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Since 2002, China has immunised 11.1 million children in the country's poorest and most remote western and central provinces against hepatitis B, reducing their risk of developing a deadly and common liver cancer, according to an announcement made today by the Chinese government and the GAVI Alliance.
Following a ceremony in Beijing, held to commend the Chinese for their dramatic progress, GAVI and Chinese health officials told journalists that the boost in immunisations represents a 60 percent increase in hepatitis B vaccine doses delivered to children in target provinces. The children reached include newborns, who receive a ''birth dose'' of vaccine plus two more doses at one and six months of age, as well as previously unvaccinated children under five, who must also receive a full three-dose vaccine series.
''Our goal is to protect all the babies at birth from this virus,'' said China Minister of Health Gao Qiang. ''The China-GAVI Hepatitis B Immunisation Project has propelled us forward on this path, covering one-third of all children born in China since the project began in 2002.''
According to an estimate based on a 1992 national hepatitis epidemiological survey, 120 million people in China are chronically infected with hepatitis B (HepB). Those infected are at risk of liver cancer or failure, and can spread the disease to others. In the western provinces, the campaign, with technical guidance from the World Health Organization (WHO) and UNICEF, has reached almost 70 percent of newborns with a birth dose of vaccine in 2005, up from 47 percent in 2002. Newborns are a key target of the effort, since vaccination within the first 24 hours of life is the only way to protect an infant from transfer of virus from an infected mother.
Since its inception, the campaign has averted over 200,000 future deaths due to the chronic consequences of hepatitis B, mainly from cancer of the liver and cirrhosis. Death typically comes decades after children are exposed to the virus during childbirth or in their first years of life.
The breakthrough is the result of a five-year US$76 million project, co- funded equally by the Government of China and the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization). Known as the China Ministry of Health/GAVI Hepatitis B Vaccination Project, the GAVI-supported campaign has targeted newborns and children under five across an area that encompasses 470 million people, including six million newborns every year. It has reached babies born in hospitals, as well as those born at home in mountain villages or in the tents of nomadic herders on the vast steppes.
''This breakthrough was 20 years in the making,'' said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. ''That is how long children in the industrialised world have had a vaccine to fight this virus, but, until recently, progress in emerging countries and poor remote areas, such as western China, had been painfully slow. China's success is a model for other countries still struggling to stop the spread of the hepatitis B virus and other vaccine-preventable diseases."
According to preliminary data, provincial governments have added to the funds provided by GAVI and the central government, contributing more than US$10 million in co-payments. Lob-Levyt noted as well that the support of the World Health Organization (WHO) and UNICEF has been critical.
''Worldwide, GAVI's support has made it possible to immunise 90 million children against hepatitis B and avert an estimated 1.4 million deaths from this disease alone,'' he added.
WHO and UNICEF are among the GAVI partners and other key immunisation groups(*) in China that support the China National Immunisation Programme efforts to reach all children with life-saving vaccines and technologies, as well as with polio eradication, measles control, and new vaccine introduction. WHO and UNICEF have supported the development and implementation of the China- GAVI project, through the national Interagency Coordinating Committee and project Operations Advisory Group.
(*) US Centers for Disease Control and Prevention, Australian Agency for International Development, World Bank, Government of Luxemburg, the PATH Children's Vaccine Program, the Japanese International Cooperation Agency, and the China Foundation for Hepatitis Prevention and Control.
GAVI's efforts are critical to achieving the Millennium Development Goal on child health, which calls for reducing childhood mortality by two-thirds by 2015. Of the more than 10 million children who die before reaching their fifth birthday every year, 2.5 million die from diseases that could be prevented with currently available or new vaccines. Since 2000, the catalysing efforts of the GAVI Alliance have ensured that 90 million children in the world's poorest countries were immunised against hepatitis B.
New Laws, Home-Grown Vaccine, and Dedicated Partners
Progress in China has been the result of national commitment to control this disease; strong partnerships; new national laws; and a home-grown vaccine industry able to supply the huge quantities of vaccine needed.
The Government of China and the GAVI Alliance embarked on the five-year project in 2002, with the goal of reaching 75 percent of newborns with a birth dose of vaccine and 85 percent of children under the age of 12 months with all three doses of HepB vaccine necessary to prevent infection. GAVI financial support was used to purchase and distribute 55.39 million doses of hepatitis B vaccine and 145.6 million safe, auto-disable (AD) syringes. That financial support was also designed to catalyse national action and sustained commitment to HepB vaccination in China.
In 2002 the Chinese national government added hepatitis B to all routine childhood immunisations (known as EPI vaccines). Then, in March 2005, it passed a new regulation stating that all EPI vaccines be given at no cost to parents. The Ministry of Health also designated hepatitis B as one of four high priority diseases for national control and developed a national hepatitis B control plan for 2006-2010, with the goal of reducing to less than one percent the proportion of children under the age of five who are carriers of the hepatitis B surface antigen.
The Chinese vaccine industry, which has produced HepB vaccines since the 1980s and had a licensed vaccine since 1990, was also prepared to scale up. The GAVI-supported project used this vaccine, purchased through a national bid and tender process with international observers.
Reaching Babies with Safe Injections Wherever They are Born
Success has also been bolstered by China's Safe Motherhood Initiative, which urges mothers to give birth in hospitals. In addition, unprecedented cooperation between grassroots vaccination staff and child and maternal health staff in hospitals has fostered the approach of ''whoever delivers the infant should give the immunisation.''
As a result, today more than 90 percent of the babies in the project area hospitals receive their birth dose of hepatitis B vaccine on time-within 24 hours of delivery.
The biggest challenges remain reaching babies born at home in the most remote rural areas. Efforts to scale-up immunisation there include increased coordination between village doctors, vaccinators, midwives and mothers, as well as regular vaccine deliveries to remote areas.
In addition, a key component of the project has been ensuring safe injections through the use of auto-disable (AD) syringes. By design, these syringes cannot be reused, thus eliminating the danger of spreading multiple diseases through injections given with dirty needles. As a result of the project, today all childhood vaccines in the targeted regions are delivered using AD syringes.
Challenges Remain
About three-quarters of the 1301 project counties have reached the target of 85 percent of children receiving the complete HepB vaccine series, and half have reached the timely birth dose target. However, over one million babies born each year in GAVI project counties are still not receiving a timely birth dose.
In the project's final years, it will concentrate on achieving those targets in every county, both through reaching more babies born at home and by waging a ''catch-up" campaign to reach still unvaccinated children. The project will also focus on enhancing injection safety through wider use of AD syringes, and will encourage the expanded use of AD syringes for all immunisations given in China.
''Finally, long-term success depends on assuring that no new financial barriers arise to block HepB immunisation in the future,'' Lob-Levyt said. ''This is one of the greatest challenges, and the solution lies not just within China, but with a global community mobilised to ensure access to vaccine financing for all developing nations.''
The GAVI Alliance
An alliance of all the major stakeholders in immunisation, the GAVI Alliance includes among its partners developing country and donor governments, the World Health Organization (WHO), UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, NGOs, and the Bill & Melinda Gates Foundation. It is estimated that more than 1.7 million early deaths will have been prevented as a result of support by GAVI up to the end of 2005.
GAVI's efforts are critical to achieving the Millennium Development Goal on child health, which calls for reducing childhood mortality by two-thirds by 2015. Of the more than 10 million children who die before reaching their fifth birthday every year, 2.5 million die from diseases that could be prevented with currently available or new vaccines
Notes to Editors:
The GAVI Alliance
THE NEED
Immunisation prevents millions of deaths every year and reduces the costs of treatment and of disability caused by infectious diseases. Immunisation also has the potential to significantly boost economic growth(1). By improving the health of a population, immunisation also improves its education and work prospects.
Yet in many countries, efforts to increase immunisation coverage are hampered by weak health systems, conflict, and the high cost of some vaccines. As a result (according to the most recent available data(2)):
-- More than 27 million children missed out on immunisation during their
first year of life - leaving them vulnerable to infectious diseases
both in childhood and during the productive adult years (2004 data).
-- 1.4 million children under five died from vaccine-preventable diseases
for which vaccination is already included in most immunisation
schedules (2002 data).
-- More than 1 million children died from pneumococcal disease,
meningococcal disease, and rotavirus diarrhoea -- diseases for which
vaccines are likely to become available in the near future (2002 data).
THE RESPONSE
The GAVI Alliance is a public-private global health partnership committed to saving children's lives and protecting people's health through the widespread use of vaccines.
GAVI was launched in 2000 to improve access to immunisation for children in impoverished countries. Governments in industrialised and developing countries, UNICEF, WHO, the World Bank, the Bill & Melinda Gates Foundation, non-governmental organisations, vaccine manufacturers from industrialised and developing countries, and public health and research institutions work together as partners in the Alliance.
Key to achieving the goals of the Alliance is a dramatic increase in new funding for immunisation. Building on the resources already provided by individual partners in the Alliance, GAVI partners created The GAVI Fund to help fill critical gaps in the overall global effort and to maintain a significant source of new and additional financial support from public and private donors. GAVI resources help strengthen health and immunisation systems, accelerate access to selected vaccines and new vaccine technologies- especially vaccines that are new or underused, and improve injection safety. These areas will remain a crucial focus as the GAVI Alliance moves into its second phase (2006-2015).
GAVI has been financed by ten governments to date -- Canada, Denmark, France, Ireland, Luxembourg, the Netherlands, Norway, Sweden, the United Kingdom, and the United States -- as well as the European Union, private contributors, and the Bill & Melinda Gates Foundation. It provides multi-year grants to more than 70 of the world's poorest countries. Grants are made based on a rigorous application process in which country proposals are reviewed by a panel of independent experts drawn from a wide geographic base.
A total of almost US$ 3.3 billion has since been raised in traditional funding from government and private sources, including US$ 1.7 billion actually received. In addition, commitments by France, Italy, Spain, the UK, Sweden, Norway and Brazil have been secured through the new International Finance Facility for Immunisation (IFFIm), which will yield more than US$ 4 billion in additional disbursements before 2015 and additional funds after 2015 as the debt is paid off.
The resources that have been received have been used in order to help countries with a GNI of US$ 1000 or less:
-- strengthen healthcare delivery systems;
-- boost coverage with established vaccines (against diphtheria, tetanus,
pertussis, tuberculosis, measles and polio);
-- introduce underused vaccines where needed (hepatitis B, Hib and yellow
fever);
-- ensure immunisation safety;
-- accelerate the development of, and affordable access to, priority new
vaccines for developing countries (e.g. against rotavirus, pneumococcal
disease and meningitis types A and C);
FUNDS DISBURSED
As of December 2005:
Total funds committed by GAVI over five years: more than US$ 1.6 billion
GAVI has disbursed US$ 672 million (as of 30 September 2005) as follows: (3) (in US$)
-- Vaccines/supplies: 419 million
-- Accelerated development of priority new vaccines (ADIPs): 32 million
-- Yellow fever vaccine stockpile: 11 million
-- Immunisation safety: 83 million
-- Immunisation services support: 120 million
-- Introduction of new vaccines 7 million
GAVI ACHIEVEMENTS
More than 1.7 million future deaths averted through GAVI support(4)
It is projected that by end-2005, nearly 1.7 million future deaths from Hib disease, pertussis and hepatitis B will have been averted through GAVI support. Some of those deaths would have occurred in childhood and others (e.g., from hepatitis B) in the most productive adult years.
Increasing routine immunisation coverage
In the countries receiving funding to help strengthen immunisation services:
-- An additional 8.3 million children were immunised with DTP3 by December
2004(5).
-- It is projected that approximately 13 million additional children will
have been immunised with DTP3 by the end of 2005.
Support for underused vaccines
As of December 2005, it is projected that the number of children immunised through the introduction of underused vaccines in GAVI -supported countries will include(6):
-- hepatitis B vaccine:
approximately 90 million
-- Hib vaccine:
approximately 14 million
-- yellow fever vaccine:
more approximately 14 million
MAKING A DIFFERENCE:
HEPATITIS B VACCINE
With support from the GAVI Alliance:
-- More than more than 1 million future deaths (from HepB, Pertussis and
Hib) have been averted through GAVI support as of December 2004. It is
projected that this number will reach 3.6 million by the end of 2008.
-- 56 of the more than 70 eligible countries have been approved for
funding for hepatitis B vaccine so far - up from only 7 before the
launch of GAVI.
-- 32 (57%) of the countries approved for funding for hepatitis B vaccine
have opted to use combination vaccines - thereby avoiding an increase
in the number of immunisation injections needed during the first year
of life.
SAFE INJECTIONS
-- More than 1 billion single-use auto-disable syringes have been supplied
for immunisation (as of December 2005).
SUSTAINABILITY
-- All the 15 countries where GAVI support for injection safety has now
ended have already secured funding for continued injection safety
support.
-- Of the countries receiving GAVI support for new vaccines, 11 have
already begun co-financing their vaccine supply as of 2005.
ACCOUNTABILITY
-- To date, 30 countries have successfully undergone an external data
quality audit (DQA) to verify the accuracy and completeness of their
administrative reporting system.
-- Of the 48 countries eligible for rewards for increased DTP3 coverage
(as of December 2004), 27 have received at least one reward. A further
21 have not yet received rewards (11 because they failed a DQA and 10
due to weak performance).
STATUS OF COUNTRY SUPPORT:
-- Number of countries currently eligible for GAVI support: 73 (as of June
2006)
-- Number of countries that have applied: 73 (as of December 2005)
-- Number of countries that have had at least one type of support
approved: 73 (as of December 2005)
NUMBER OF COUNTRIES SUPPORTED FOR:
-- DTP-HepB combination: 14
-- DTP-Hib combination: 1
-- DTP-HepB-Hib combination: 16
-- monovalent hepatitis B: 23
-- yellow fever: 15
-- immunisation services support: 53
-- immunisation safety: 69
References
(1) David Bloom, David Canning and Mark Weston, ''The Value of
Vaccination'', World Economics (Vol. 6, No. 3, July-September 2005
(2) WHO data.
(3) Includes some long-term funding not yet received by countries.
(4) WHO estimate. Includes both deaths averted among children under five
years and deaths from hepatitis B that would have occurred in
adulthood.
(5) WHO estimates
(6) WHO estimates
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