While dramatic reductions in deaths from childhood diarrheal disease have been achieved in Bangladesh, there are still more than 2.4 million rotavirus cases each year. It causes 2 out of every 3 diarrhea-related hospitalizations among children under 5. There are also serious economic consequences. One episode of rotavirus costs the average Bangladeshi family about USD $80 in direct hospital costs, a significant portion of average monthly income.

In neighboring India, where rotavirus is equally ubiquitous, the disease poses a significant financial burden to families and the country’s economy. Studies have shown that a hospitalization for rotavirus could potentially push a family into poverty or keep them there. Depending on the level of care, the total cost of a rotavirus hospitalization could range anywhere from nearly $32 to more than $135, equal to up to 2 months of income for an average Indian family. Rotavirus also burdens the healthcare system with the high cost of hospitalizations and outpatient visits. One study estimated that hospitalizations and outpatient visits cost India approximately $78 million and $86 million each year, respectively—each more than the estimated $72 million it would cost to fund a rotavirus immunization program.

For fast-growing countries like India and Bangladesh, tackling rotavirus—which cheats children and the nation of productivity, well-being and development—should be a priority. However, the available and effective rotavirus vaccines are not yet available in the national immunization programs of either country. 

Many of my scientific colleagues in Bangladesh are making a good case to their leaders for national introduction of rotavirus vaccines. And, I’m inspired by the strides being made in India. Last July, Prime Minister Narendra Modi announced that rotavirus will be included in the Universal Immunization Programme; and just last month, the first India-made rotavirus vaccine, ROTAVAC, was launched. Now is the time to get to the finish line—the cost of delaying access to rotavirus vaccines continues to mount. Together we can close this immunization gap and virtually eliminate rotavirus.

Dr. Mathuram Santosham is the Director of the Center for American Indian Health, Chair of the ROTA Council, and Senior Advisor at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. Dr. Santosham and his colleagues won an Honorable Mention in GHN's Untold Global Health Stories Contest for their submission of rotavirus in Bangladesh and India. GHN will feature one Honorable Mention story per month from now until the next contest in early 2016.

This post originally appeared on the VaccinesWork blog and is cross-posted here with permission.

By Huma Khawar

In 2012, Pakistan was the first South Asian country to introduce the pneumococcal vaccine with Gavi support. Provided free of charge to children under the age of five, the vaccine protects against a major cause of pneumonia, a disease that is a major killer of children worldwide. But in order for any vaccine programme to be successful, information and support are essential. And where do many people get their information? The media.

Pakistan Media Session

The question and answer session in action. Photo: Huma Khawar

Dr Taimoor Shah, Deputy Director Khyber Pakhtunkhaw province’s Expanded Programme on Immunization (EPI), knows this well. On World Pneumonia Day last November, he took the opportunity to gather a room full of journalists of all backgrounds at the Press Club in Peshawar, to talk specifically about the pneumococcal vaccine and to answer their questions. 

The result was a discussion that sounded more like a medical classroom than a group of reporters. How many vaccines are included in a child’s immunisation programme? What are the diseases that can be prevented through immunisation? How expensive is the pneumonia injection? It was difficult to decide whether to feel surprise at the lack of awareness among the media about vaccine preventable diseases or to be happy at the eagerness and genuine interest expressed in the reasons for Pakistan’s high rates of child mortality.  

The session was both informal and interactive. Journalists from different organisations suggested ways to educate people on vaccination and eradication of fatal diseases through media messages. They concluded that it was the common duty of parents, government health institutions, media and civil society to take steps for overcoming health issues through vaccination and timely treatment. 

One journalist confessed that although he knew all about how and when to give the different vaccinations, he didn’t know the importance of each. ”It will be easier, he said, to convince mothers on the importance of getting their babies immunised.”  

The session also gave the health journalists an opportunity to express their own opinions and share insights. They talked openly about how, over the years, with so much money and emphasis directed towards polio eradication, routine immunisation had taken a backseat.    

By the end of the session, some 30 plus media personnel had learned much more about vaccines and routine immunisation. One digital reporter admitted that this type of question and answer sessions was essential as a vast majority of journalists have limited knowledge of vaccines and their potential. 

“A lot of mothers get their information from newspapers. Media should be up to date. If their knowledge is suspect, they will pass on wrong information to parents. This can be very dangerous,” he said.

And in a country where each year one in twelve children born die before reaching the age of five, many of them due to vaccine-preventable diseases, spreading this newfound knowledge can only be a good thing. 

media event in Pakistan card

Photo: Humar Khawar

Huma Khawar is a freelance journalist and IVAC communications consultant who works in Pakistan.


Huma Khawar

Huma Khawar is a freelance journalist and IVAC communications consultant who works in Pakistan.

This post originally appeared on the VaccinesWork blog and is cross-posted here with permission.

Vaccine implementation requires policy and community-level approaches to ensure on the one hand that vaccines are available and on the other hand that parents bring their children to be immunized. Two events held in Pakistan this year on World Pneumonia Day illustrate the importance of these approaches.

On the eve of World Pneumonia Day, as a joint initiative of the communications team at the Federal Expanded Program on Immunization (EPI), which includes Pakistan’s EPI and partners from Gavi, UNICEF, and Japan’s International Cooperation Agency, a meeting with members of Provincial Assembly of Sindh was held to discuss immunization, not just for pneumonia but the entire routine immunization program and polio, which is of course a top priority for the country.


More than 70 members of the Sindh Assembly attended. Deputy Speaker Syeda Shehla Raza opened the meeting, followed by remarks by Ms. Ayesha Raza Farooq,  Coordinator Prime Minister’s Polio Cell, who spoke about the role of the Federal government in routine immunization and the Prime Minister’s commitment to the cause. Ms. Shahnaz Wazir Ali, Provincial Coordinator for public and primary health care programme, spoke about the current status of polio and routine immunization in Sindh, where vaccine coverage levels are very low. Members expressed their concern about the overall 29% coverage of routine immunization in the province and recommended legislation on compulsory immunization to improve the current state of the coverage. The meeting concluded with a declaration presented by Syeda Shehla Raza on behalf of all members in support of Immunization and Polio Eradication Program.

The next day, in Islamabad, the capital city of Pakistan, civil society organizations working with Expanded Programme on Immunization and Civil Society Human and institutional Development Program held an awareness raising event in a minority slum community. More than 120 children and their mothers participated. The event included a puppet show that gave the children information about immunization, followed by a quiz with prizes awarded. The children also enjoyed face painting and games while an EPI vaccinator administered PCV 10 to children who had previously been missed in the community.

Many other organizations across Pakistan took advantage of the day to draw attention to pneumonia, which kills more than 100,000 children in Pakistan each year and sickens many more.


Above: the one day event for under privileged children in Islamabad, Pakistan. Messages on pneumonia and other preventable diseases were given by doctors to children and their mothers. A quiz competition on vaccine preventable diseases and a puppet show was also part of the event. 

Photo: Huma Khawar

Inactivated Polio Vaccine and Its Role in Eradication Plan

By Lois Privor-Dumm

It’s been just under a decade since the focus of my work shifted to resource-constrained countries. At the time, it seemed a far-off dream that so much progress could be made in protecting children from vaccine-preventable diseases. Eradication efforts had only ever succeeded against one disease – smallpox – and there were still many cases of polio in endemic countries (which at the time were Afghanistan, India, Nigeria, and Pakistan). Immunization was discussed, but never received the focus it does today. Now, on this World Polio Day, I reflect on where the world was and where it is today - closer than ever to reaching a goal of ending polio for good – AND doing it while strengthening immunization programs that have been all too weak in the past.


The rollout of IPV in the Philippines was marked by a ceremony attended by several health dignitaries including the Secretary of Health, Enrique Ona, the Undersecretary of Health, Jeanette Garin and the Assistant Secretary of Health Enrique Tayag among other high-ranking officials.


In 1988, when the Global Polio Eradication Initiative (GPEI) began, polio paralyzed more than 1,000 children worldwide every day. Today thanks to millions of volunteers more than 2.5 billion children have been immunized against polio. Global immunization campaigns have reduced polio by 99% worldwide. Eradication is within reach.

This year kicked off with a huge milestone, with India being declared polio-free in January, leaving just three countries with ongoing transmission. While Pakistan faces many challenges and has seen an increase in polio cases this year, Nigeria has had the fewest cases of wild poliovirus ever, with just six cases so far this year, and Afghanistan’s burden also remains low with just 12 cases this year.

Another important step forward was taken this year as countries began introducing inactivated poliovirus vaccine (IPV), an important milestone in the Polio Eradication and Endgame Strategic Plan, an ambitious but achievable plan endorsed by the World Health Assembly in 2013. The plan calls on countries to introduce at least one dose of IPV into routine immunization schedules and gradually withdraw all oral polio vaccines (OPV). Until now, OPV has been the primary tool in the global polio eradication effort, and has been instrumental to achieving the reach necessary to eliminate polio from all but three countries, and to reduce cases to a mere fraction of historic trends in Nigeria, Pakistan, and Afghanistan. However, new evidence now clearly demonstrates that adding one dose of IPV to multiple doses of OPV is the most effective method available to stop the virus and protect children.

The amazing part is that countries are introducing IPV along with other important new vaccines. In September, Nepal became the first country to introduce IPV with Gavi support. Gavi-supported rollouts will continue, as more than 90% of Gavi-eligible countries have applied for support. Next month, Nepal is also expected to introduce pneumococcal conjugate vaccine. Gone are the days when countries have to wait years between vaccine introductions. In fact, in 2014, five countries have introduced more than one vaccine already, and nearly 15 more multiple introductions are planned for next year, accelerating the path to reducing both child death and severe illness.

But it’s not only Gavi supported countries that are making strides. Middle-income countries, where most of the world’s poor reside, are also recognizing the importance of IPV and making the investment to introduce this and other new vaccines. Earlier this month, the Philippines became one of the first non-GAVI countries to start the transition from an all-OPV schedule to add one dose of IPV. The global rollout of IPV will continue across 126 countries through the end of 2015.

IVAC is proud to be part of the global efforts to help eradicate polio and support the introduction of new vaccines through targeted advocacy efforts in middle-income countries, helping to engage and sensitize civil society, and supporting communications activities of partners. It is a big job ahead, but with committed governments, partners and advocates, we now know it is possible. The hard part of our job as advocates is just beginning, but we look forward to more milestones in the fight against polio in the coming year, as the finish line gets closer.


Lois Privor-Dumm, MIBS, is Director of Policy, Advocacy & Communications