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In honour of World Immunization Week, we take a closer look at the troubling state of immunisation worldwide and highlight some of the challenges and opportunities in the global effort to put the “prevent” back into preventable disease. |
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Top newsThe big catch-up: UNICEF and the WHO are sounding the alarm about the biggest sustained backsliding in childhood immunisation in a generation. Between 2019 and 2021, 67 million children missed out on their routine vaccinations. 48 million didn’t receive a single routine vaccine, also known as “zero-dose,” placing them at risk of deadly – but preventable – diseases. Diphtheria tetanus toxoid and pertussis (DTP3) vaccines are often considered a proxy for routine childhood immunisation. Coverage increased significantly over the past 20 years. But for the first time in three decades, DTP3 coverage among children decreased in 2021. Countries and international partners are doubling down on efforts to reach these children. For example, Gavi aims to reduce the number of zero-dose children by a quarter in Gavi-eligible countries by 2025. It has launched new tools aimed at understanding more about who has been missed and how to reach them with life-saving vaccines.  The elephant in the (...waiting) room: The pharmaceutical industry spends roughly $250 billion per year on research to develop new drugs. And 90% of that is spent on diseases affecting just 10% of the world population (read: people living in wealthy countries). Infectious diseases that are not endemic in the West, for example Ebola, tend to receive little private funding for vaccine research and development. The pharmaceutical industry likes to blame a lack of market incentives for diseases concentrated in more vulnerable countries. But that’s a poor excuse, especially considering that vaccine research frequently benefits from public subsidies, as we saw during the pandemic, when the private sector reaped most of the profits from the largely publicly funded COVID-19 vaccines, but didn’t facilitate equitable access. One common-sense solution: public funding should come with strings attached to guarantee equitable access to treatment and ensure that a portion of the profits are channelled into infectious disease research. Past is not prologue: 1.3 million more lives could have been saved during the first year of the COVID-19 vaccine rollout if leaders had upheld promises to equitably distribute vaccines. To (hopefully) avoid similar outcomes in the future, WHO member states are negotiating a legally binding instrument to strengthen primary healthcare, support healthcare workers, and provide the framework to prevent, prepare, and respond to pandemics in an equitable, inclusive way. With the acute phase of the COVID-19 crisis behind us, WHO guidance has shifted to focus on vaccinating those at high risk of severe disease and death. Gavi will be integrating COVID-19 vaccines into its routine immunisation programs after 2023, as part of an effort to ensure that low- and lower-middle income countries can access the supply they need. Let's hope that the next time the world faces a global health crisis, these life-saving measures are adopted at the start, not three years later. Home is where the vaccines are? In response to vaccine inequity experienced during the COVID-19 pandemic, the African Union and Africa CDC proposed an ambitious target to manufacture 60% of Africa’s routine and outbreak immunisation needs on the continent by 2040. It’s an admirable and necessary goal, but the regional agenda is nascent, and delivering on it in a sustainable way will require a long-term and strategic approach. To learn more about what’s happening and what’s needed, check out ONE’s new analysis that looks at three areas where efforts on regional manufacturing are advancing. The misinformation pandemic: The percentage of people who view vaccines as important for children declined in 52 of 55 countries during the pandemic, according to analysis from UNICEF. Even before the pandemic, vaccine hesitancy posed a threat to global health initiatives. UNICEF suggests some ways to tackle hesitancy and promote vaccine confidence, including working with trusted voices, such as community and faith leaders and community health workers, to convey clear messages on the importance of vaccination. Also important: clear political commitments from governments. New buzz on the malaria vaccine: This month, Ghana and Nigeria became the first countries to approve the world's second malaria vaccine, R21. Other African countries could soon follow. The WHO is currently assessing whether to prequalify the vaccine for wider use, which would enable Gavi and UNICEF to begin funding and procuring doses immediately to protect children across Africa. This breakthrough follows the first WHO approved malaria vaccine, RTS,S (trademarked as Mosquirix), in October 2021. That vaccine is already being rolled out in high-burden countries with support from Gavi and UNICEF. Africa is home to 96% of malaria deaths globally and children under 5 account for about 80% of the deaths in the region. Bad maths, good maths: A global surge in cholera is putting over 1 billion people at risk and straining the global supply of cholera vaccines. There are only 37 million doses available in 2023. That has prompted the WHO to ask donors for $25 million to help fight the outbreak, including the emergency provision of vaccines in priority countries. Over half of countries reporting active cholera outbreaks are in Africa. Cholera kills nearly 100,000 people each year, even though it is easily treatable. Only three cholera vaccines are WHO-approved. And one of those is being discontinued: In 2020, before the recent cholera surge, Sanofi announced that it will cease distribution of its cholera vaccine Shanchol™ by the end of 2023 due to low demand. 😮 In better news: Biovac, a South Korean drug maker, announced an agreement that will enable cholera drug manufacturing in Africa. But regulatory and WHO approval are at least three years away, so there’s no immediate relief in sight for the current cholera outbreak. TB [vaccine] or not TB [vaccine]: Another preventable and treatable disease is not receiving sufficient attention: Tuberculosis claimed 1.6 million lives in 2021, partly because there’s only one licensed TB vaccine with moderate efficacy. Progress in developing other TB vaccines has been slow, which the WHO attributes to inadequate funding for research and development and “lack of industry engagement.” Meanwhile, pharma companies spend billions of dollars to develop drugs like Viagra and Botox to treat non-life threatening conditions. The WHO plans to establish a TB Vaccine Accelerator to speed up vaccine development through innovation and strategic partnerships. World leaders will meet in September for a High-Level Meeting on TB. Let’s hope they step up and invest the $10 billion needed to develop more effective TB vaccines. Less is more: Human papillomavirus vaccination rates fell from 25% to 15% for first doses between 2019 and 2021 due to supply constraints and higher demand. But new WHO guidelines could help: It’s now recommending a one- or two-dose schedule of the vaccine instead of 2-3 doses. Sexually transmitted HPV is responsible for 95% of cervical cancer cases, which is the fourth most common type of cancer in women globally. Mortality rates from cervical cancer are three times higher in Africa than the global average. Yet only 1 in 8 women and girls globally are fully vaccinated, despite 60% of WHO member states including the HPV vaccine in their national routine immunisation schedules. The Serum Institute of India launched its HPV vaccine in January, which will hopefully help ease supply constraints. 🤞 From the ONE Team
The numbers
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Quote of the week
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What you should read, watch, and listen to:
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A look ahead28-30 April: Mo Ibrahim Foundation Governance Weekend, Nairobi, Kenya 29-30 April: G7 Digital and Technology Ministers’ Meeting, Gunma, Japan 1 May: International Workers’ Day 3 May: World Press Freedom Day 8-9 May: UN High Level Meeting Multi-stakeholder Hearings on TB, UHC, and PPR, New York, US 21-30 May: World Health Assembly |
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The ONE Campaign’s data.one.org provides cutting edge data and analysis on the economic, political, and social changes impacting Africa. Check it out HERE. |
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