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Global vaccine plan draws criticism

The international humanitarian relief organization Médecins Sans Frontières (MSF), also known as Doctors Without Borders, has called a vaccination effort developed by the Bill and Melinda Gates Foundation, among other partners, seriously flawed.

The Global Vaccine Action Plan (GVAP) aims to increase immunization world wide. But MSF says that the plan fails to address the 20% of infants — some 19 million — who never receive basic, life-saving shots.

Rather than pushing for novel vaccines, the plan should focus more concretely on strategies to get existing vaccines to children, MSF says.

The organization is hoping to draw attention to this issue ahead of discussions that will occur next week in Geneva at the 2012 World Health Assembly.

“It’s great to have new vaccines, but we need to address the problem of getting what is needed to where it is needed,” says Jane Boggini, a field nurse for MFS.

Misleading statistics account, in part, for why vaccine coverage has fallen to the wayside in the current plan, says Daniel Berman, deputy director of the MSF Access Campaign. “The rhetoric we see is that routine vaccination is working, and now we can just add new vaccines to the mix,” Berman says. Vaccination surveys come up with varying results, he explains. For example, the World Health Organization claims that 82% of children in the poorest countries received their three basic DTP3 (diphtheria, pertussis and tetanus) vaccines in 2011, but Berman says that the numbers are closer to 30% or 40% in many regions.

Further, gaps in vaccination fade into the background when global health organizations emphasize only gains made over the past decade, says Berman. The organization would prefer that world leaders discuss why six of the ten countries listed as having the highest proportion unvaccinated children in 2006 remained at the top in 2010, or why 28 African countries suffered measles outbreaks in 2010, when a vaccine to prevent the potentially fatal respiratory disease has existed for 40 years.

Last year, Boggini gained first-hand knowledge of what current vaccine campaigns lack when she worked with her MSF colleagues in South Sudan during a measles outbreak. To vaccinate children in rural villages, Boggini says, the team trudged through streams and swamps, carrying food, water, syringes, and vaccines kept in heavy, cooled containers. “Sometimes the water was up to my shoulders,” Boggini says. “We vaccinated 1,500 children, but we had to return before we reached the most remote regions because we could no longer keep the vaccines cold.” As in South Sudan, health workers in the Democratic Republic of Congo, Sierra Leone, Nigeria, India, Pakistan and other countries struggle to keep vaccines at 3–8° Celsius.

Injections provide another obstacle, as people trained to give shots are in short supply in regions that can’t afford to pay health workers salaries. Thus, MSF says, the global plan should have pushed for ways to reformulate vaccines so that they can be given orally or through nasal sprays. The group adds that the plan also ought to have included a discussion on how quality-assured vaccine manufacturers in India and other developing countries can help to lower the cost of vaccines so that developing countries’ governments can afford them.

Finally, MSF recommends more research on vaccination schedules. At present, babies must visit health workers four times for the DTP3 and measles vaccines within their first year of life. In industrialized countries, these appointments may seem reasonable. But in the developing world, a hospital visit often requires a walking journey down dirt paths, with multiple children in tow. Berman says that an MSF research group is now assessing the efficacy of a single pneumonia vaccine given anytime before a child reaches 14 years old, rather than three doses at specified dates. “These are the types of studies that need to be in the global plan, but they will not be in the plan if industry has too much say,” he says, adding, “that is against their financial interest.”

Photo credit: Amy Maxmen

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