Vaccination programmes are popular with donors

HEALTH: Saving lives for the price of a cup of coffee

Photo: David Gough/IRIN

Vaccination programmes are popular with donors

LONDON, 14 June 2011 (IRIN) – The Global Alliance for Vaccines and Immunization, (GAVI) has succeeded in raising more than enough money to fund its programme for the next five years.

The organization had asked donors for US$3.7 billion, enough to immunize more than 250 million children in the world’s poorest countries, a programme which would, it estimated, save more than four million young lives. In the event donors – both governmental and private – pledged $4.3 billion, at a meeting in London hosted by the British and Liberian governments and the Bill and Melinda Gates Foundation.

The new pledges included a billion dollars from the Gates Foundation, and 1.33 billion from the British government. Norway will give $677 million, and the USA overcame its reservations about multi-year financing to offer $450 million. The administrator of USAID, Raj Shah, said making a multi-year pledge was what he called a “challenging step”, but recognized that this kind of five-year commitment meant GAVI could drive a harder bargain with the vaccine manufacturers and so get better value for money.

Bill Gates told a news conference after the meeting that they had hoped donors would push themselves to be generous, and that was exactly what had happened. He particularly welcomed new donors, such as Brazil (which contributed 12 million dollars), and Japan, which he said still wanted to be part of the project, despite the particular challenges it currently faced. Four hours was a long meeting, he told journalists at the end of the session. “But if you can save four million lives in four hours, it’s well worth every minute.”

The funding means GAVI can support qualifying countries (those with a per capita gross national income of less than $1,500) to maintain their current vaccination programmes and, in addition, start rolling out vaccination programmes against two of the leading killers of small children, pneumonia and diarrhoea.

Nineteen countries have already been approved for GAVI funding for the vaccine against pneumococcal disease, and five for a rotavirus vaccine to prevent the most deadly form of diarrhoea.

HPV vaccine for Senegal

Senegal’s health minister, Modou Diagne Fada, told IRIN he was eager to introduce the two new vaccines, and also wanted to have the vaccine against HPV – the Human Papilloma Virus, which can lead to cervical cancer in women – available by 2015.

He said patterns of disease were changing in Senegal: “Malaria is no longer our biggest killer. Now we have problems of chronic disease, and non-transmissible diseases like cancer. Among those there is one very deadly cancer, cancer of the cervix, and we believe that if we can get the HPV vaccine, we will be able to save the lives of our women.”

Photo: Wikipedia Commons

Rotavirus, which causes severe diarrhoea, kills more than half a million children a year

At a time when the global financial crisis is putting a squeeze on aid budgets, vaccination programmes clearly remain popular with donors. Partly it is the magic of the thought that – as the UK’s Secretary for International Development Andrew Mitchell put it – you can save a child’s life for the price of a cup of coffee. But it is also because vaccinations can be counted, targets can be verified and outcomes measured in the form of reduced incidence of disease.

Asked by IRIN about the attraction of this kind of aid for donors, Mitchell said: “The British government set up an examination of all 43 multilateral agencies through which taxpayers’ money is spent in development. From some we removed money and with others we froze money, but GAVI is one of the best… It’s absolutely brilliant value for money… 80 percent of its funding is spent on vaccines… It’s very cost effective. And we owe it to taxpayers in Britain to ensure that every penny we spend is really used to secure these brilliant results.”

Middle income countries – a potential problem?

Paradoxically, this enthusiasm can have its drawbacks if vaccination becomes too closely identified with international donors. Last week one paper in a special vaccination edition of the medical journal, the Lancet, identified a potential problem as more nations pass the threshold to become classed as middle-income countries, and then the slightly higher threshold for GAVI funding.

One of its authors, Orin Levine of the Johns Hopkins School of Public Health, told journalists that this had big implications for vaccination programmes. “Most of the world’s poor people are now living in middle-income countries. Those countries have some means; they are not poor enough to qualify for GAVI support and generally don’t qualify for the preferential pricing arrangements of the kind announced by drug companies last week. This is going to be an increasing challenge to tackle in the years ahead.”

GAVI does in fact have a system of co-financing by which eligible countries have to buy some of their vaccines themselves, paying the equivalent of 10-30 US cents per dose, gradually increasing as their national wealth increases. GAVI said that as part of this pledging round, developing countries had committed themselves to maintain or increase the co-financing of their vaccine programmes.

Beyond compulsory vaccination

The other risk is that vaccination becomes not just something international donors do for you, but something they do to you. Another Lancet author, Heidi Larson of the London School of Hygiene and Tropical Medicine, has studied the reasons why some parents resist having their children vaccinated. When she visited the very marginalized areas in northern Nigeria where the revolt against polio vaccine started in 2003 she found people bemused and suspicious about why outsiders kept coming and insisting on this particular intervention, when they were reluctant to help with things people really felt they needed: “Why are they always giving us this polio vaccine, they said, “when that’s not our big problem?”

Scientific explanations clearly do not address this kind of feeling. Larson stresses that resistance to vaccination, right from the very early days, has been as much, or more, about compulsion than about the vaccine itself. “And no health intervention,” she says, “is so government regulated as vaccination”.

To those who understand it, the virtues of vaccination are so self-evident that pressure to vaccinate is justified. In Ethiopia, vaccinating your children is compulsory. In India vaccination teams pursue travellers with babies even on to trains and station platforms. Science continues to advance, and thanks to today’s replenishment, funding is now assured, but people have to be involved and their concerns listened to if vaccination is to achieve its fullest benefits.

eb/cb source www.irinnews.org

Global problem: foot and mouth disease affects every continent except Antarctica

Analysis: Local wisdom key to combating animal diseases

Photo: IRIN

Global problem: foot and mouth disease affects every continent except Antarctica

NAIROBI, 21 June 2011 (IRIN) – Flush with success over the unprecedented eradication of rinderpest, scientists are setting their sights on the next big livestock disease to rid from the world. Experts are aligning their crosshairs over foot and mouth disease, which affects every continent except Antarctica.

“In my opinion foot and mouth disease is by far the most important socio-economic disease of livestock worldwide,” said George Saperstein, a veterinary medicine professor at Tufts University. “It is highly contagious, affects multiple species, is difficult to control, has a major impact on international trade of animals and animal products, and causes dramatic reductions in livestock productivity for farmers on a global scale.”

“Foot and mouth disease could be the next big target for the international community at large,” said Kazuaki Miyagishima, deputy-director-general of the World Organization for Animal Health (OIE.) “There are still more than 100 countries suffering either endemically or periodically.”

The Food and Agriculture Organization (FAO) and the OIE plan to hold a pledging conference next summer to motivate international donors to provide more funding for vaccine research to combat the disease.

But experts agreed that eradicating it would be an especially tall order.

There are several strains of food and mouth disease, so one vaccine will not protect against all types. The vaccination has to be kept cold, one of the most daunting challenges in administering it in remote locations. And the immunity it provides does not last very long; animals have to be vaccinated over and over again to keep them safe.

Eradication the goal?

Not everyone is on board with making eradication the goal.

It took 50 years, hundreds of millions of dollars and a global effort to eradicate rinderpest, a relatively simple disease

“We should move away from the focus on eradication, which has had its day,” said Andy Catley, an epidemiologist and veterinarian at the InterAfrican Bureau for Animal Research. “It took us 50 years, hundreds of millions of dollars, and a global effort [to eradicate rinderpest]. And it was a relatively simple disease.

“Eradication is easy for the public and donors to understand. The question is, do you really need to eradicate any other disease in these pastoral areas? Technically it’s incredibly difficult and economically it might not be needed to get the trade benefits.”

Instead, Catley suggested bringing epidemiologists, economists, and livelihoods experts together to take a closer look at how to control diseases with community involvement, instead of bounding off on an overly-ambitious, and uncertain global eradication campaign.

Catley believed one of the reasons the rinderpest eradication worked was that it did not just involve local collaboration, it was based on it. But a community-based, culturally-appropriate local effort to control disease can be a hard sell and a long haul. “It’s a more complex, less sexy message to sell to donors,” he said.

Rinderpest lessons

When the highly contagious rinderpest virus was inadvertently introduced to sub-Saharan Africa in the late 1800s, it ruined pastoral economies and social structures, and left 90-95 percent of cows in Africa dead.

“It swept across the whole continent and all previously known livestock diseases paled into insignificance beside the trail of destruction left in its wake,” wrote IRIN journalist Louise Tunbridge in a 2005 book on animal health care in Southern Sudan. “Historians describe it as the greatest natural calamity ever witnessed in Africa.”

Once a vaccine was developed that could survive the scorching African heat without a cold chain, it took another decade for it to be deployed effectively to the desolate locales where the virus still lurked. Success started with 20 local herdsmen in Cameroon who were trained to vaccinate their own cattle and quickly proved they were able to access more cows than government veterinarians.

“The pastoralists knew how to inject their animals. They were also at home in the harsh terrain, wading up to their waists in swamps, clambering up rocky mountainsides and walking with heavy loads for days at a time,” wrote Tunbridge. “How many town-based professional veterinarians would endure such discomforts?”

Photo: Catherine-Lune Grayson/IRIN

Local expertise: closely involving pastoralist communities is key to tackling animal diseases

Juan Lubroth, FAO’s chief veterinary officer, agreed that local wisdom was key to recognizing where to go to vaccinate in Southern Sudan and Somalia. But he said Western biotechnology and science still had a big role to play in combating diseases.

PPR

While the vaccines for foot and mouth disease are technically and logistically problematic, another livestock disease called Peste des Petits Ruminants (PPR) already has a successful vaccine. An acute and highly contagious disease that affects mostly sheep and goats, it is caused by a virus similar to rinderpest, and according to OIE’s Miyagishima, could be a more promising target for eradication.

“We have a relatively good and cheap vaccine for PPR. The problem is that small ruminants have less economic importance so it’s harder to get countries and governments engaged,” he said. Since cows are traded on the global economy while poorer people keep small animals for household use, diseases that affect them are paid less heed by scientists, researches and donors.

“Small ruminants are usually held by the poorest of the poor; they don’t have the same value as cattle,” said FAO’s Lubroth. “For PPR, we have similar tools that we had for rinderpest; it’s related to it; we know a lot about it and we have diagnostics. What we don’t really have is the political support.

Miyagishima said foot and mouth disease would probably be prioritized despite its technical problems, because governments are more conscious of it and see more economic benefit in its eradication.

“Certain wealthy countries with sophisticated surveillance systems and favorable geography can keep [foot and mouth disease] out, but it is in everyone’s best interests to eradicate it worldwide rather than exclude it from individual countries – usually the wealthiest countries,” said Tufts University’s Saperstein.

Meanwhile, the InterAfrican Bureau for Animal Resources warned: “Unless coordinated action is taken to control the spread of the disease, small ruminant plague [PPR] is likely to spread to most of Africa, bringing with it untold losses of livestock and endangering the livelihoods of millions of African farmers and herders.”

“You can’t just be in a comfortable chair in the capital and know what’s going on on the ground,” said Miyagishima. Locals are essential in watching out for signs of the disease and reporting them to the authorities. “If they start hiding the disease, it will be propagated,” he said.

Animal owners often do want to hide evidence of an outbreak, since authorities respond to some diseases by killing animals, even healthy ones. Some developed countries have financial compensation schemes, or even private insurance. “But in most of the developing world, there’s no incentive to report disease,” said Miyagishima. “This is something that’s really important to address since early detection is key.”

jb/kr/cb  source www.irinnews.org

The world is short of about 350,000 skilled midwives

HEALTH: Better midwifery could save millions of lives

Photo: MSF

The world is short of about 350,000 skilled midwives

DURBAN, 20 June 2011 (IRIN) – Up to 3.6 million maternal and child deaths could be avoided each year if midwifery services were upgraded, according to a new report released by the United Nations Population Fund (UNFPA) and partners at a conference in Durban, South Africa.

“Public health advisors and practitioners are not relying on the key health professional that can improve maternal mortality – the midwife,” said Vincent Fauveau, Senior Maternal Health Advisor with UNFPA, who led the drafting of the report.

Of the nearly 1,000 women who die every day as a result of complications during pregnancy and childbirth, 99 percent live in developing countries, mainly in sub-Saharan Africa. A woman in Sweden has a roughly 1 in 11,000 chance of dying from pregnancy-related causes, while a woman in Niger faces a 1 in 16 chance during her lifetime.

The first State of the World’s Midwifery report released on 20 June at the International Confederation of Midwives (ICM) 29th Congress, said most of these deaths, as well as many of the severe illnesses and disabilities caused by childbirth, could be prevented by a proficient, motivated and supported midwifery workforce.

The report focuses on the 58 countries with the highest rates of maternal, foetal and newborn mortality. These countries account for 91 percent of the global burden of maternal mortality, but have less than 17 percent of the world’s skilled birth attendants.

The fifth Millennium Development Goal (MDG), which focuses on reducing maternal health, had seen the least progress, Fauveau told IRIN. Nearly half of all deliveries occur at home without a skilled birth attendant. To meet the MDG 5 target of 95 percent of all births being assisted by a skilled birth attendant, some countries will need to increase the number of midwives by six to 15 times.

“It is not unusual to find one midwife managing 200 women in one facility. We must prioritize investment in midwives to deliver life-saving care in the communities where mothers are needlessly lost,” said Lennie Kamwendo, a midwife and Chairperson of the White Ribbon Alliance for Safe Motherhood in Malawi.

Ahead of the congress, more than 2,000 midwives marched in Durban in solidarity with midwives across the world to urgently call for more midwives to save mothers and their babies. The report highlights the uneven distribution of midwives, with rural areas losing out to urban areas, and the fact that not all midwives are adequately trained.

Photo: Kate Holt/IRIN

IRIN’s publication, Veil of Tears, is a collection of personal testimonies from Afghanistan on loss in childbirth. You can download the full booklet in PDF version here.

The International Confederation of Midwives (ICM), a global umbrella body and host of the Durban conference, has launched new standards and regulations for midwifery but Fauveau said these will only be successful if “countries revise their educational curriculum”.

Many women also struggle to access midwifery services, especially in rural areas, because of the distance they must travel to reach health facilities or because they cannot afford the transport costs and fees.

“We must advocate for free health services for all pregnant women in all countries. Women often do not have the funds to pay to get into the health facility during childbirth or pregnancy, so they die at home,” said ICM President Bridget Lynch. Fauveau added that “a complication with childbirth is one of the most common ways to bring a family to poverty.”

The report calls for governments to recognize midwifery as a distinct profession, and to increase investment in the number of schools, trainers and tutors for midwives, with adequate budget allocations for midwifery services included in national health plans.

“Midwives do far more than deliver babies,” said Bunmi Makinwa, Africa Regional director of UNFPA. “They are the first to identify and treat HIV, tuberculosis and malaria, and sexually transmitted diseases. They also provide counselling to expecting women, and family planning advice. Midwives play a critical role.”

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