Developing nations

In the developing world, large-scale efforts to prevent disease through widespread vaccination and immunization began in 1974, when success in smallpox eradication led the World Health Organization (WHO) to establish the Expanded Programme on Immunization (EPI) (Levine, 2004; Plotkin and Orenstein, 2004). By 1970 vaccines had been developed against numerous infectious agents, including diphtheria, pertussis, tuberculosis, tetanus, polio, measles, mumps, and

Etc.

Neisseria gonorrhea Mycobacterium Tb Multiple sclerosis (th)

Melanoma (th) Diabetes mellitus (th) Histoplasma capsulatum Herpes Simplex Hepatitus C Helicobacter pylori Epstein-Barr Enterotoxigenic E. coli

Cytomegalovirus Coccidioides immites Chlamydia

Human papillomavirus

Varicella zoster

1983

1993

Pneumococal disease

Meningococcal

Hepatitus A

2005

Pneumococal disease

Meningococcal

Hepatitus A

Pneumococal disease

Meningococcal

Hepatitus A

Pneumococal disease

Meningococcal

Hepatitus A

1983

1993

2005

2020

Figure 10.3 Vaccine-preventable diseases - yesterday, today and tomorrow. Source: US Centers for Disease Control.

2020

Figure 10.3 Vaccine-preventable diseases - yesterday, today and tomorrow. Source: US Centers for Disease Control.

rubella. Despite this success, only 5 percent of children worldwide had access to these vaccines (see Figure 10.6).

The goal of EPI at its inception - so named because it sought to "expand" both the scope and reach of immunization services worldwide - was to make six key vaccines available to all children worldwide by 1990 (Keja et al, 1988; Plotkin and Orenstein, 2004). Through the promotion of routine immunization services that led to the development of national immunization programs in most countries,

ESTIMATED VACCINATION COVERAGE of US CHILDREN 19-35 Months of Age with 4:3:1:3:3:1

• four or more doses of DTaP

• three or more doses of poliovirus vaccine

• one or more doses of any measles containing vaccine

• three or more doses of HebB

• one or more doses of varicella vaccine NATIONAL AVERAGE: 79.1% (±1.1)

□ 60-69% □ 70-74% ■ 75-79% ■ 80-84% ■ 85-89% H 90-95% Source: National Immunization Survey, 2005

Figure 10.4 Estimated coverage of US children 19-35 months of age with 4:3:1:3:3. Source: US Centers for Disease Control.

EPI achieved remarkable success in the 20 years following its inception. By 1994, the number of children worldwide receiving immunization services had risen to 80 percent (Levine and Levine, 1997; Bland and Clements, 1998). Success, however, was not uniform, and the momentum to maintain and expand these efforts was not consistent through the 1990s. Achievement of regional polio eradication and measles elimination during this period, though, led to renewed interest in and support for immunization programs. As a result, the Global Alliance for Vaccines and Immunization (GAVI) was launched in 2000 (Plotkin and Orenstein, 2004). GAVI is a collaboration of governments in both developed and developing countries; international organizations including the WHO, UNICEF, and the World Bank; the Bill and Melinda Gates Foundation; other non-governmental organizations; vaccine manufacturers in both developed and developing countries; and public health and research institutions. The primary goal of GAVI is to improve

100 n

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 '

Source: Data for 1994 from Eberhardt M.S., Ingram D.D. Makuc D.M. et al. Health, United States, 2001, with Urban and Rural Healthbook Hyattsville, Maryland National Center for Health Statisitic 2001: Table 73. Data for 1995-2001 from National Center for Health Statistics. (2003). Health United States, 2003 with Chartbook on trends in the Health of American National Center for Health Statisitcs Table 71 Data for 2002 from National International Program (2003). Immunization Coverage in the US. Results from National Immunization Survey Centers for Disease Control and prevention. Data for 2003 National Immunization Program (2004). Immunization Coverage in the US results from National Immunization Survey.

Centers for Disease Control and Prevention. Available online at http://www.edu.gowhipcoverage default htm. Data for 2004 Centers for Disease control and Prevention, National Immunization Program (2005). NIS data, tables, Jan-Dec 04. Available online at http://www.edu.gowhipcoveragedefault htm.

Figure 10.5 Percentage of children aged 19-35 months receiving the combined series of vaccination (4:3:1:3), 1994-2004. Source: Child Trends Data Bank (2006), US Centers for Disease Control.

DPT3 coverage, 1980-2003

Coverage of the DPT3 vaccine is lower in Eastern Southern Asia and West Central Africa than in other regions

100%

100%

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Figure 10.6 Worldwide DTP3 coverage 1980-2003. Source: UNICEF (2005).

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Figure 10.6 Worldwide DTP3 coverage 1980-2003. Source: UNICEF (2005).

access to immunization for children in low-income countries, and to reduce the time it takes from the development and distribution of new vaccines in industrialized countries to their introduction and widespread use in developing nations. In the five years since GAVI's formation it has raised almost US$3.3 billion, and it estimates that its support has prevented more than 1.7 million premature deaths (GAVI Fact Sheet, 2006). As of 2003, all WHO regions realized gains in DPT3 coverage (percent of children receiving three doses of the combined diphtheria, pertussis, tetanus vaccine), with seven out of eight regions achieving more than 70 percent coverage (UNICEF, 2005).

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