The Decade of Vaccines Collaboration: developing a global roadmap for saving lives

Keywords::

• Bill & Melinda Gates Foundation
• Decade of Vaccines
• diphtheria–tetanus–pertussis
• GAVI
• Hib
• PATH
• pediatric vaccines
• vaccines

Written by Lauren Constable (Commissioning Editor) based on a conversation with Dr Christopher Elias, President and CEO, PATH, and Co-chair, Decade of Vaccines Collaboration.

Pediatric vaccination, developing countries & the past 10 years

Over the last decade, all countries have benefited from increased investments in immunization. More children are immunized against more diseases than ever before, thanks to scientific breakthroughs, such as pneumococcal and rotavirus vaccines, as well as a growing political will to increase access to immunization for all people, regardless of where they live.

In the past 10 years, the GAVI Alliance has helped to raise the profile of immunization through its work to provide access to new and underused vaccines in the world’s poorest countries. Rich and poor countries alike have invested unprecedented resources to strengthen health systems and expand immunization programs; these investments have paid great dividends.

For example, approximately 10 years ago, when GAVI was just getting started, most GAVI-eligible countries (countries with a GDP of US$1000 per person/per year of life [1]) had yet to introduce the hepatitis B vaccine, despite the vaccine being available from the 1980s. With GAVI we saw the introduction of both the hepatitis B vaccine along with the Haemophilus influenzae type b (Hib) vaccine, which had proven itself in reducing childhood bacterial meningitis and pneumonia in industrialized countries [2]. Thanks to the introduction of hepatitis B and Hib vaccines, as well as investments in immunization against pertussis (whooping cough), measles, polio and yellow fever, more than 5 million deaths have been prevented in GAVI’s first decade [3].

The progress both in coverage of existing childhood vaccines and the introduction of new vaccines has been incredible. By the end of the first decade of GAVI we saw the rotavirus vaccine essentially being launched in developing countries in the same year that it was introduced in the USA. This is the first time a vaccine has become available in the USA and in a GAVI-eligible country in the same year and this project is moving along well [4]. In addition, we have seen real accomplishments in the acceleration of vaccine introduction and the shortening of the length of time between when vaccines become available in wealthy countries and when their introduction begins in developing countries.

When we look into what enabled this we can see that a changing variable in the past decade was the level of political commitment to using vaccines and immunization as highly cost-effective tools for improving public health. Momentum in the last few years has indeed been tremendous but we are not yet finished; there is more work to be done.

What needs to be done in the next decade?

Coverage rates of currently available pediatric vaccines are high; global coverage of infants in 2009 with the diphtheria–tetanus–pertussis vaccine was 82% [5]. However, hurdles remain with regards to vaccinating the last 20%. These include location, children living in either remote or conflict-ridden countries and, of course, a shortage of resources. Very few public health interventions can boast an 80% coverage rate but, given how cost–effective vaccines are, we need to meet this challenge. That is a priority for the next decade.

In addition to increasing coverage of vaccines already administered in the developing world, we also need to begin or increase the rate of introduction of some of the new and very effective vaccines for rotavirus and pneumococcal disease. These diseases are two of the biggest killers of children under 5 years of age; in 2008 pneumonia and diarrheal diseases accounted for 18 and 15%, respectively, of all deaths in this age group [6]. For previous vaccines, such as hepatitis B and Hib, there was a gap of more than a decade between introduction in industrialized countries and their use in developing countries. While we are shrinking that gap, we need to move faster. Most countries are just gearing up to introduce pneumococcal and rotavirus vaccines, and while families wait for this vaccine, lives are lost.

In its most recent round of country proposals, GAVI received 75 applications from 50 countries, the majority of which were to introduce rotavirus and pneumococcal vaccines [7], and with a successful replenishment conference GAVI now has the resources to do that. In the next decade we need to accelerate the introduction of these new and highly effective vaccines while at the same time preparing for the next generation of vaccines. For example, we are optimistic that within this decade we will have the first malaria vaccine. In addition, given exciting advancements in our understanding of the immune system and the new targets coming out of genomics and proteomics, we may soon be able to develop vaccines tailored to meet the needs of countries, not just for this next decade but for the decades beyond.

The Decade of Vaccines Collaboration

At the World Economic Forum in 2010, the Bill & Melinda Gates Foundation issued a call for a ‘Decade of vaccines’ and pledged US$10 billion over the next 10 years from their foundation towards this goal [8]. However, they understood that, despite this substantial donation, this amount would not be sufficient if we really are going to both optimize and maximize the public health impact that vaccines and immunization can deliver. More development partners and more money would be needed. After the Gates Foundation issued their call, the WHO and UNICEF joined the cause, with the aim of using the next decade to bring the benefits of vaccines to all children no matter where they live. In meeting this goal the aforementioned groups along with the National Institute of Allergy and Infectious Disease (USA) formed a leadership council for what is now called the Decades of Vaccines Collaboration. The leadership council that guides this effort comprises Rajeev Venkayya (Director, Global Health Vaccine Delivery at the Bill & Melinda Gates Foundation), Anthony Lake (Executive Director for UNICEF), Margaret Chan (Director General of the WHO), Anthony Fauci (Director of NIAID, part of the National Institutes of Health) and Joy Phumaphi (Chair of the International Advisory Committee and Executive Secretary, African Leaders Malaria Alliance). The leadership council recruited Pedro Alonso (Director of the Institute for Global Health of Barcelona) and Christopher Elias (PATH) to co-chair the 17-person steering committee, which is charged with developing a roadmap for the next decade on how best to save lives using vaccines. These groups represent a broad cross-section of the vaccine and immunization community and include:

• • Nicole Bates (Senior Program Officer, Global Health Policy and Advocacy, Bill & Melinda Gates Foundation)

• • Seth Berkley (CEO, GAVI Alliance)

• • Zulfiqar Bhutta (Founding Chair, Division of Women and Child Health, Aga Khan University)

• • Lola Dare (CEO, Centre for Health Sciences Training, Research and Development International)

• • Helen Evans (Deputy CEO, GAVI Alliance)

• • Lee Hall (Chief, Parasitology and International Programs Branch, Division of Microbiology and Infectious Diseases, NIAID)

• • T Jacob John (Professor and Head, Departments of Clinical Microbiology and Virology, Christian Medical College, Vellore, India [Retired])

• • Orin Levine (Executive Director, International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health)

• • Jean-Marie Okwo-Bele (Director, WHO Department of Immunization, Vaccines and Biologicals)

• • Ciro de Quadros (Executive Vice President, Sabin Vaccine Institute)

• • David Salisbury (Director of Immunization, UK Department of Health)

• • Anne Schuchat (Director, National Center for Immunization and Respiratory Diseases, CDC)

• • Peter A Singer (Director, McLaughlin-Rotman Centre for Global Health, University of Toronto)

• • Lucky Slamet (Deputy for Therapeutic Products, Narcotic, Psychotropic and Addictive Substance Control, National Agency of Drug and Food Control, Indonesia)

• • Gina Tambini (Area Manager, Family and Community Health, PAHO)

• • Jos Vandelaer (Chief, Immunization, Programme Division, UNICEF)

• • Sandy Wrobel (CEO and Managing Director, Applied Strategies)

The work of putting together the global strategy is focused on four primary areas: research and development; delivery of vaccines; public and political support; and global access – looking at supply, pricing and sustainable financing of the vaccines. The aim of the global strategy is to determine and gain consensus on the priorities of the global immunization community for the next decade. A global consultation process is launching to engage experts from civil society organizations, governments, academics and the private sector including pharmaceuticals, biotechnology companies and manufacturers of vaccines from developing countries. We expect to engage a diverse group of stakeholders from all over the world to help us develop a strategy that will be presented to the World Health Assembly in Geneva, Switzerland for review, discussion and, hopefully, endorsement.

Impact of the Decade of Vaccines Collaboration on pediatric vaccination in the next decade

As we consider the global strategy it becomes apparent that there are a number of strategic areas where the good work of the past decade needs to be continued, strengthened and better resourced for the next decade. We have seen a significant increase in coverage rates in the last decade [5]. Globally, between 1990 and 2009, diphtheria–tetanus–pertussis coverage increased from 75 to 82%, polio from 75 to 83%, and measles from 73 to 82%. We need to keep that momentum going and extend it to achieve universal coverage against vaccine-preventable disease. At the same time, there are a number of what we are tentatively calling ‘transformative actions’ that are needed if we are to meet our goals. One is to stimulate more demand for vaccines. We need to help communities and families understand the value of vaccines. It has become increasingly apparent worldwide that vaccines have the same problem a lot of prevention approaches have; as the problem goes away it is hard to remember that it was ever there. We must prevent this complacency by building demand from individuals, families and communities for access to immunization as a human right.

We need to bring about broader coverage, little or no delay between when a vaccine becomes available in rich countries and when it becomes available to children in poor countries, and an optimized scientific enterprise to apply the burgeoning innovation and discoveries to the development of affordable, high quality and safe vaccines needed by people in both poorer countries as well as in middle-income and rich countries.

Financial & competing interests disclosure

Chris Elias is President and CEO of PATH. PATH is a nonprofit, non-governmental organization whose mission is to improve the health of people around the world by advancing technologies, strengthening systems, and encouraging healthy behaviors. As such, PATH receives funding from a variety of sources and has agreements and collaborations with various parties involved in global health, including governments, academic institutions, nonprofit, non-governmental organizations, and for-profit enterprises. Since PATH works in the field of vaccine development to further its mission, it works with numerous parties including developing country and international pharmaceutical and biotechnology companies. Elias has no financial or other interest in the publication or in any company related to vaccines. Furthermore, Elias serves as the co-chair of the Decades of Vaccine Collaboration, which is funded by a grant from the Bill and Melinda Gates Foundation. Elias also serves on the boards of a number of non-profit organizations involved in global health. Chris Elias has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.