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Wednesday, September 23, 2020
Joshua Kyalimpa and Terna Gyuse
KAMPALA, Jun 14 2011 (IPS) - GAVI, the Global Alliance for Vaccinations and Immunisation, secured pledges of 4.3 billion dollars from donors in London on Jun. 13 with the aim of securing funding to ensure life-saving vaccinations for every child on the planet.
As many as two million children – overwhelmingly in low-income countries – die each year from diseases which could be prevented by vaccinations such as pneumonia and diarrhoea. GAVI’s programmes have already immunised well over a quarter million children in the past 10 years, and if the pledges from the London conference are honoured, the money will allow the alliance to reach a further 243 million by 2015.
Entering an age of immunisation
Thanks in large part to GAVI, the past decade has seen renewed attention to developing vaccines against diseases affecting the world’s poorest, including meningitis, pneumococcal disease and malaria.
Among the organisations whose investments have supported a breakthrough in prevention of one of the world’s most dangerous diseases is the Malaria Vaccine Initiative (MVI), a global programme of the independent non-governmental organisation PATH.
Malaria vaccines are a long-overdue means to prevent infection and work towards eradication of the disease. The eradication of malaria in the developed world has been cited as one reason developing a vaccine previously received little attention from pharmaceutical companies or government research facilities.
The debut of a first vaccine against malaria, for example, could now be less than five years away – final testing is under way in seven countries.
Yet developing an effective vaccine is only part of the challenge – effectively integrating it into public health will require careful planning and execution.
The recent history of Africa’s immunisation programmes – from the re-emergence of polio in West and Central Africa, to the persistence of meningitis and infant pneumonia – is littered with promising solutions that have failed to have the expected impact. Against a background of poverty and conflict, vaccination campaigns have been hampered by weak infrastructure, insufficient staff or funding, and even popular resistance to vaccinations.
Across the continent, there is new attention to the practical requirements of effective immunisation campaigns. Dr Seraphine Adibaku, head of Uganda’s malaria control programme, says his country has already started raising popular awareness of the coming availability of a malaria vaccine, with the most recent meeting of officials from the ministry of health and developers of the vaccine and other stake holders held in May.
“We are conscious not to cause excitement because it can lead to undesirable consequences but we have to tell the people that a vaccine could be here sooner than later,” says Adibaku.
Uganda is banking on using infrastructure like ware houses and refrigerators from the Uganda National Expanded Program on Immunisation, which is already in place and has been used on previous immunisation programmes, to roll out the malaria vaccine. Adibaku says training will be given to vaccinators on handling the new vaccine with funding from GAVI, all of which shall be in line with the national vaccination policy.
Adibaku has questions about the vaccine: “We do not know yet for how long the vaccine will offer protection. Do you get protection for six months, one year, or for the rest of your life? These are some on the questions not answered yet.”
He says for a vaccine to be effective, it should offer a high level of protection – between 80 and 90 percent – provide long-lasting resistance, and be affordable.
New resolve to get it right
The London conference on funding for vaccines is an important signal that the value of immunisation programmes is understood by both donors and governments seeking assistance.
“When GAVI got started, it was something that had never been tried before,” says Dr Helen Saxenian, from the Results for Development Institute.
“The idea was that prices would fall (once large-scale demand for vaccines was created) and so some countries would be able to afford them without assistance. GAVI quickly realised prices were not – and are not – falling fast enough, and realised the alliance would need to be involved with subsidising vaccines for a longer period of time.”
The reasons vaccine prices have not fallen include the cost and complexity of producing newer vaccines, as well as limited competition between a very small number of producers; but Saxenian points out that there have been some successes, notably for the rotavirus and pentavalent vaccines.
In 2008, GAVI introduced a requirement for recipients of assistance to co-finance the procurement of vaccines. The Results for Development Institute recently evaluated GAVI’s policy on co-payment, to assess the ability of countries receiving assistance to cover their share of the costs.
“The finding,” says Saxenian, “is that low-income countries will not be able to pay the full cost of vaccines any time soon. However co-payments (from national budgets) at 20 cents per dose would be affordable for almost all countries.”
Shared responsibility maximising impact
She argues that the co-financing requirement has been a valuable learning process for all involved. It has strengthened forward planning by national health ministries, communication between health ministries and finance ministers who must make appropriate and timely allocations from national budgets, and between various countries and the UNICEF Supply Division, through which all of Africa’s GAVI aid recipients purchase vaccines to meet their obligations.
Aid recipients have said that they prefer to contribute part of the cost of paying for vaccines, says Saxenian. “Immunisation managers would like to see national budgets for vaccinations grow. It’s a key priority for healthcare, and since one can’t assume that donor assistance will last forever, they would like to see national budgets for it grow,” she told IPS over the phone from the United States.
“A basic way of thinking about this is that if something is completely free, there’s not as much of a sense of ownership as when you’re paying for even part of it. When it’s free, then countries may think, I’ll take it, whether they’re ready or not to adopt it.”
Adibaku says that when one considers the cost of Malaria to the national economy, Uganda should be able to contribute to the vaccination programme but if it is within the range of what they have been spending on the disease
Developing countries could be required to make substantial contributions towards a malaria vaccine but this could be a worthwhile investment considering the amount of money the economy looses because of their illness.
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