GAVI Alliance brings down prices of vaccines

Following the increasing impact of the GAVI Alliance on the vaccine market, the price of one of the major combination vaccines, the pentavalent, is falling considerably, which is expected to enable GAVI’s partners to vaccinate more than 6 million more children in the developing world this year.

The GAVI Alliance is a Geneva-based public-private partnership aimed at improving health in the world’s poorest countries.

News of the unprecedented progress was announced in Hanoi, Vietnam just before the GAVI Partners’ Forum, which unites some 400 participants from all over the world including ministers of health, donors, civil society and industry representatives, researchers and development experts.

“This is the GAVI effect at work: encouraging and pooling growing demand from countries, attracting new manufacturers and increasing competition to drive down prices,” said GAVI CEO Julian Lob-Levyt. “The price drop has come later than we had hoped and it needs to fall further. But this is a clear indication that our market-shaping efforts work.”

Dr Lob-Levyt said that pentavalent – widely considered the gold standard for childhood immunisation because it delivers protection against five diseases: Hib (Haemophilus influenzae type b), diphtheria, pertussis, tetanus and hepatitis B. – is projected to be GAVI’s single biggest expenditure through to 2015, accounting for some 40% of vaccine spending. “Its price, and those of other GAVI vaccines, is the major determinant of the future support that the GAVI Alliance will be able to provide to countries.”

Most of the vaccines financed through GAVI are purchased by Alliance member UNICEF. A recent tender for pentavalent vaccine has shown a significant price drop with the weighted average price for 2010 falling below US$3, a decrease of almost 50 cents per dose on the 2009 price. This will create approximately US$55 million in savings in 2010 and enable GAVI to finance the immunisation of 6.3 million more children.

“This price drop is no accident, but rather the result of a strategy to leverage the purchasing power of hundreds of millions of people,” said UNICEF Deputy Executive Director Saad Houry. “Clearly, industry understands and responds to a market, regardless of whether that market is in poor or rich countries. The Alliance’s model is beginning to work, and we are optimistic that the trend will continue, as competition and demand increase over time.”

GAVI’s business model is based on the expectation that rising demand for immunisation in developing countries induces more companies to produce vaccines, thus creating competition and driving prices down. Through the new data, success becomes evident. Whereas in 2001, there was only one company producing the pentavalent vaccine, now there are four. Two are Indian companies, whose products came on the market in 2008. Today, 50% of the vaccines funded by GAVI are from developing country manufacturers.

“We have now vaccinated 256 million children in the poorest countries through GAVI support. The number of deaths averted as a result vindicates the decision we made ten years ago to create a unified effort to speed new and underused vaccines to the world’s most vulnerable children,” said Daisy Mafubelu, Assistant Director-General for Family and Community Health at the World Health Organization. “The challenge we face, particularly in the midst of the financial crisis, is to maintain and extend our gains with basic vaccines while ensuring that new life-saving innovations are chilmade widely available in the developing world – especially new vaccines against pneumococcus and rotavirus, the leading causes of pneumonia and diarrhoea mortality respectively.”

ECDC warns against overuse of antibiotics

The European Centre for Disease Prevention and Control (ECDC ) warned at a press briefing in November that that the overuse of antibiotics is leading to antibiotic resistance, which is a major threat to public health in Europe and added that across the European Union the number of patients infected by resistant bacteria was increasing.

As part of an antibiotics awareness drive the ECDC urged doctors to stop overprescribing antibiotics and to stand firm against patient demands for antibiotics for viral infections as they won’t work. Doctors are aware of this but patients aren’t and “doctors must not give in to pressure from patients”.

According to the ECDC the six most common multi-drugresistant bacteria – superbugs – cause around 400,000 infections a year in Europe and kill around 25,000 people.

The ECDC calculated the financial burden as costing Euro 900 million a year in extra hospital costs and a further Euro 600 million a year in lost productivity.

Dominique Monnet of the ECDC’s scientific advice unit was quoted as saying: “If this wave of antibiotic resistance gets over us, we will not be able to do organ transplants, hip replacements, cancer chemotherapy, intensive care and neonatal care for premature babies [as antibiotics are needed in all these treatments].”

Researchers suggest H1N1 originated in lab

Respected virology researchers are suggesting in an a commentary published November last year in the open access Virology Journal, that the influenza A (H1N1) virus was most probably man-made and originated in a laboratory, rather than being the work of nature.

The Australian scientists Adrian J Gibbs, John S Armstrong and Jean C Downie write in their article, “From where did the 2009 'swineorigin' influenza A virus (H1N1) emerge?” that the swine-origin influenza A (H1N1) virus that appeared in 2009 and was first found in human beings in Mexico, is a reassortant with at least three parents. The say six of the genes are closest in sequence to viruses isolated more than a decade ago.

“Sequences of these genes do not directly reveal the immediate source of the virus as the closest were from isolates collected more than a decade before the human pandemic started. The three parents of the virus may have been assembled in one place by natural means, such as by migrating birds, however the consistent link with pig viruses suggests that human activity was involved.

The researchers suggest the possibility that laboratory errors involving the sharing of virus isolates and cultured cells, or perhaps vaccine production, may have been involved.

They also point out that it is “important that the source of the new virus be found if we wish to avoid future pandemics rather than just trying to minimise the consequences after they have emerged”.

Their paper can be read online here: content/6/1/207

● Citation Adrian J Gibbs, John S Armstrong and Jean C Downie, “From where did the 2009 'swine-origin' influenza A virus (H1N1) emerge?” Virology Journal 2009, 6:207doi:10.1186/ 1743-422X-6-207

Increasing access at core of GE Healthcare’s new business

In the first half of last year GE announced its six-year ‘healthymagination’ initiative, during which the company said it would spend US$3 billion on healthcare innovation that would help increase access to and reduce costs of healthcare. In addition, the company said it would commit $2 billion of financing and $1 billion in related GE technology and content to drive healthcare information technology and health in rural and underserved areas. As part of healthymagination, GE is changing the way it develops new health products. By 2015, GE said it is committed to delivering 100 innovations that lower cost, increase access and improve quality by 15%.

Oxford Analytica, an independent international research and consultancy firm, is reviewing GE’s commitments in product innovations to determine if they meet the standards the company has set. To date, Oxford Analytica has qualified 27 GE product innovations, including products such as low-cost digital x-ray machines, portable ultrasounds and premium CT systems. GE Healthcare said it is making ‘healthymagination’ inherent to product development.

“This is not a marketing campaign,” said Omar Ishrak, president and CEO of GE Healthcare Systems at a healthymagination showcase in New York City in November last year. “It’s a new framework for the way we operate.”

Heart disease found in Egyptian mummies

Hardening of the arteries has been detected in Egyptian mummies, some as old as 3,500 years, suggesting that the factors causing heart attack and stroke are not only modern ones; they afflicted ancient people, too.

Study results appear in the 18 November 2009 issue of the Journal of the American Medical Association (JAMA).

“Atherosclerosis is ubiquitous among modern day humans and, despite differences in ancient and modern lifestyles, we found that it was rather common in ancient Egyptians of high socioeconomic status living as much as three millennia ago,” says UC Irvine clinical professor of cardiology Dr Gregory Thomas, a co-principal investigator on the study. “The findings suggest that we may have to look beyond modern risk factors to fully understand the disease.”

The nameplate of the Pharaoh Merenptah (c. 1213- 1203 BC) in the Museum of Egyptian Antiquities reads that, when he died at approximately age 60, he was afflicted with atherosclerosis, arthritis, and dental decay. Intrigued that atherosclerosis may have been widespread among ancient Egyptians, Thomas and a team of US and Egyptian cardiologists, joined by experts in Egyptology and preservation, selected 20 mummies on display and in the basement of the Museum of Egyptian Antiquities for scanning on a Siemens 6 slice CT scanner in February last year.

The mummies underwent whole body scanning with special attention to the cardiovascular system. The researchers found that 9 of the 16 mummies who had identifiable arteries or hearts left in their bodies after the mummification process had calcification either clearly seen in the wall of the artery or in the path were the artery should have been. Some mummies had calcification in up to 6 different arteries.

Using skeletal analysis, the Egyptology and preservationist team was able to estimate the
age at death for all the mummies and the names and occupations in the majority. Of
the mummies who had died when they were older than 45, 7 of 8 had calcification and
thus atherosclerosis while only 2 of 8 of those dying at an earlier age had calcification.
Atherosclerosis did not spare women; vascular calcifications were observed in both male populaand female mummies.

The most ancient Egyptian afflicted with atherosclerosis was Queen Ahmose Nefertiri’s nursemaid Rai, who lived to an estimated age of 30 to 40 years around 1530 BC. To put this in context, Rai lived about 300 years prior to the time of Moses and 200 prior to the Pharoah Tutankhamun.

In those mummies whose identities could be determined, all were of high socioeconomic status, generally serving in the court of the Pharaoh or as priests or priestess. While the diet of any one mummy could not be determined, eating meat in the form of cattle, ducks and geese was not uncommon during these times.

“While we do not know whether atherosclerosis caused the demise of any of the mummies in the study, we can confirm that the disease was present in many,” Thomas says.

Global Fund approves $2.4bn in new grants

 The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved US$2.4 billion in its ninth round of grants, bringing the total amount of approved funding since its inception in 2001 to $18.4 billion.

“These grants enable countries around the world to address some of the main problems they are struggling with every day,” Dr Tedros Adhanom Ghebreyesus, Ethiopian Health Minister and Chair of the Global Fund Board, said.

The two-year commitment – the second largest ever – was approved by the board of directors during a recent meeting in Addis Ababa, when it also decided to launch the tenth round of grants in May 2010.

There had been fears that as a result of a funding shortfall, the board would decide to cancel its 2010 call for funding proposals, curtailing the fight against the AIDS pandemic.

Despite the decision to go ahead with a call for proposals in 2010, Michel Kazatchkine, executive director of the Global Fund, noted that the demand for funding was ‘enormous’, and there was a need for more investment to continue the worldwide momentum of HIV prevention, treatment and care.

“We may not be able to continue approving such amounts of financing and see continued progress in health in the coming years unless donor countries scale up their funding even further than what they have done so far,” he said.

An estimated 2.3 million people around the world are on life-prolonging antiretroviral drugs paid for by the Global Fund, which has also provided anti-tuberculosis treatment to 5.4 million people.

WHO sets new HIV treatment guidelines

The World Health Organisation (WHO) issued a new set of guidelines for the treatment of HIV and prevention of mother-to-child transmission (PMTCT) on 30 November last year.

The recommendations are intended to provide a reference for countries in setting their own national standards for HIV/AIDS treatment and PMTCT. Implementation will depend on local capacity and budgets, but the guidelines could potentially have a tremendous impact on the lives of the 33.4 million people living with HIV/AIDS.

“The widespread adoption of the recommendations will enable many more people in high-burden areas to live longer and healthier lives,” said Dr Hiroki Nakatani, Assistant Director General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at WHO.

The revised guidelines, based on new scientific evidence, raise the threshold for starting antiretroviral therapy (ART) from a CD4 count (a measure of immune system strength) of less than 200 cells per cubic millilitre – as recommended by the guidelines issued in 2006 – to a CD4 count of no less than 350, regardless of whether or not the patient is displaying symptoms.

Studies have shown that starting ART earlier reduces mortality rates, but earlier treatment will mean an average additional one to two years on antiretroviral (ARV) drugs, raising concerns about the costs for governments already struggling to meet targets set according to the previous guidelines.

The 2009 guidelines suggest greater use of laboratory monitoring, including CD4 counts and viral load testing (measuring the amount of HIV in the blood), to better manage HIV treatment and care.

WHO also advises the use of first-line ARV drugs – Zidovudine (AZT) or Tenofovir (TDF) – rather than Stavudine (d4T), which has been widely used in developing countries because of its lower cost, but produces more serious side effects.

In line with several recent clinical studies that have demonstrated the efficacy of ARVs in preventing HIV transmission from mother to child during breastfeeding, the new guidelines call on all HIVpositive pregnant women to begin ARV treatment at 14 weeks of pregnancy and continue until they stop breastfeeding.

Previous guidelines recommended that ARVs be provided to HIV-positive pregnant women only in the third trimester (beginning at 28 weeks). The new guidelines encourage HIV-positive mothers taking ARVs to exclusively breastfeed their infants for the first twelve months of life.

“We are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers when they have access to ARVs,” said Daisy Mafubelu, WHO’s Assistant Director General for Family and Community Health.

Lifestyle changes save lives and reduce global warming

Eat less meat, have smaller herds of animals, switch to more efficient stoves that pollute less, and develop more sustainable public transport systems are some of the lifestyle changes and technical fixes that could save millions of lives and reduce global warming.

This is the message in a series of studies published by a group of scientists in the respected British medical journal, The Lancet, to make a case for health at the United Nations climate change conference in Copenhagen (COP15), in December last year.

Each study focuses on one sector where greenhouse gas emissions need to be reduced, including household energy use, urban land transport, electricity generation, and food and agriculture. The effect on health of short-lived greenhouse pollutants, produced by several sectors, is also reviewed.

Reducing preventable deaths is the aim: two million people die from indoor air pollution every year; 1.2 from outdoor air pollution; 1.3 million from road traffic injuries.

Each study examines the health implications of actions to reduce carbon dioxide (CO2) and other greenhouse gases in high- and lowincome countries. Supplying cleaner household energy to the poor and raising the fitness levels of the 3.2 million who die every year from physical inactivity would be simple solutions, Diarmid Campbell-Lendrum, a scientist with the World Health Organisation and a contributor to the studies, told IRIN.

“We [health professionals] cannot become spectators,” said Mike Gill, of the University of Surrey, a coauthor of a study that urged doctors to discuss climate change with patients.

“We have the evidence, a good story to tell that dramatically shifts the lens through which climate change is perceived, and we have public trust,” he wrote with co-author Robin Stott.

Gill and Stott recommended setting up a low-carbon development fund of at least US$150 billion to help developing countries implement some of the clean energy strategies.

The money could be raised by imposing a $5 tax on each of the 20 billion barrels of oil used every year by the 30 member countries of the Organisation for Economic Cooperation and Development, and a tax on airline tickets.

Andrew Haines, Director of the London School of Hygiene and Tropical Medicine, suggested: “In view of the trillions of dollars likely to be spent on greenhouse gas mitigation in the coming decades, the relatively small resources needed to guide investments along paths bringing the world closer to its health and climate goals would be money well spent.”

Measles deaths fall by 78%

The Measles Initiative announced 3 December that measles deaths worldwide fell by 78% between 2000 and 2008, from an estimated 733,000 in 2000 to 164,000 in 2008. However, global immunisation experts warn of a resurgence in measles deaths if vaccination efforts are not sustained.

All regions, with the exception of one, have achieved the United Nations goal of reducing measles mortality by 90% from 2000 to 2010, two years ahead of target. Vaccinating nearly 700 million children against measles, through large-scale immunisation campaigns and increased routine immunisation coverage, has prevented an estimated 4.3 million measles deaths in less than a decade.

“So much has been achieved in the past several years thanks to the hard work and commitment of national governments and donors. But with only two years until the target date, there are signs of stalling momentum,” said Dr Margaret Chan, WHO Director- General. “This is a highly contagious disease that can quickly take advantage of any lapse in effort.”

Dr Thomas R. Frieden, Director, US Centers for Disease Control and Prevention, said: “Despite impressive progress globally, more than 400 children die every day from this completely preventable infection. Measles can make a rapid comeback if we don't continue to make progress. We saw this happen in the United States between 1989 and 1991, when an estimated 55,000 measles cases and more than 130 deaths occurred."

● Meanwhile, UNICEF has reiterated the vital importance of administering a second dose of measles vaccine, which together with improved routine immunisation has averted 3.4 million deaths between 2000 and 2007 in countries with previously high measles burden. The call by UNICEF was made in an article published 9 November 2009 in a special issue of Indian Pediatrics dedicated almost entirely to measles immunisation in India, the only country that has not adopted a two-dose measles control strategy.

The article notes that India is in the process of introducing into its childhood vaccination programme a second dose of measles vaccination, which could save an estimated 123,000 child deaths annually.


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