Vaccine Ping-Pong: GAVI and MSF’s Advocacy Campaign for Vaccine Access

MSF (Médecins Sans Frontières, also known as Doctors Without Borders) recently posted a set of three animated videos about child vaccines as part of their latest advocacy campaign. The first one, titled “We Need Better Tools to Save Lives” is pretty straightforward – it’s a basic explanation of what is needed to vaccinate children, how MSF struggles to fill that need, and a quirky analogy about what it is like to not have that need filled. Simple enough.

The second video is a lot more direct. The show how the number of vaccines in the standard childhood vaccination battery, as well as the cost of those vaccines, have increased in the last decade. The video then takes a direct shot at pharmaceutical companies for keeping vaccine prices high in order to prioritize profits over saving lives. The debate on drug prices is a heated one, and everyone seems to have their own opinion on what “fair prices” for drugs are, but it is clear where MSF stands.

The last video was the one I personally found to be the most interesting. “Dear GAVI, Please Let Us Access Your Discounted Vaccine Prices” talks about how qualified governments are allowed to access GAVI’s low vaccine prices, but NGOs are not given access to them. MSF provides a more detailed description of their perspective on the issue in this press release:

MSF is also troubled by the fact that non-governmental organizations and humanitarian actors are excluded from accessing the GAVI-negotiated price discounts. MSF is often in a position to vaccinate vulnerable groups, such as refugee children, HIV-positive children, and older unvaccinated children who fall outside of the typical age range for standard vaccination programs. However, MSF has not been able to systematically access the lowest prices negotiated by GAVI, having to resort to lengthy negotiations with Pfizer and GSK over the last four years to access the pneumococcal vaccine. While the companies have offered MSF donations, this is not a sustainable, long-term solution for MSF as we work to respond quickly to needs in the field, and wish to expand vaccination of vulnerable groups in an increasing number of countries.

GAVI responded to the MSF campaign in this statement:

First, we agree with MSF – we do all want the same things. We want all children everywhere to be protected by immunisation. In fact, GAVI is proud to include MSF as a member of the GAVI Alliance. They are an active member of the steering committee of the GAVI Board’s Civil Society Organisation Constituency.

MSF first formally raised the issue of access to the same prices GAVI pays for vaccines at the GAVI Board meeting in December 2012. This issue is currently being discussed through the Alliance’s Governance channels. We find it disappointing that MSF, which knows and is engaged in the GAVI Governance process, has chosen to take on this issue as a public campaign.

MSF then offered this statement in response:

Thank you GAVI for publicly acknowledging our request for access to your vaccine prices. MSF has been frustrated by bilateral discussions, which have been ongoing for a few years now, with vaccine manufacturers and the GAVI Alliance on finding a solution for humanitarian actors to access pneumococcal conjugate vaccine at the GAVI price, and we anticipate that accessing GAVI prices for other new vaccines (for rotavirus, HPV) will also be a challenge. We ask GAVI to fast-track this process so that MSF can vaccinate more kids as soon as possible.

We often talk about issues of coordination (or lack thereof) and collaboration between different aid groups and funding organizations in the wake of natural disasters and humanitarian crises. It is interesting to see this kind of friction between different groups who are trying to do exactly that because of how complicated it can actually be.



To protect children right now, we have to use vaccines that aren’t well suited to the job they have to do. Vaccines can’t take the heat — they have to be kept at between 35 and 46 degrees at all times. But we need to use them in some of the hottest places on earth. For this and other reasons, we need better-adapted vaccines to protect children from life-saving illnesses.



Children are now protected with 11 vaccines; up from six vaccines a decade ago. The price of vaccinating a child has sky-rocketed. It cost $1.37 to vaccinate a child 10 years ago, now it’s $38.80. That’s a whopping 2,700 percent increase. So how do we decide how many vaccines children need? Is it based on how much money you can make, or on how many children’s lives can be saved?



The price to vaccinate a child has risen by 2,700 percent over the last decade. Countries where Doctors Without Borders/Médecins Sans Frontières (MSF) works will lose their donor support to pay for vaccines soon, and will have to decide which killer diseases they can and can’t afford to protect their children against. MSF is asking the GAVI Alliance to open up their discounted vaccine pricing to humanitarian actors that are often best placed to respond to vaccinating people in crisis.

The GAVI Alliance is an international public-private partnership whose stated mission is to increase access to immunization for children in poor countries. GAVI co-finances the cost of vaccines with qualifying countries. Participants include governments of developing and donor countries, the World Health Organization, UNICEF, the World Bank, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other philanthropic organizations.

Another Disease in the Crowd? Pneumonia back in the spotlight on World Pneumonia Day

Nearly every disease, cause, and social issue claims a calendar date for itself to raise awareness, from well-known causes such as HIV/AIDS and cancer to somewhat more obscure issues, such as parental alienation.  World Pneumonia Day, which was yesterday, is no exception.  It, like many others, came amid general fanfare, advocacy, and, well, awareness, but it will undoubtedly step back into the crowd of causes competing for attention and funding.

But should it?

In this climate of fiscal austerity, foundations and organizations competing for an ever narrowing stream of donor funding.  Times are tight, so each disease has to make its case, so to speak.  Without a doubt, all of them are worth funding, but none of them will get the funding they need.  The question, then, becomes one of priority: how do donors decide how to make their dollars count?

Pneumonia can make a compelling case for being at the front of the line.  It is simultaneously the world’s number one killer of children under five and one of the world’s most preventable diseases.  We have effective vaccines and proven interventions, including reducing indoor air pollution (which will also make the clean cookstoves people happy) and increasing breastfeeding during the first six months (which will make the breastfeeding advocates and MCNH people happy).

Unfortunately, the impact of pneumonia and the ease of treating it do not diminish the importance of other diseases.  Many NTDs, for example, are extremely debilitating and only cost of a few cents to treat.  Tuberculosis is re-emerging with a vengeance and frightening antibiotic resistance. And recent shortfalls in contributions to the Global Fund endanger the gains we have made against HIV/AIDS, TB, and malaria.

So what is a cause to do? Own its awareness day and get the word out, which is precisely what the major players, like the GAVI Alliance and IVAC at Johns Hopkins, have done.  Dr. Orin Levine is making his usual rounds.  IVAC
has published a report card on the progress made by the 15 countries with the highest rates of childhood pneumonia, which examines their vaccination, treatment, and breastfeeding rates, in addition to progress in reducing pneumonia-related mortality.  Extra points for getting their recent
vaccine drive in Nicaragua on PBS
, too.

I am no judge of which global health causes should be prioritized when it comes to funding – but then again, who among us is?  All advocates can do is make their own individual cases.  Let us hope that pneumonia can get the respect it deserves among the other worthy global health causes and not just go back to being another disease in the crowd after World Pneumonia Day.

Global Health News Last Week

Note: There will be no news round-up next week, as the IH section will be conducting its usual array of activities during APHA’s Annual Meeting.  Please tune in for updates on section sessions and activites at the conference.  Meanwhile, you can get your global health news fix from the DAWNS digest, Humanosphere, or the Healthy Dose.

October 16 was World Food Day.
October 17 was International Day for the Eradication of Poverty.

POLITICS AND POLICY

  • Scientists are warning officials negotiating a global treaty on mercury that banning the deadly chemical completely would be dangerous for public health because of the chemical’s use in vaccines. 
  • The Washington Post runs an editorial critical of the GOP presidential candidates’ hostility toward foreign aid.
  • An influential panel of MPs warned that changes in UK aid policies may make overseas aid more prone to corruption and misuse.
  • Attendees at the Asia Pacific Conference on Sexual and Reproductive Health and Rights have called on countries in the region to introduce comprehensive sexuality education in schools.
  • The Kaiser Family Foundation has released a report which finds that global HIV/AIDS funding dropped by 10% in 2010.

PROGRAMS

  • HP Signed a Memorandum of Understanding with USAID to collaborate in the fight against global poverty through initiatives directed at issues such as public health.
  • GAVI CEO Seth Berkley pens an op-ed in Huffington Post on the economic value of childhood vaccines.
  • The Pan African Parliament has passed a resolution that urges African nations to prioritize maternal, newborn and child health programs.
  • USAID is initiating research to find out whether developing world families will adopt a new cooking technology and adapt their cooking methods to save their health.
  • At an event in Washington, the Aspen Institute’s Global Leaders Council called for increased accessed to contraception worldwide. 
  • Microfinance initiatives to fund development could benefit from reinvigorating their aims and taking on new, integrated approaches, according to experts at the 2011 International Forum on the Social and Solidarity Economy in Montreal.

RESEARCH

  • A new study, by researchers from the National Institutes of Health, Gilead Sciences Inc. and universities in Belgium and Italy, suggests that a microbicide gel, which was originally developed to fight AIDS in Africa, could lower the incidence of herpes in many women.
  • RTS,S a malaria vaccine developed by GlaxoSmithKline, is showing great of promise in the early stages of its huge clinical trial.  The American Society for Tropical Medicine and Hygiene Council Member and Science Director at the PATH Malaria Control Program, Rick Steketee, explores the impact of the new RTS,S clinical trial results and what this breakthrough means for science and neglected tropical disease research. On the other hand, Sarah Boseley wonders where the money will come from once the vaccine has passed its trials, and Karen Grepin is not as excited about the new GSK malaria trial results as many others.
  • Adults who have fallen behind on mortgage payments exhibited higher rates of depression and are skipping meals and medications because they cannot pay the bills, a study published in the American Journal of Public Health found.
  • Teenage drivers have fewer crashes after they’ve been driving for a while, but new research in the American Journal of Public Health suggests that a few months behind the wheel do not improve their driving skills much.
  • A recent study finds that the best way to fight TB in patients with HIV is to treat as early as possible.

DISEASES AND DISASTERS

  • The famine in Somalia isn’t getting much public attention, but not because things are improving. Aid workers predict things will get worse before they get better. Much-needed rain is coming, but the rainfall could deepen the crisis for the four million people there who need help.
  • Numerous UN agencies are ready to be deployed if Southeast Asian nations ravaged by flooding request for assistance.
  • A report by Roll Back Malaria Partnership released at the start of the Gates Foundation’s Global Malaria Forum says that the world is making positive steps towards eradicating malaria. Specifically, 29 countries are on track to stop malaria within a decade.
  • Environmental hazards sicken or kill millions of people — soot or smog in the air, for example, or pollutants in drinking water. But the most dangerous stuff happens where the food is made — in peoples’ kitchens.
  • World Health Organization officials say the rapid and extensive globalization of food production has increased the incidence of food contamination worldwide.
  • Speculators in the agricultural commodities markets are forcing grocery prices to rise too quickly and erratically, according to some top economists marking World Food Day Sunday.
  • Climate change poses an immediate and serious threat to global health and stability, as floods and droughts destroy people’s homes and food supplies and increase mass migration, experts warn.
  • A survey of 87 countries showed more than half the countries reported more or much more awareness of mental illnesses in the past three years. Unfortunately, there is not a whole lot of new money behind that awareness.

Global Health News, Week of September 26-30

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe. Interested parties should register here. Please note that registration will close on October 14th. Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.


The University of Washington has launched the first full year of its Global Health Minor program!

POLITICS AND POLICY

  • Tobacco companies knew that cigarettes contained a radioactive substance called polonium-210, but hid that knowledge from the public for over four decades, a new study of historical documents revealed.
  • Latin American leaders have agreed to accelerate their efforts to address maternal health at the 51st Directing Council of the Pan American Health Organization/World Health Organization.
  • Journalist Georgianne Nienaber looks at the impact of PEPFAR and how it may be impacted by budget battles in Congress.
  • Earlier this week, the World Health Organization released a report analyzing air pollution levels in nearly 1100 cities in 91 countries. The analysis was based on air particulate levels between 2003 and 2010.
  • When it came out a while ago that the CIA had used a fake vaccination scheme to try to find out where Osama bin Laden might be in Pakistan, many said it would undermine real health and humanitarian efforts. Here’s one group’s story.
  • Foreign aid has acquired a bad reputation in recent years, as something usually wasteful and useless. Yet all this sound and fury has overshadowed the evidence that aid often can work.
  • A report by the Partnership for Maternal, Newborn & Child Health finds that over 100 countries have increased financing for maternal and child health initiatives.
  • The humanitarian impact of the world economic crisis became clearer this week, as the UN warned of huge job losses, a rise in the number of people afflicted by chronic undernourishment, and the “extraordinary price” being paid by children as “austerity programs” constrict the developing world.
  • There is enough water in the world’s rivers to meet the demands of the expanding global population, but the rivers have to be better managed, according to a series of studies released today at the 14th World Water Congress in Porto de Galinhas, Brazil.
  • UNICEF has called on the IMF and World Bank to ensure that children are not negatively impacted by austerity measures carried out by various countries.

PROGRAMS

  • The New York Times shows how male circumcision is one of the most effective and simple solutions in HIV reduction, but has so far been hard to implement.  Meanwhile, a group of economists, including Bjorn Lomborg, are casting doubt on the cost-effectiveness of voluntary male circumcision campaigns as an HIV prevention measure.
  • The New York Times features an article about the simple innovation of using vinegar to detect if a woman has cervical cancer by applying it with a brush to the cervix.
  • The Global Fund, the world’s largest funder of global health, is set to radically shake up the way it disburses and manages donor money, in a move to boost efficiency that could reallocate a third of its financing in order to save more lives.
  • On Tuesday, the Global Alliance for Vaccines and Immunization announced that it will be expanding its target vaccine areas to directly address diarrhea and pneumonia.
  • UNFPA has announced that it is now collaborating with UNICEF to combat Female Genital Mutilation.

RESEARCH AND INNOVATION

DISEASES AND DISASTERS

  • Roads may accelerate spread of antibiotic resistance: Samples from villages by major roads in Ecuador compared to more rural villages shows antibiotic resistant E. coli is spreading along roads.
  • The recent heavy flooding caused by the monsoon in Pakistan, most devastating in Sindh, has affected the lives of over five million people. The Health and Nutrition Cluster is appealing for US$45.9 million. WHO requires US$14.8 for response for Health, Nutrition and Water and Sanitation intervention.
  • New enterovirus causes respiratory disease: Promed reports on 6 clusters of respiratory illness associated with human enterovirus 68 in Asia, Europe, and the United States during 2008–2010.
  • More than 20 percent of the population of Latin America and the Caribbean lacks basic sanitation and 15 percent has no access to drinking water because of poor management, said experts at a meeting that ended Thursday in Brazil.
  • The likelihood of water-borne disease outbreaks is high in areas in Philippines recently devastated by Typhoon Nesat.
  • Aid groups are criticizing the U.S.government delay on deciding whether to resume large-scale food donations to North Korea. The charities warn that many vulnerable people in the impoverished communist state could die from starvation.
  • In a new report on rabies, the WHO finds that 45% of cases in the world take place in Southeast Asia.
  • A decade-long study of 135,000 men found that those who did not have children had a higher risk of dying from heart disease than those who did, raising new questions over the links between fertility and overall health,U.S. researchers said on Monday.
  • More money is needed to save lives in famine-ravaged East Africa, with the UN saying it’s something like $700 million through year’s end. The World Bank announced from Washington it would boost its aid to area countries to nearly $1.9 billion.  As if famine weren’t enough, Nick Kristoff tells us that as Somalis stream across the border into Kenya, at a rate of about 1,000 a day, they are frequently prey to armed bandits who rob men and rape women in the 50-mile stretch before they reach Dadaab, now the world’s largest refugee camp.
  • An explosion of new technologies and treatments for cancer coupled with a rapid rise in cases of the disease worldwide mean cancer care is rapidly becoming unaffordable in many developed countries, oncology experts said on Monday.

TOTALLY UNRELATED TO ANYTHING – Twitter knows what you’re feeling!

Global Health News Last Week

SECTION NEWS

The following announcement, from Eric Williams, calls for any IH section members interested in assisting efforts to address federal global health and HIV/AIDS funding.  Please see the text of the announcement below.  Eric can be contacted by e-mail at ericwms@gmail.com.

Dear Colleagues,

I’m writing to request assistance in a “grasstops” effort to address federal global health and HIV/AIDS funding. As you are likely well aware, there have been serious threats and concerns regarding global health funding over the last several years. There is a real need to mobilize influential members of our community in an effort to ensure that Congress does not backtrack on our global health commitments.

I am doing some consulting work with amfar and they want to identify experts, donors, high-profile individuals and/or organizations in select states who can reach out to key Senate leadership. We need these individuals/organizations to show and voice their support for continued and sustained commitments for global health.

States of focus include Nevada (Sen. Harry Reid), Iowa (Sen. Tom Harkin), and Washington (Sen. Patty Murray). We believe these senators are in key positions to influence appropriations decisions and sure up support for global health.

The aim of this effort is to:

  1. identify grasstop individuals/organizations and
  2. plan, coordinate, and carry out outreach efforts to Senate leadership in a variety of ways, including state-level meetings, Hill visits, op-eds, sign-on letters, and so forth.

If you are interested or able to provide assistance in helping to identify and/or reach out to the above stakeholders, I would be very interested in speaking. If there is strong support for this I would be happy to facilitate a conference call to discuss in full.


August 19 was World Humanitarian Day.

POLITICS AND POLICY

  • The CDC has made updates to its flu vaccination recommendations aimed at children and people with egg allergies.
  • The United Nations has released a list of 248 organizations from 48 nations that are accredited to attend the UN High Level Meeting (HLM) on non-communicable diseases (NCDs) during September 19-20, 2011.  Meanwhile, as has been widely reported (including here and here), negotiations have stalled over an “outcomes document” that is to be approved at the meeting.
  • The World Health Organization is calling for a ban on a common blood test for TB, saying the test is unreliable.
  • Twenty-two children in Kancheepuram, Indiawho were not allowed to go to school because they are HIV positive have been ordered to return to school after a court ruled in favor of the students.
  • International funding for HIV fell by 10 percent in 2010 from the previous year, according to the Kaiser Family Foundation and UNAIDS; activists worry that a continued reduction will undermine progress in global HIV prevention and treatment efforts.

PROGRAMS

RESEARCH

DISEASES AND DISASTERS

  • The WHO Says Libya is facing a medical supply crisis.
  • The United Nations food agency called on Thursday for long-term aid for farmers in the Horn of Africa, saying constant crises in the region should shame the world.
  • A report by the National Institute of Malaria research in Delhi has found that climate change will enable malaria to move to new areas.
  • New research finds that radiation from the nuclear plant accident in Japanin March reached Californiawithin days, showing how quickly air pollution can travel, but scientists say the radiation will not hurt people.
  • According to an article published in Science, 19 August, cases of Chagas disease are rising outside Latin America, because large numbers of people who are already infected are migrating fromLatin America.
  • Len Rubenstein comments on the attacks on healthcare personnel inBahrain and the recent progress made to protect healthcare workers in conflict zones.

INFOGRAPHICS AND OTHER INTERESTING VISUALS

Thanks to Tom Murphy and Mark Leon Goldberg, Larry Johnson (filling in for Tom Paulson), Isobel Hoskins, and Jeff Meer.