The Children's Vaccine Initiative Achieving the Vision (1993) / Chapter Skim
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2 Why a Children's Vaccine Initiative
2 Why a Children's Vaccine Initiative
Pages 19-35
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From page 19... ...
and supported by numerous individual governments, nongovernmental organizations, and bilateral and multilateral agencies, was established in 1974. Its aim was to build on the success of WHO's Smallpox Eradication Program and to assist national immunization programs in the developing world.
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From page 20... ...
Each year, EPI-sponsored immunization programs prevent some 2.9 million deaths from measles, neonatal tetanus, and pertussis as well as 440,000 cases of polio worldwide (Kim-Farley et al., 1992; Pan American Health Organization, 1993; World Health Organization, 1992~. This great achievement stands in sharp contrast to the situation in the mid-1970s, when less than 5 percent of the developing world's children were adequately immunized and when nearly 5 million children died each year from vaccine-preventable diseases (UNICEF, 1989~.
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From page 21... ...
The initial focus of the CVI, launched after the World Summit for Children in New York City in September 1990, was to accelerate efforts to develop vaccines that could enhance the performance of EPI (World Health Organization/Children's Vaccine Initiative, 1991a, 1992~. A number of specific, desirable features of future children's vaccines were proposed (see the box "What Is the Children's Vaccine Initiative?
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From page 22... ...
Task forces focused on the following topics have been established to date: priority setting and strategic planning, relations with vaccine development collaborators, situation analysis of the global vaccine supply, assessment of national vaccine regulatory capabilities and needs, and strengthening national epidemiological capacities to ensure the best use of vaccines. A new task force on the management of DTP combinations for the developing world has been proposed as a means to plan, coordinate, and implement a global effort to ensure the development and supply of quality DTP combination vaccines to developing countries.
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From page 23... ...
At the World Summit for Children in New York City in September 1990, world leaders called for an acceleration of the application of current science to the development of new and improved childhood vaccines. Preceding the summit, world vaccine experts proposed a number of desirable features for future children's vaccines.
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From page 24... ...
The success of the CVI depends on the cooperation of vaccine manufacturers, governments, and multinational organizations, such as UNICEF and the Pan American Health Organization, which supply vaccines to much of the developing world. Effective cooperation will allow vaccine developers to create new and improved vaccines of use to suppliers, and it will help the suppliers make long-term plans that take into account the vaccines of the future.
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From page 25... ...
The complexity of the vaccination schedule contributes to and exacerbates two categories of problems common to many immunization programs: high dropout rates and missed opportunities for vaccination (de Quadros et al., 1992~. Whether because of the lack of information, difficulty getting to the health clinic, or inappropriate clinic hours, families may not take their children for necessary and additional booster shots, and thus drop out of the vaccination program.
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From page 26... ...
Vaccines Should Be Heat Stable Without refrigeration, vaccines have a limited usable shelf-life, and refrigeration and maintenance of the "cold chain" have been critical limiting factors of EPI in many countries (de Quadros et al., 1992; Pan American Health Organization, 1993~. An immunization program can extend only as far as the cold chain permits.
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From page 28... ...
In the last 10 years, WHO has sought to encourage researchers to study the health challenges facing developing countries. The UNDP/WHO Program for Vaccine Development and the UNDP/World Bank/WHO Special Program for Research and Development in Tropical Diseases, for example, were both created to bring laboratory investigators face-to-face with the problems encountered in the field.
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From page 29... ...
, the latter of which have actually decreased (Robbing, 1991~; rather, it suggests that the children who were most easily vaccinated were immunized first, increasing the per-child cost of vaccinating the remaining children (Robbing, 1991~. If past experience is any indication, the prices of new and improved vaccines on the international market fall over time.
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From page 30... ...
Many developing countries rely on outside support for their immunization programs and are unlikely to be able to sustain these efforts in the future without a continued infusion of outside resources (Claquin, 1989, 1990; REACH Project, 1990; Rosenthal, 1990~; thus, expanding the program depends upon persuading donor organizations to provide more funding for global vaccine procurement (an unlikely strategy in the light of scarce resources and competing priorities) or reducing the costs of immunization.
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The Centers for Disease Control and Prevention (CDC) , in conjunction with state and local health departments, recently completed retrospective assessments of vaccine coverage in 20 U.S.
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. Another recent survey of 51 immunization projects nationwide indicated that the overall immunization levels of children under 2 years of age were low, with 16 projects reporting immunization levels below 50 percent (Centers for Disease Control and Prevention, 1992b)
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From page 33... ...
, inadequate access to health care, and lack of public awareness of required immunizations (National Vaccine Advisory Committee, 1991; Peter, 1992; Schulte et al., 1991; Szilagyi et al., 1993~. As in other parts of the world, the vaccination schedule for U.S.
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From page 34... ...
1992. Desired field performance characteristics of new improved vaccines for the developing world.
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From page 35... ...
1988-1989. Prospectus from WHO, EPI Technical Series: The Cold Chain Product Information Sheets, No.
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