Vaccines work

You've seen the hashtag, now dig deeper into global immunisation

[vaccineswork]

What don’t you know about vaccines?

Ian Roe and Takuto Shiota, I Boost Immunity

Photo: I Boost Immunity.

A year ago we launched I Boost Immunity, a fun new website featuring a series of online quizzes designed to help raise literacy about immunization. The site pairs local learning with global giving: for every quiz question answered correctly, a vaccine is donated to a child in support of UNICEF Canada. Thanks to people like you, I Boost Immunity was an instant success!

To help celebrate Immunization Awareness Week (April 22-29), we’d like to return the favour. After a year of collecting anonymous data from answers to over 500,000 questions, some interesting patterns started to emerge. As most of our users tend to be very supportive of immunization already (including many health workers), this made some of our findings all that more surprising.

Let’s take a look at a few results from the past year:

1. The economic impact of vaccines is underestimated

Q - For every $1 invested in vaccination, developing countries get a direct return of: A - $16

This question was answered incorrectly 46% of the time. When users answer the same question in a later quiz, this falls to 37%. Thirty percent of respondents answered $5 underestimating the impact of vaccines considerably.

The take-away? We are clearly not talking enough about the economic benefits of vaccines!

2. HPV is much more common than some people assume

Q - About ___ % of sexually active people will get at least one human papillomavirus (HPV) infection at some time in their lives. A – 75%

Answered incorrectly by underestimating the figure 56% of the time.

This was quite surprising – again, considering our pro-vaccine audience. Clearly the ubiquity of HPV distinguishes it from many other sexually transmitted infections.

3. Even people that support immunization are sometimes uninformed about the importance of vaccine schedules

Q - Spacing out vaccines will cause fewer side effects. A – False

Answered incorrectly 41% of the time.  When users answer the same question in a later quiz, this falls to 15%.

What’s unsettling about is that this myth is that it comes straight out of the anti-vax playbook. Indeed, this fiction has become so widespread that it can even infect a pro-vax community.

4. Meningitis is not well understood

Q - There are vaccines that can protect against some diseases that can lead to viral meningitis. A – True

Answered incorrectly 49% of the time.

Many of our questions about meningitis had similar results to this leading us to conclude that not only are people uninformed about the differences between bacterial and viral meningitis – they are wholly unaware of the vaccines available to prevent infection.

Some Final Thoughts

Do you any of these topics surprise you?  The silver lining to these findings is that it helps us to understand some of the most fruitful topics to focus on in terms of education.  What is also encouraging is that our users not only believe strongly that vaccines are safe, the more questions they answer, the more knowledgable they become about the importance of immunization for themselves and their kids. 

Think you know a lot about vaccination? Then try one of our toughest immunization quizzes: ‘Do you know nursing’? Once you sign up it’s easy to ‘learn and earn’. You will have access to over 800 questions about vaccines and the diseases they prevent earning one vaccine in support of UNICEF for every correct answer. To learn more, go to www.iboostimmunity.com

[vaccineswork]

This week in vaccines

9th April 2017

This week saw remarkable progress in child health since 1990 was explored, showing that deaths had almost halved in the 25 years since. 

Immunisation in India was praised for a promising start to 2017, introducing new vaccines to protect against measles, rubella and others major diseases.  

The challenges of preventing disease for vulnerable people in Nigeria was also highlighted, as measles threatens. 

Two new studies came out this week, affirming the power of vaccines. One showed that whooping cough vaccines for pregnant women could protect newborns and that flu vaccines could also reduce child deaths. 

And after a few years of developing Ebola vaccines, a new trial is about to start to find out how well different candidates and strategies work to protect people on the ground. 

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One shot, two diseases: India protects children with measles and rubella vaccine

Sonia Sarkar, Communication Officer at UNICEF India

Children at the vaccine launch in Bengaluru. UNICEF/2016/ S.Sarkar

“It is for our own safety and health,” says 13-year-old Yashwanth, a student of Morarji Desai Residential School in Bengaluru.  His face lights up into a bright smile when asked to translate the messages on the placard he is waving. Yashwanth is one of the 200 students who have come to witness the historic launch of the measles-rubella (MR) vaccination campaign in the southern Indian state of Karnataka.

The campaign targets around 410 million children across the country, the largest ever immunisation campaign of its kind. The vaccine will be provided for free in schools, health facilities and at outreach session sites. Launched in five states and Union Territories including Karnataka, Tamil Nadu, Puducherry, Lakshadweep and Goa, the campaign will be expanded to other parts of India over the next two years and will be later integrated into India’s Universal Immunization Programme.

The campaign marks the introduction of the rubella vaccine in India’s childhood immunisation programme for the first time. Rubella, which is commonly referred to as German measles is a mild infection, but can have serious consequences if it occurs in pregnant women.  

“If a pregnant woman gets rubella in her early weeks of gestation, it can develop into Congenital Rubella Syndrome (CRS), which is not treatable. CRS often leads to miscarriage and stillbirth,” said Dr. N.K Arora from the Inclen Trust, an Indian health research network. “Children born to mothers suffering from CRS are likely to develop irreversible hearing loss, blindness and heart defects”.

The newest addition to India’s routine immunisation programme also protects against measles, a major killer of small children. Highly contagious, it spreads through coughing and sneezing. Of the 134,200 measles deaths globally in 2015, around 49,200 occurred in India - nearly 36 percent. Those who survive are more vulnerable to other serious illnesses such as diarrhoea and pneumonia.

UNICEF/2016/ S.Sarkar: Yashwanth, a student of Morarji Desai Residential School, Bengaluru.

The small wooden placards that Yashwanth and his friends are carrying at the launch function also display the time and place for vaccination in the local language.  This method has been adopted to help ensure that mothers turn up on time to vaccinate their children. The 2009 Coverage Evaluation Survey showed that 40 per cent of mothers were either not aware of when and where the vaccination sessions are being held and/or did not understand the importance of vaccination. This can mean that children miss out on vaccination. This time, school children are eager to do their bit to raise awareness about the new measles-rubella vaccination campaign in their schools, homes and neighbourhoods.

Yashwanth is one of the 16.5 million children in Karnataka who will receive the vaccine. Separated by a few rows from the school children, hundreds of community health workers dressed in uniform pink sarees witness the momentous launch in Bangalore.  Mary, a government health worker from North Bengaluru, mobilises communities for regular rounds of routine immunisation. “I feel happy and very proud to be able to contribute to this important health initiative, which will keep our children and mothers safe,” she says. These village level female health workers represent a silent yet powerful workforce to support large public health campaigns.

UNICEF/ 2016/S. Sarkar: Mary, a frontline worker from North Bengaluru in Karnataka

The work of Mary and her colleagues has international backing too. Both the World Health Organization (WHO) and UNICEF are supporting the Indian Government with micro-planning, monitoring and implementation of the campaign.

“Breaking the cycle of transmission and eliminating this contagious disease is a priority,” says Louis Georges Arsenault, UNICEF India representative. “UNICEF lauds the efforts of government and partners in making the measles-rubella campaign a success, simultaneously with strengthening of the health system for achieving high routine immunisation coverage.”

A special drive to create awareness among parents, teachers, frontline workers and local doctors has also seen partners such as Gavi, the Vaccine Alliance, the Lions Club, the Indian Academy of Pediatricians and the Indian Medical Association join forces to make the campaign a success.

Through collaboration and persistence, India has done what it takes to make  vaccines launches like the one in Bengaluru happen. As the ceremony comes to a close, school children and health workers join government officials to release orange, white and green balloons into the sky. It is a symbolic celebration of a nation’s determination to protect children like Yashwanth from the suffering and death that diseases like measles and rubella can bring.

[vaccineswork]

Guyana: the challenge of vaccinating the last five percent

Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance

The author with children, partners and health workers in Guyana. Photo: Shabana Shaw.

I found my recent visit to Guyana in South America to be instructive and uplifting. The country exudes optimism, aspiration and pride. Once a British colony, it attained independence only in 1966. A country rich in gold, diamonds and bauxite, Guyana is making rapid progress. Yet the mountainous hinterland, and a general lag in development, has left some behind.

Immunisation in Guyana is a major success. They have introduced the full range of children’s vaccines. Now they are preparing to roll out the human papillomavirus (HPV) vaccine for adolescent girls. Although Gavi has supported these vaccine introductions, Guyana has taken full ownership. Coverage levels are high, with most vaccines reaching almost 95% of children. Immunisation has wider reach than any other health programme. But I am glad to see that the government offers a package of guaranteed health services free of charge.

Yet for Guyana, good is not good enough. Everybody that we met, from political leaders to health managers, cared about equity. It bothers them that more than one in ten people in the hinterland lives in poverty. Deep rooted cultural practices remain a challenge. For example early sex, often without contraception, brings teen pregnancies. Rates of violence against children and girls are also very high. Poverty and malnutrition lead to anaemia and stunting. Too many children are still born at home with only the care of a traditional birth attendant, which can put mothers and babies at higher risk.

The hinterland is also where the five percent of children miss out on essential vaccines. These are the children the government is keen to reach. We travel across thick rainforest to reach a remote region. It accounts for one third of the country’s land mass, but only four percent of the total population.

 A rural village clinic. Photo: Shabana Shaw.

We fly for more than two hours in a small plane to land at Aishalton. This is a small village of Amerindians, an indigenous tribe. The landscape is very challenging. I can see immediately why it is so hard to deliver immunisation and other health care services. Their traditional way of life is to move from place to place in search of arable land. Each village only has a small number of children to vaccinate, anywhere between one and ten.

Health workers have to cross torrential rivers, dense forests and steep mountains. They often take several hours to reach them. Yet against all the odds this region topped the charts on maternal and child health care last year. We watch as they receive the trophy for best performance.

A small delivery plane. Photo: Shabana Shaw. 

Delivering vaccines by plane to these communities is very costly. Attracting, training and retaining health workers requires extra incentives. Social mobilisation of scattered populations takes time and money. It is very challenging to deliver healthcare without good roads and electricity.

From Aishalton, we drive on to Lethem, the regional Headquarters. It takes over six hours on an unpaved, bumpy track, rattling every single bone! How can pregnant women survive it? Without an obstetrician or blood storage facility Lethem cannot provide emergency obstetric care. Women must go to Georgetown which is another 18 hours away, or cross over the border into Brazil.

Even though Guyana relies on Cuba to train their doctors, specialists are very scarce. This is a common problem in most developing countries. Yet, the question is not whether Guyana can afford to reach and serve these hinterland communities - can it afford not to do so? This is a moral imperative. In the age of the sustainable development goals no one should be left behind.

The author talks to a mother and her baby at a Guyanese clinic. Photo: Shabana Shaw. 

There is also a strong business case. Unvaccinated populations have a high risk of diseases that easily cross borders. At the moment yellow fever outbreaks in Brazil pose a grave risk across the region.

I leave Guyana reflecting on their request for continued Gavi engagement. They no longer need us to pay for vaccines. Guyana has always paid its share, and has increased its total immunisation budget. Gavi support is ‘a hand up rather than a hand out’. But they still want the ideas, expertise and innovation offered by Gavi and its partners.

This, they believe, holds the key to reaching the last five percent of children. After all, these children deserve the same chance to “survive, thrive and transform”.

[vaccineswork]

Vaccines Work When Supply Chains Do

At the same time that we build vital demand for families to vaccinate their children, we must also ensure that adequate supply is available for the families when they come. Vaccine availability depends on a multitude of factors, but a critical component is the supply chain and logistics systems that ensure vaccines (and related supplies) arrive safely when and where they are needed. So how does a manufactured vaccine arrive at a health facility in full potency?

This week, Erin Fry Sosne, a Senior Policy & Advocacy Officer at PATH, is taking over the @Vaccines channel to talk about the importance of careful planning by supply chain managers around the world to coordinate the necessary data, staff, vehicles, and equipment to make sure lifesaving vaccines reach every child.

Why this week? On Thursday, March 30th, the journal Vaccine will launch a special edition called "Building Next-Generation Immunization Supply Chains.” Compiled for the first time, the evidence in this special edition will highlight the need to prioritize innovation, investment, and support for strong supply chains from vaccine discovery through delivery. These 31 articles authored by 129 experts from 55 organizations in 17 countries around the world represent decades of immunization supply chain work from implementing partners, country governments, and donors.

Stay tuned to Erin on @Vaccines to read the journal and learn more about the importance of strengthening immunization supply chains around the world.

[vaccineswork]

Partnering to Prevent Cholera Outbreaks across Africa

Claire Macdonald, Grants Writer and Editor at Agence de Médecine Préventive

Access to clean water and vaccination in lower income countries (like Malawi, pictured) is vital to prevent cholera. Photo: Christel Saussier.

Preventing and controlling outbreaks is by no means an exact science. It was hard to avoid this conclusion in 2015, as Ebola spread through five African countries, reached Europe and the US, and killed more than 11,000 people. The West African outbreak showed how quickly a disease that had been relegated to ‘small outbreaks’ could spin out of control.

Ebola is not alone in this; cholera also causes outbreaks with devastating consequences, and it is thought to kill more than 100,000 people annually. In the past two years alone, large African cities such as Accra, Kinshasa, Goma and Dar-Es-Salaam have witnessed cholera epidemics that ravaged their communities.

Fortunately, the vulnerability of Africa’s cities has caught the attention of global stakeholders, whose desire to stay one step ahead of the next serious epidemic is also at the core of French NGO Agence de Médecine Préventive (AMP) and its international and local partners. Together, they have been working since 2010 to prevent outbreaks through the African Cholera Surveillance Network consortium (Africhol, for short).

Thanks to a grant from the Bill & Melinda Gates Foundation, the multi-partner consortium supports a cholera prevention network in 11 African countries. The bedrock of the project is surveillance, which remains the key for detecting cholera outbreaks, controlling the disease, and reducing deaths. It is now a proven working model that could even be replicated throughout the world for other contagious diseases.

Cholera is closely linked to poor sanitation, a lack of clean water and inadequate infrastructure. Typical at-risk areas include peri-urban slums, as well as camps for internally displaced persons or refugees. Urbanization, the uncontrolled sprawl of cities in low-income countries together with the stream of refugees fleeing into unsanitary camps creates ideal conditions for contagious diseases to spread quickly. Global warming is also thought to encourage the disease, which means cholera remains a worldwide threat.

The nature of the disease makes it difficult to control. It does not distinguish between adults and children, and can kill within hours, leaving little time for diagnosis, treatment, or reporting. Although it’s easy to treat, many people still die, especially in remote areas where even basic health care can be difficult to access.

The main aim of Africhol is to inform prevention strategies, such as immunization, across Cameroon, Côte d'Ivoire, Democratic Republic of the Congo, Guinea, Kenya, Mozambique, Nigeria, Tanzania, Togo, Uganda, and Zimbabwe. These strategies enable public health authorities to target measures such as immunization by identifying cholera hotspots, community behaviors that contribute to spreading cholera, and high risk populations. This can make immunization campaigns more effective, and not just a shot in the dark.

A girl receives a cholera vaccine in Cameroon. Photo: Gavi/2015/Athanas Makundi.

The impetus behind the project was the blind nature of intervention in cholera epidemics. Nearly 200,000 cases and more than 1,000 deaths were reported to the World Health Organization (WHO) in 2015, but these numbers are thought to be misleading due to underreporting and inadequate national surveillance systems, as well as countries’ fear of trade and travel sanctions. The true global cholera burden is estimated to be one to four million cases and up to 150,000  deaths annually.

The way cases are reported has also prevented a clear picture of the disease. Methods for recognizing and classifying cholera cases varies between, and even within countries, with delays and incomplete reporting between district and national levels.

Africhol targeted these problems by helping participating countries to expand their laboratory capacities for routine confirmation of suspected cholera cases, while also working within existing national surveillance systems. A common protocol for all participating countries ensures that the data collected is comparable between countries.

As a result, we have a wealth of new information on at-risk populations and geographical hotspots. This has provided participating countries and global stakeholders with a new understanding of cholera in Africa and the basis for innovative ways to fight the disease. These information gathering systems are also paving the way for future work on cholera and other contagious diseases, and have made a decisive impact on the public-health systems of the countries involved.

Like most battlefields, however, conditions constantly change and up to date information is essential if strategies are to remain effective and antibiotic treatments to stay current. As new epidemic threats loom over Africa, the consortium remains a vital information and communication hub, where members have a common place to share data, launch initiatives, and develop common tools and protocols for use on and beyond cholera.

The Africhol consortium demonstrates the importance of disease surveillance and the power of collaboration to create the essential tool of unified foresight for all kinds of threats. With this tool in place, the consortium can and should provide a platform for the identification, prioritization and implementation of effective prevention measures against epidemic diseases in some of the world’s most vulnerable populations.

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The women who made modern vaccines work

Have you heard of Edward Jenner, the inventor of the modern vaccine? Or Jonas Salk, whose polio vaccine was a turning point in the fight against this debilitating disease? If you know something about global health, you’ve probably heard of these vaccine pioneers. But what about the women who also helped lay the foundations for modern immunisation? Meet five remarkable women who pushed forward the frontiers of science.

Lady Mary Wortley Montagu (1689-1762)

Image via Britannica. 

Lady Mary Wortley Montagu defied convention by introducing smallpox inoculation into Western medicine. While visiting the Ottoman Empire, she leant about Turkish customs and witnessed the practice of inoculation against smallpox. Lady Mary was eager to spare her children the suffering of smallpox, so in 1718 she had her son Edward inoculated. On her return to London, she promoted the procedure, despite resistance from the medical establishment. 

Drs Pearl Kendrick & Grace Eldering (1890-1980, 1900-1988)

Photo via Michigan Women’s Hall of Fame. 

Working with a limited budget, Eldering and Kendrick researched pertussis (whooping cough), tested their vaccine first on themselves, and then ran a successful clinical trial. This resulted in the first vaccine against the disease being introduced in America in the 1940s. 

Following the development of the pertussis vaccine, they combined it with two other vaccines (diphtheria and tetanus) into a single shot, now universally referred to as “DTP”. 

Dr Margaret Pittman (1901-1995)

Photo via Encyclopedia of Arkansas. 

Among her many achievements, Pittman is known for her research into the Haemophilus influenzae bacterium. She identified six types of Heamophilus influenzae, labelling them “a” to “f”. Type b (Hib) is the most harmful, causing meningitis and other serious infections. Her work led to the development of vaccines that protect against Hib. 

She was also the first woman to lead a National Institutes of Health Laboratory in the US. 

Dr Isabel Morgan (1911-1996)

Photo via Wikipedia.

Throughout the 1940s Morgan worked with a team of virologists at Johns Hopkins University in the USA, advancing understanding of polio viruses. She and her team were the first to prove that an inactive or “killed” virus could produce immunity in monkeys, overturning the previous belief that only live viruses could do so. 

Her work fed directly into the development of Jonas Salk’s vaccine against polio in 1955. She is also the only woman on the 17 person polio “wall of fame”. 

Dr Ruth Bishop (1933-)

Photo via Science In Public Aus.

In 1973, Bishop led a team of researchers that discovered rotavirus, a major cause of severe diarrhoea in children around the world. The discovery, which Bishop attributes to a “mixture of calculated research and serendipity”, has had an enormous impact. 

The identification of an infectious cause of deadly diarrhoea kick-started the successful 30-year hunt for a vaccine against it. Today, the vaccines are slowly reaching children in lower income countries, but rotavirus still accounts for an estimated 200,000 deaths per year. 

Who did we miss? Tweet us @Gavi to let us know about any female vaccine heroes we left out. 

[vaccineswork]

Let’s be bold for change

Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance

Rukhsar and her mother. Photo: via Impatient Optimists. 

The last person to be affected by polio in India was a little girl. Unlike her elder siblings, Rukhsar didn’t receive the vaccine. In meeting her family I was struck by their remorse – if only they could turn back the clock. Her father became a tireless advocate for the polio campaign, carrying his small daughter on his shoulders as he persuaded other parents to make sure their children were vaccinated. Still a toddler, gender wasn’t yet a major issue, but in a very traditional society it does raise questions of what impact a lasting disability will have on the young girl’s future.

The fact that girls are excluded from many fundamental opportunities in life is not a surprise to many. However, it might be more of a surprise to learn that immunisation has high gender parity, with no major differences in the immunisation rates between girls and boys in most countries. That said, persisting gender related barriers play a profound role in 19 million children, both boys and girls, missing out on even the most basic lifesaving vaccines every year.

For example, in some traditional societies, the fact that nearly all vaccinators are men discourages mothers to bring their children for immunisation. I saw this first hand in Pakistan where it was clear that some women at the sessions I attended were very hesitant to speak to the male vaccinators, reluctant to ask questions. In Indonesia, in one of the rapidly growing slum areas, increasingly common in the developing world, I was struck by the lack of flexibility around immunisation schedules. Typically they take place once a month at an hour when most women on low incomes are earning their daily wage, which they can ill afford to give up. At the same time we have seen how immunisation rates rise when mothers are educated, pointing to the fact that educational barriers to women impact on their own health and development, as well as their families.

The author speaks to a mother at a vaccination clinic in Lahore. Photo: Gavi/I. Griberg. 

International Women’s Day gives us an opportunity to celebrate the progress made in gender equality and women’s empowerment in the past few decades. At the same time we must pledge to do better. For example, girl’s access to education in low- income countries has improved, with enrollment rates at primary school level now at parity. But keeping girls in schools remains an abiding challenge. Much too often, they are forced to drop out early because they have to take care of their siblings, or they reach puberty which triggers fears among parents about their security. Lack of something as basic as a toilet, predominance of male teachers and high rates of molestation and even rape in some countries are among the many factors that cause girls to drop out.

In India, where I’m from, I have personally seen any number of highly educated parents agonize over whether their daughters warrant the same level of investment in higher education as their sons. Many of them would not think twice before sending their sons to expensive foreign universities but hesitate when it comes to deciding about their highly talented daughters. My husband and I opened all possible doors of growth for our two daughters, including making it possible for them to attend ‘first-in-class’ universities - a highly deliberate act of rebellion against India’s predominant social and cultural norms. Alas, discrimination against women, both among rich and poor, remains one of the most significant threats to sustainable development.

Students pose for a picture after class in Nepal. Photo: Gavi/ Oscar Seykens. 

The Millennium Development Goals brought a focus on women and children that did not exist before. As a result, developing countries stepped up their efforts to improve the inclusion of girls and women in both education and health. Maternal mortality fell by 43% between 1990 and 2015, but it is unacceptable that more than 300,000 women still continue to die every year in birth related complications. Giving birth to a child is the most natural act that gives more than nine months of advance notice. Yet if women die while creating life, nothing is more shameful. Maternal deaths are the aggregate outcome of several forms of discrimination that women continue to suffer - from child marriage, lack of access to contraception, poor nutrition, domestic violence, inadequate care during pregnancy, lack of skilled birth attendance and broader health care. Nothing disturbs me more deeply than the fact that as many as 16 million girls under the age of 19 give birth each year. And it’s no secret that a small number of mothers’ are as young as 11 or 12 years of age. This is what I call the horrific phenomenon of ‘children giving birth to children’.

It would be wrong to believe that it is only in poor countries that women are discriminated against. Gender discrimination is rampant in most economies, though it manifests itself somewhat differently. Violence against women is a pandemic that affects all countries. Worldwide, more than one in three women have experienced some form of physical or sexual violence, most often from an intimate partner or someone close to them. Social expectations are still a major barrier – far too many women, even in industrialised countries, bear the burden of unpaid care and domestic work. The proverbial glass ceiling for women still persists, and women continue to be denied their fair share of decision making and influencing roles. For such deep-rooted challenges, where can we start to find the drivers of change?

A nurse gets ready to administer HPV vaccine to school girls in Ghana. Photo: Gavi/ Evelyn HocKstein. 

It’s very clear that when women are educated and empowered, they take charge of their lives in a myriad of ways. They become bold and take charge of their destiny. Growing up in India, I am acutely aware of how education opened up doors for me, and for many more like me. But, in spite of such successes, far too many women have yet to find the power of their voice and realize anything close to their true potential.

Like Rukhsar’s father, it’s time for us all to be bold and speak out for change. Let us on this Women’s Day re-dedicate ourselves to working tirelessly to expand opportunities for all women and girls. In Mahatma Gandhi’s words, let us ‘be the change that you wish to see in the world’.

[vaccineswork]

Shifting the Narrative for Women on the Frontline of Pakistan’s Polio Eradication

Aleena Khan, Asia Programme Manager, Global One

Tayyuba Gul vaccinates a child against polio. Photo: Rotary International / Khaula Jamil.

Tayyuba Gul routinely visits an average of ten households a day in Nowshera, Khyber Pakhtunkhwa in Pakistan. As she travels door-to-door, she is escorted by government personnel due to the upsurge in violence against polio workers. She is not only trained to provide the polio vaccine, but also gives advice on other vital issues such as family planning, pregnancy care and child health. As someone who comes from the community, Tayyuba feels a sense of purpose and dedication to her work and the people she serves. She sets an example for young women who need educated, strong, and brave role models within their communities, and it is imperative that unheard stories such as hers are brought to a wider audience.

Tayyubba is just one of the courageous women featured in a photo exhibition by female photojournalist Khaula Jamil, which shares stories of women who risk their lives in the battle to make Pakistan polio free.

Khaula captured these powerful images on assignment for Rotary International in which she followed the journey of Lady Health Workers and female vaccinators across Pakistan. The images depicted not only the vaccines being administered, but also the unique dynamics of Pakistan as a country that has mass movements of people within (and across) its borders.

The exhibition has recently been touring the United Kingdom in partnership with our NGO Global One, in a bid to engage the global diaspora in the ongoing challenges of ending polio in Pakistan and to celebrate the women who make it happen. At the exhibition in London, Khaula and other eminent change makers had the opportunity to discuss the critical role of women to polio eradication in Pakistan, from the lady health workers who meet families face-to-face to the vaccinators and co-ordinators who organise and execute campaigns. To aid their conversations, they also screened Rotary’s video ‘Walk with Pride’, which outlines the difficulties of immunising children in transit.

For Miriam Doan, a visual storyteller at Rotary International, it was important to highlight the women who help to raise the political will for polio eradication. She lauded Pakistan’s Senator Ayesha Raza Farooq and Dr Rana Safdar as catalysts who turned the immunisation situation around in the country.

Ahmereen Reza, Country Director of Aman Foundation UK, went further, arguing for the unique role that the diaspora can play when they actively involve themselves in resolving health issues in Pakistan. This can take the form of the diaspora using their talents and skills to shift the narrative within mainstream media about the role of women in development, as well as the polio eradication initiative in Pakistan. The diaspora can also fundraise for, and donate to immunisation linked projects in Pakistan.

Ahmereen also shone a spotlight on the importance of leveraging the existing infrastructure for polio vaccination, to tackle other overarching health concerns in communities.  

With a room full of young advocates listening intently, Khaula herself shared how the most fascinating moment of the assignment was when she followed vaccinators trying to reach children on the move – they had seconds to get on a bus, administer polio drops and jump off the bus before it left for the next station!

Khaula with one of her photos. Credit: Global One / Shy B Photography.

But it’s not just challenges like these that matter, as Allan Jagger OBE of Rotary Elland explained. It is just as essential for families to understand why their child should be immunised, building the community’s confidence in the potential of their collective efforts to fight polio. Whether in areas at high risk of polio or engaging the diaspora further afield, media is an important tool in keeping families, networks and communities up to date on the need for polio immunisation. Khaula’s powerful photos are one great example of how to start a global conversation about these realities for the women eradicating polio on the ground.  

Global One, the UK’s first Muslim women led international NGO organised a UK tour with photographs by Khaula as part of its initiative focused on engaging the UK diaspora in polio eradication efforts. Find out more about their work here: www.globalone.org.uk 

[vaccineswork]

This week in vaccines

5th March 2017

This week the World Health Organization took measures to counter misinformation, outlining trustworthy online sources when it comes to immunisation information. The CDC kept up its vaccine advocacy on Twitter with the image above. 

The role of civil society organisations in campaigning for and delivering vital vaccines in lower income countries was fully recognised at a meeting in Bangladesh, while Results for Development continued to explore the challenges and opportunities for countries to fund their own immunisation programmes

And finally, in response to Bill and Melinda Gates’ Annual Letter, artists and designers created visual representations of various aspects of child health and progress, in recognition of the Gates’ optimism.  

[vaccineswork]

@Vaccines for a Shot At Life

This week, @Vaccines is curated by Paula Kiger, a Shot@Life Champion Leader, blogger and mother of two from Tallahassee, Florida.  Paula is attending the annual Shot@Life Champion Summit taking place in Washington, D.C. from February 27th until March 1st.

The annual Summit brings together volunteers from across the U.S. to learn about and advocate for global childhood immunisations.  Attendees will hear from Gavi, UNICEF, the CDC as well as polio survivors and Washington insiders. Those in attendance will also have the opportunity to meet with representatives on Capitol Hill to ask them to support full funding for immunization at home and abroad.

Paula has promised to share important statistics, inspiring quotes and the passion that all Shot@Life Champions have for children around the world. So, if you are not in D.C. this week, make sure to tune in to @Vaccines for Paula’s updates.

[vaccineswork]

This week in vaccines

26th February 2017

This week global health leaders assessed progress towards vaccination for all children, and concluded that the world is behind schedule. The plight of children in Yemen, left at risk of polio due to conflict, was also brought to the fore, while a vaccination campaign to contain cholera was organised in South Sudan. 

New guides were released to help countries sustainably finance immunisation were released, and we were reminded once again of the economic value of investing in vaccination.  

NPR explored the additional hurdles faced by Zika vaccines, as well as the literal bat caves where the next pandemic could originate. 

Finally, concerns around the anti-vaccination movement in the US continued, and in the Twittersphere, a GIF showing the power of herd immunity got people talking.

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Islands, inequalities and immunisation - Indonesia prepares for one of the world’s largest vaccine campaign

Anuradha Gupta, Deputy CEO at Gavi, the Vaccine Alliance

A view of sprawling Jakarta, via Flickr. 

As we sit in our car, baking in the heat of Jakarta’s midday rush hour, our driver tells me that an average Jakartan spends 10 years of their life in traffic. It’s not hard to believe. As we slowly make our way across this sprawling megacity to meet Director of Surveillance and Health Quarantine, Dr Jane Soepardi, I observe how the sheer size and complexity of Indonesia’s capital city mirror the challenges facing the national immunisation programme.

Indonesia is home to almost 250 million people, spread across an archipelago of more than 8,800 islands and three time zones. Almost five million children are born in Indonesia each year, yet one in five still misses out on the most essential vaccines. As a result, at least one million children remain under-immunised every year and as these numbers accumulate year after year, the risk of disease outbreaks such as diphtheria, pertussis and measles grows in proportion. These are highly infectious diseases that can kill children.  These are typically children who suffer from multiple deprivations - they are generally poor, live in unsanitary conditions, have suboptimal nutrition and may not have access to good education. Not surprisingly they are at the highest risk of disease, disability and death and thus in dire need of protection of life saving vaccines.

Anuradha speaks to Indonesian television about Gavi and immunisation (from 6:27). 

Gavi partners in Indonesia - WHO, World Bank and UNICEF – highlight the multiple challenges that prevent every child from having equal access to immunisation. Indonesia’s geography certainly doesn’t help. Some remote islands can be reached only once a month with medical services. However, it is intriguing that it can be just as difficult - and sometimes even more so - to reach children in the growing urban slums in Jakarta, a city whose population is expected to grow to over 40 million by 2040. And this is a phenomenon that needs new thinking and approaches. The rapid pace of urbanization, the mushrooming of highly dense slums and the near absence of organized primary health care in impoverished urban and peri-urban settlements are among factors that may result in cesspools of disease threatening health security. By 2050, 64% of population in Asia and 54% of Africa’s population would live in cities calling for urgent attention and contextualized strategies to provide basic health care including immunisation services to the urban poor.      

When we finally reach the offices of Indonesia’s Department of Surveillance and Health Quarantine, Dr Jane greets us with helpings of delicious Indonesian cuisine. She has dedicated most of her life’s work to immunising children, and it’s clear that her passion is highly motivating for others. During the meeting and the media interaction, we talk frankly about her country’s achievements in immunisation but also the persisting challenge of inequity and lack of introduction of important vaccines which several poorer countries have successfully introduced around the globe.

Indonesia’s state-owned vaccine manufacturer has become a major global supplier producing vaccines that protect children in over 100 other countries. The national pride is palpable but even more heartening is the growing recognition that delay in indigenous production must not hold up introduction of new vaccines in their public health program. A very welcome development indeed as protecting the lives and health of children is urgent business that brooks no delay. As the country steps up its effort to expand the national insurance scheme, it is vigorously exploring opportunities to prevent illness and reduce hospitalization costs. And what better investment in prevention than the vaccines where every dollar invested fetches a return of 44 dollars by way of broader social and economic benefits! I take this opportunity to highlight the value of introducing Rota, PCV and HPV which can help avert diarrhea, pneumonia and cervical cancer and related costs. Nearly 34 000 children die every year in Indonesia because of diarrhea and pneumonia alone, the two main killers of children globally.

Mother and her child wait to be vaccinated at an Indonesian clinic. Photo: Indonesian Ministry of Health.

Together, we discuss the upcoming measles-rubella vaccination campaign, which aims to immunise around 70 million Indonesian children under 15 years of age. It will be one of the largest vaccination campaigns in history, and Dr Jane’s team are under a great deal of pressure. Vaccinators must reach at least 95% of all children for the risks of congenital rubella syndrome (CRS) to be effectively contained. Despite the many challenges they face, they are already thinking outside of the box.

In my role here at Gavi I often hear the criticism that vertical, disease-focused vaccination campaigns can derail routine immunisation. While the scale of the required logistics can place a strain on routine resources, I do believe there’s an exciting opportunity for what I call “horizontal” campaigns, which deliver a range of vaccines and other health interventions together. With over one million newborn children in Indonesia missing out on vaccines annually, we urgently need to detect  pockets of under-immunised children growing across the country and use the upcoming campaign to “catch them” with all other vaccines that they missed.  

I discuss these ideas with Dr Jane and together we brainstorm how this enormous vaccination effort that Indonesia is about to launch can add value and help reach children with even more vaccines. I am impressed with how quickly Jane and her team bring these up in the meeting with Indonesia’s Minister of Health and am delighted to be able to add my voice in support.

As I say goodbye to Dr Jane, I’m struck by the vital role that individual leadership and commitment play in moving a country’s immunisation efforts forward.

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This week in vaccines

12th February 2017

This week saw the passing of data-loving “edutainer” and vaccine advocate Hans Rosling, prompting many to re-share his famous TED talk and other notable occasions when he shared his optimism about global health and immunisation. 

The New York Times delved into the history of cholera, and the 200 year journey towards treatment and effective vaccination. Meanwhile, the prospects of polio eradication in Afghanistan looked increasingly optimistic. Meanwhile the inventor of vaccination as we know it, Edward Jenner, was revealed to be the inspiration behind a new approach to malaria vaccination. 

More than 350 US-based organisations wrote to their new President to express confidence in vaccines and explain their value to the whole country. At the same time, paediatrician Dr Peter Hotez shared his fears for child health in the US as vaccine exemptions continue to rise.

Finally, NPR released the second of its videos in the #KillerViruses series, which chronicles the “golden age of germs”, when people were starting to travel and live in bigger settlements, but before vaccines had been invented. Watch it here. 

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In photos: the first steps towards preventing cervical cancer

With over half a million cases diagnosed worldwide every year, cervical cancer is one of the most common cancers among women, claiming 266,000 lives. But these numbers hide another even more damming fact: cervical cancer is a disease of disparity. Around 85% of women diagnosed and 87% of women who die from cervical cancer live in low or middle-income countries where there is often very limited capacity for screening and treatment.

In such countries, prevention through the human papillomavirus (HPV) vaccine is critical. By supporting the introduction of this vaccine, Gavi and its partners have helped 19 lower income countries take the first steps towards protecting girls against the cause of 70% of all cervical cancers.

Immunising adolescent girls with the HPV vaccine can be a challenge, so countries often begin by conducting “demonstration” projects to understand how to best reach this population group. Once lessons have been learnt, the vaccine can be introduced nationally. Following on from World Cancer Day, we look at some of the lower income countries that have been working hard to take these first steps towards protecting women and girls from cervical cancer.  

Bangladesh

Bangladesh conducted an HPV vaccine demonstration project from 2015-6. Cervical cancer is the second most fatal cancer for women in the country.  

Photo via GaviSeth on Twitter. 

Benin

Benin, in West Africa, also ran an HPV vaccination demonstration project from 2015-16. The programme represented an important step change in the expansion and strengthening of the national immunisation system.  

Photo via Gavi on Twitter. 

Nepal

In 2015, Nepal underlined its commitment to reducing cervical cancer rates by starting an HPV vaccine demonstration project within months of suffering a devastating earthquake.

Photo via Gavi on Twitter. 

Honduras

Honduras launched the HPV vaccine into its routine immunisation system in 2015, at the same time the country was transitioning away from international support for its immunisation programmes – a real sign of its government’s commitment to vaccination for years to come!

Photo via Gavi on Twitter.

Liberia

Despite the challenges of the Ebola outbreak, Liberia was able to go ahead with its HPV vaccination demonstration project in 2015. The authorities quickly realised that community health centres were the most effective way to find and vaccinate adolescent girls who weren’t attending school. The administration of the HPV vaccine also offers a valuable point of contact with the health system to deliver other life-protecting interventions.

Photo: Gavi/ D Graham Rowe

Cambodia

Cambodia has just  started its journey to reach adolescent girls with the HPV vaccine, launching a demonstration project in the south east of the country in 2016. Cervical cancer is the most prevalent type of cancer among women aged 15-44 years in Cambodia so the vaccination programme is poised to have a dramatic impact on the battle to save women’s lives.

Photo: UNFPA Cambodia. 

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 This week in vaccines

5th February 2017

This week had a promising start as footballers endorsed vaccination at the Africa Cup of Nations, and leaders from across the African continent united in their support of access to immunisation for all children. 

Vector borne disease continued to cause concern as yellow fever threatened cities in Brazil, the spread of drug resistant malaria demanded attention, and a possible Zika vaccine took a small step forward. 

NPR explored the origins of germs for which we now need vaccines, and a survey of the US public found that the majority of people recognise that the benefits of measles, mumps and rubella vaccines outweighed the very small risks. Across the other side of the world, the Indian government also launched a massive immunisation campaign aiming to protect children against measles and rubella. 

Finally, this Saturday marked World Cancer Day, drawing commentary on the power of vaccines to prevent certain types of cancer, and their importance in preventing a cancer crisis in lower income countries.  

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Halima Aso (left), mother of 8 and member of the Women’s Federation, Berhale District, Ethiopia.  

After I received training, I started working with the Women’s Forum teaching the benefits of immunization. At the training session, we mainly focused on the need to ‘clear away’ the bad misconceptions around immunization - that vaccines are safe and can protect against many killer diseases.

Once I’d received this training, I went back to my village and organized another small meeting with sub-Kebele women’s forum members, where I told them everything I’d learned at my training session. They then talked to their local network, which consists of 1-5 members. So in this way, what is told at District level, will be extended and messages will reach everyone.

One of the misperceptions is that vaccines will bring infertility to women, and also it is believed that if the child receives a vaccine, that child will become paralyzed. These were the beliefs. After working hard with Health Extension Workers and Social Mobilization Committee members, these beliefs are changing.

Now there is a huge improvement – almost all are getting immunized. These beliefs are being solved.  Going back some years, there are so many sad stories – I cannot tell you in one day, it will take a long time to recount this. There are many lives claimed from measles outbreaks, even my own child died from measles. Most families would have lost at least one child like this. My relatives, my neighbors, they all lost children. Sometimes, even 5-6 children at one time. This was normal life – it wasn’t just my daughter, it happened to every family.

No question, having lost my own daughter to measles is one reason for why I joined the Women’s Federation. I feel pain when remembering the past, but it makes me happy to be part of creating a different future.

Read more about the project in which Halima is involved here .