New technologies boost immunisation rates, safety

As global health leaders struggle to meet the United Nations goal of reducing mortality among the world's poorest children, vaccines are attracting more and more attention. The purchase of the vaccine is just the beginning, however, as the effectiveness of a vaccine is only as good as its delivery system.

According to a recent series of reports from PATH's Children's Vaccine Program (CVP), it is possible to rapidly introduce new vaccines and dramatically improve both immunization rates and injection safety practices.

CVP's experience in the field demonstrates that simple and effective technologies and management strategies enhance the success of developing countries' efforts to promote immunization-shown to be one of the most cost-effective health interventions. The series of papers released this month describe what it takes to immunize and improve immunization safety for children in developing countries of Africa and Asia.

"The Children's Vaccine Program has been a valuable partner in revitalizing global and local attention to immunization," said Carol Bellamy, Executive Director of UNICEF. "CVP has been a key advocate in supporting the introduction of new and needed vaccines in developing countries. We applaud their commitment to work in new and innovative ways."

The Children's Vaccine Program was launched in December 1998 through a major grant to PATH from the Bill & Melinda Gates Foundation. CVP was a founding member of the Global Alliance for Vaccines and Immunization (GAVI), and has worked with The Vaccine Fund to catalyze support for immunization.

PATH's CVP covers nearly six years of working both globally and with national governments in enhancing the effectiveness of immunization programs in countries such as Cambodia, China, India, Indonesia, and Senegal. The reports profile proven methods of addressing the devastating burden of vaccine-preventable disease in developing countries. They are available on the CVP website.

PATH promotes innovative technologies and techniques to improve the performance of immunization systems. Examples include improving management and logistics to increase immunization coverage and improve delivery of vaccine, and use of technologies that reduce the dangers posed by used needles and other immunization waste products. One such technology-the auto-disable or AD syringe, a syringe that can only be used once-prevents re-use and the spread of infection. AD syringes are now used to deliver all vaccines in 75 of the poorest countries in the world. These innovations help to improve health systems.

"Our approach is to work with local colleagues to design and test promising approaches for delivering vaccines at a community or state level, then to encourage our partners-national governments and health agencies-to replicate these successes, first nationally and then internationally," said CVP Director Mark Kane.

In some areas, such as in West Africa, the results have been dramatic: Senegal, for example, reports that two regions where CVP worked in the north-St. Louis and Matam-experienced a 40 percent jump in the number of children immunized against diphtheria, pertussis and tetanus; now, more than 80 percent of the children are protected against these and other diseases. In Andhra Pradesh, a heavily populated state in southeastern India, the introduction of the hepatitis B vaccine state-wide was achieved in only 30 months-more than two years ahead of schedule. And the Indian government has decided to make safe injections part of its official national policy in 2005.

Dr. Y.S. Rajashekar Reddy, the new Chief Minister of Andhra Pradesh (AP) in India, has announced his commitment to improving AP's health systems. "Towards this end," he said, "We appreciate the role of [the] Children's Vaccine Program in mainstreaming new vaccines and technologies and motivating health workers at all levels."

Vaccines and the technologies and management techniques that streamline immunization services are desperately needed in the world's poorest countries, where vaccine-preventable diseases kill as many as one out of every six children. By focusing on developing countries such as those with among the largest populations and the greatest burden of disease-India, China and Indonesia-CVP has had a considerable impact.

"The Children's Vaccine Program continues to make amazing contributions to GAVI. When we need them, they are there," said Tore Godal, Executive Secretary of GAVI, a partnership that includes UNICEF, the World Health Organization, and the World Bank, among other members. "CVP has a keen ability to anticipate challenges and problems."

PATH's CVP has, through its health partnerships at the country level, continued to foster health system strengthening. In Indonesia and Vietnam, for example, CVP and health officials there are now able to track whether vaccines are being kept at the temperature required to avoid damage to the vaccine as it gets transported in more remote areas. In Cambodia, for example, the government piloted a new approach to planning focused on clear deliverables with detailed "micro-planning" for each district. Cambodia also intensified monitoring and managerial support using a plan for improving vaccine coverage linked to results-based performance measures. These in turn helped local health agencies target resources to areas that most needed them.

"Cambodia managed to immunize almost 25,000 more children in 2003 than in 2002," Kane said. "In just twelve months, immunization coverage in targeted districts rose 13 percentage points-from 70 percent to 83 percent. By strengthening delivery systems and working on practical solutions, NGOs like PATH are able to make a difference in children's lives for the better health of all."

To access the summaries on CVP's work, please visit: http://childrensvaccine.org/files/changing-face-of-immunization.htm