Global Report: Wanted: Attention

The Threat Of A Bird Flu pandemic has pushed the life-saving potential of vaccination right up the news agenda. But according to the World Health Organization (WHO) and other immunization partners at the World Vaccine Congress, held in Lyon, France in October, it's not just the flu—millions of lives could be saved by better immunization against other diseases.

Sarah Houlton

Although the past quarter of a century has seen great strides being made in immunization around the world, further increases in coverage at a global level would make a huge difference, speakers at the event said.

"Vaccines must be brought to the millions of people who are currently unreached, and all people must benefit from new, life-saving vaccines," said Jean-Marie Okwo-Bele, director of WHO's department of immunization, vaccines, and biologics.

WHO estimates that in 2002, 2.1 million people, including 1.4 million children under five, died from diseases that could have been prevented by vaccines that WHO currently recommends. However, it also anticipates around 20 new or improved vaccines will reach the market within the next decade, including some that represent major breakthroughs, such as a cervical cancer vaccine.

The latest global immunization data compiled by WHO and Unicef show that there has been a dramatic expansion in the use of hepatitis B and Haemophilus influenza type B (Hib) vaccines, with 153 countries now routinely vaccinating children with hepatitis B vaccine. The popularity of Hib immunization has escalated—it's now a component of routine childhood immunization regimes in 92 countries, up from just four in 1991.

These figures were welcomed by Okwo-Bele. "The spectacular gains made in immunization in the 1980s have been sustained," he said. "This is the result of strong commitment of countries and partners, effective strategies and substantial financing. But we can and must do better."

Smallpox was eradicated thanks to vaccination, and another disease is close to following its example. Cases of polio have already been reduced from 350,000 a year in 1988 to fewer than 1,500 thus far in 2005. The virus is still endemic in Nigeria, India, Pakistan, Afghanistan, Niger and Egypt, and 10 previously polio-free countries—mostly in sub-Saharan Africa—have been re-infected in the past year. However, the Advisory Committee on Polio Eradication believes the end is near for polio.

Mission Possible

"All the tools are now in place to finish polio once and for all," said ACPE chairperson Steve Cochi. "It is now up to the remaining polio-affected countries to effectively use these tools. There is no reason why polio should continue to exist anywhere in the world after next year."

The newly introduced monovalent oral polio vaccine is the key to the fight against the disease: It accelerates protection to specific virus types and already appears to have stopped transmission in Egypt and much of India. It was developed in under six months earlier this year, and appears to work faster than traditional trivalent oral polio vaccine in building up immunity.

The biggest threat to the success of polio eradication is Nigeria, where the immunization program was suspended on religious grounds in some parts of the country for 12 months in 2003 and 2004. ACPE believes polio could become a thing of the past everywhere except Nigeria in the next six months.

However, these strategies can only succeed with sufficient funds, with ACPE reporting a funding gap of $200 million for 2006. Some of the money needed to pay for increased vaccination coverage will come from the International Finance Facility for Immunization, which aims to fund a $2.2 billion immunization program over the next decade. The governments of the United Kingdom, France, Italy, Spain, and Sweden have made large annual pledges, backed up by a big donation from the Bill & Melinda Gates Foundation.

What's different about the scheme is that it uses long-term financial commitments to front-load resources for the Global Alliance for Vaccines and Immunization. This means funds will be available now, controversially borrowed on the financial markets against guaranteed future funding. "In years to come, we will end up using aid money to pay off the interest to financiers rather than helping the poor," said Peter Hardstaff, head of policy at the World Development Movement.

Sarah Houlton, PhD, is Pharmaceutical Executive's global correspondent. She can be reached at sarah@owlmedia.co.uk