TBT: Looking beyond the money: Crucial steps to getting vaccines to children

Lois Privor-Dumm

Over the past 5 years we have had some great, insightful and inspiring posts, many of whose content is still relevant today. For this reason we are implementing TBT on the blog. Every Thursday we will run blogs from the past. Enjoy!

The following post originally ran on May 8, 2012.

Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more. (more…)

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Looking beyond the money: Crucial steps to getting vaccines to children

Lois Privor-Dumm

By Lois Privor-Dumm. Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the successes and challenges in immunization coverage.   Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed.

Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery (I really like this one!). (more…)

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The Road to Conquering Polio: A Major Milestone

Lois Privor-Dumm

A man who contracted polio walks on crutches in the village of Kosi, 113 miles from Patna, India. Photo by Altaf Qadri / AP.

By Lois Privor-Dumm. This is a moment we have been cautiously optimistic about. Would Friday the 13th finally be the day? Rather than being an unlucky day this year, it is the day that India has gone one year without a single new case of poliovirus!  Every time I look out the window as I’m driving around India, I witness the all-too-common sight of someone suffering the debilitating effects of the disease.  That image is a reminder about how horrible this disease is and that polio’s impact is not just on the individual, but a whole nation.

The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, there was just a single new case in 18-month old named Rukhsar from West Bengal. It was a heartbreaking occurrence, but efforts persevered.

I am struck by the level of effort committed to this goal: government, civil society and international organizations including WHO, the National Polio Surveillance Project (NPSP) based in Delhi, UNICEF, CDC and Rotary are all laser-focused on making sure that kids even in the hardest to reach places were immunized. The Bill & Melinda Gates Foundation is also instrumental in these efforts. It was no easy feat, as we’ve seen in other polio-endemic countries including Nigeria, Pakistan and Afghanistan. India was considered one of the toughest countries to tackle, making this effort all the more impressive. (more…)

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World Pneumonia Day – Get Creative About Building Awareness

Lois Privor-Dumm

By Lois Privor-Dumm. A few years ago, we were thinking about how do you get people to recognize that pneumonia is a problem in children? The answer is, we don’t have to figure it out – give people the simple facts and they will amplify the message. This week, I have seen so many innovative ways that individuals and organizations are getting the word out and showing they care about solving this very solvable problem of pneumonia: from the health departments, students and other interested people all over the Philippines creating their song and building it up with a “>dance contest; the children’s fashion show and boat regatta in Nigeria; the virtual Baby Shower For Good sponsored by the Baby Center, UN Foundation’s Shot@Life Campaign, Global Alliance for Clean Cookstoves, and ABC news; GAVI Alliance’s blog carnival to highlight the progress in the rollout of pneumococcal vaccines as part of the fight against pneumonia.  It’s all working towards the same goal to build awareness and support for solutions to child pneumonia.

My personal favorites were two simple things that I gave to my 3-year old niece – a plushy blue and pink lung pillow and coloring book. She loved it and her mother wanted to learn more about what I was working on. Pneumonia has been a problem for so long that many seem to forget about it. In the US, it is rare that you hear about a baby dying of pneumonia. Mainly because they generally are not malnourished (although this is still a problem in some areas), get their immunizations against the major causes of pneumonia including pertussis, measles, Hib and pneumococcus. And even if they do fall ill, they generally have good access to care. (more…)

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Coke or medicines – which reaches Timbuktu?

Lois Privor-Dumm

By Lois Privor-Dumm. We’ve heard the anecdote that you can find Coke in just about any village in Africa, but not always essential medicines.  Is that really true?  Well, our team at the International Vaccine Access Center (IVAC) at Johns Hopkins set out to find out. 

It’s actually not as easy as you might think to test the hypothesis, as Hopkins PhD candidate Kyla Hayford found out.  We did, however, get enough data to say comfortably that the anecdote is true as you will find in our new IVAC report, Improving Access of Essential Medicines through Public-Private Partnerships.

Photo credit: Tielman Nieuwoudt

First, we found an astonishing lack of available data about stock outs, wastage and other measures that indicate whether essential medicines are available.  Our report compared this to measures of availability of consumer packaged goods – things like candy bars and cola and calling cards – which seem to be stocked in abundance throughout the developing world. 

Why are these indicators important?  The simple truth is that no one dies if there aren’t mobile phone cards at the local kiosk, but the stakes are high if an antibiotic is not available to treat a child with a deadly disease.  Why is it, then, that consumer goods companies have many means to effectively track distribution, while there are very few measures in place to track the availability of essential medicines throughout Africa?

We found that injectable ceftriaxone, for example – a life-saving antibiotic for those with severe infections – was available in Kenyan and Tanzanian hospitals less than half the time, while mobile phone cards were available 90% of the time. 

So what can be done? (more…)

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Small investments in their future, great gains for Africa and us

Lois Privor-Dumm

By Lois Privor-Dumm. We’ve all heard these words: “There is tremendous need here at home,” or “money in Africa has been wasted for so long.”   This is why this simple video from the ONE campaign struck me. Through a public health lens it is a no-brainer: of course you want to spend on cost–effective interventions that will save lives.  For others, while they admit that it is an admirable goal, the connection is not made.  In times of financial uncertainty, we have to be more careful with our money, don’t we?

One of the best and prudent ways to invest though, is in future generations.  In the US, we provide all of our children the best chance at life, with fewer worries about preventable, devastating disease.  Imagine what that kind of security could do for a family in Africa.  Healthier children in Africa would be able to stay in school.  Families would worry less about the all too common diseases of pneumonia and diarrhea, and their devastating costs.  Rather than accepting the fate that their children may fall ill, they would be thankful that new vaccines are being made available.  Throughout the years, as healthcare improves because of our investment, so would income and productivity. Our investment would return to us through a country’s improved stability, better governance, and more – and all directly relate to our own security. 

The introduction of a new vaccine is not something taken for granted in the developing world.  Up-to-date immunization cards of young children are among a family’s prize possessions.  Throughout Africa, pneumococcal vaccines, once deemed far from the reality of any African village are now being introduced and are offering hope.  Rotavirus vaccines, helping prevent one of the most deadly forms of diarrhea in young children, may soon also be a reality across Africa -  all for a relatively small fraction of the US budget.  How often do we have a chance to save so many lives with such an effective and minimal financial commitment?  Four million lives over a five-year period is a pretty good return on investment!

Let’s make wise investments

Next month, the GAVI Alliance will be holding their pledging conference to encourage donor countries like ours to contribute to providing the most basic and effective prevention.  Please tell President Obama and your local leaders that you care.  Sign the ONE petition, and tell your friends and family to do so. The more they hear from you, the more they know this is an investment we as Americans care about.  Do it for their future – and ours.

Photo credit: Adrian Brooks, Imagewis

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New Investments, New Era?

Lois Privor-Dumm

By Lois Privor-Dumm. A decade can make a difference.  Eleven years ago this month, I had the privilege of launching pneumococcal conjugate vaccine (PCV) here in the US.  It was a vaccine that I knew would have a profound impact on children and families all over the country, Protection against severe meningitis and other infections allowed American children to move along the path of their lives –with a low risk of this potentially life-changing catastrophic disease.

Children in developing countries though faced a different picture over the past decade. Pneumococcus in the developing world not only causes severe meningitis, but is a leading cause of pneumonia.  Without access to PCV, 3 month-old Dominic Mwangi, found himself in the district hospital undergoing antibiotic treatment for life-threatening pneumonia.  His mother was away from home and family for 3 days.  Dominic was lucky and recovered; An astonishing 1.5 million children, mainly in Africa and Asia, are not so lucky.  Almost half of all severe pneumonias and meningitis deaths are thought to be caused by bacteria that can be prevented by the use of vaccine. Much more disease could be prevented with better nutrition and access to care.   Dominic, because he was born in Kenya, was 112 times more likely to die of pneumonia than an American child.  In Afghanistan, that number is 400. 

2011 paints a more promising picture.   A new generation of vaccines from Pfizer and GSK providing the broader protection needed to fight pneumonia and meningitis in developing countries has been made available in Nicaragua, Yemen and now Kenya within a year of launching in the industrialized world.  By 2015 more than 40 countries will do the same. 

What changed?  It was a convergence of factors – pharmaceutical companies, seeing a greater likelihood of demand with secured financing, were willing to offer low prices to those most in need, supplying at prices of less than 90% of those in industrialized countries.  Low-income countries wanted the vaccine because they saw the potential impact and a plan again for financing.  Financing was needed – and eventually made possible by Italy, UK, Canada, Russia, Norway and the Bill and Melinda Gates Foundation who donated $1.5B to the Pneumococcal AMC, an innovative financing mechanism and the GAVI Alliance who is making up the price differentials that low-income countries cannot manage as yet.   

It took a lot of effort to see these pieces fall into place, but one that can’t stop with just this example.   In a time where all of us are paying attention to how to do more with less, efforts like this one provide an important lesson of what is possible. Investing in health, individual countries have made dramatic economic progress and this will help all of us.  Take a look at this Rosling video and you’ll see why investments in health are, well, a good investment.   Children of all nations deserve a solid foundation to become healthy adults. We have more to do, we need to keep going.

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Innovation In And Beyond The Vial: Reducing Immunization Costs

Lois Privor-Dumm

By Lois Privor-Dumm.  A wealth of new vaccines are available that can prevent many important causes of disease.  Innovations are great, but can they reduce costs?  New technologies often require a larger up front investment while the dividends are sometimes less easily measured.  New vaccine prices can be high; looking at price alone, however, doesn’t tell the full story. Costs come in many forms, and so do savings. 

Development Innovations and Process Improvements

There are a number of new technologies that fit into the category of innovations.  Often we see technologies resulting in higher priced vaccines.  This doesn’t mean though, we’re not saving money.  Although an investment must be made to prevent disease, treatment costs can become even higher when disease threats become serious, not to mention the potential lives lost, lasting disabilities or impact on productivity.  More effective vaccines, even at higher prices, can significantly reduce cost of disease and make a lot of sense.

Understanding the importance of technologic innovation to get vaccines to the public when needed, the Centers for Disease Control and Prevention, recently announced $2 billion to help increase availability of pandemic flu vaccines.  Companies have taken novel approaches including use of surrogate human immune systems or collaborations on synthetic strains of flu vaccines that allow companies to react faster to the most prominent threats.   

Technological innovations also come in the form of vaccine delivery systems such as intranasal or Jet Injector technologies, that eliminate the cost of disposable syringes and may reduce the amount of vaccine required when immune responses are improved. For those of us who just don’t like needles – that is another benefit!

Some technologies help vaccines prevent more disease.  Development of pneumococcal common protein vaccines, hopes to broaden protection against potentially deadly forms of pneumonia and meningitis and replace current vaccines, which are difficult to develop and manufacture.

Delivery Innovations

We don’t often think of storage and handling as impacting the cost of a vaccine program significantly, but technologies that offer improved stability, eliminating need for refrigeration and reducing wastage as a result of spoilage can be as important as the vaccine itself.  In developing countries this innovation is particularly note worthy. (more…)

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Santé – Raising a Glass to New Partnerships

Lois Privor-Dumm

By Lois Privor-Dumm. Building attention for long-standing but important problems is not always easy. Even when a disease is recognized as the leading child killer, gaining the attention of the public and our leaders to fighting it is easier said than done.   But that’s where creativity can be a big help.

A few of months ago, IVAC’s  Executive Director, Orin Levine, recounted a joke he read in Eric Asimov’s New York Times blog. “What is the difference between a case of pneumonia and a case of Syrah?  You can get rid of the case of pneumonia.”

Next thing I knew, Orin’s wheels were spinning.  He issued a challenge to America’s Syrah producers:  How can we turn this into an opportunity to raise awareness and build support to defeat this leading child killer?  Public health stakeholders often suffer by limiting discussion of important issues to the ‘usual suspects’ – professionals within their own community. 

Bringing in new partners has long been a goal – and here we had a whole new opportunity.  Why not engage America’s wine makers?  Doing so offers the tremendous opportunity to engage those that love wine in the cause.  After a weekend of throwing out ideas to family and friends, we came back and discussed as a group.  What have we got to lose? Orin issued a challenge on his Huffington Post blog and lo and behold –Larry Schaffer of Tercero Wines stepped up to the plate, offering to bring in the Rhone Rangers, America’s leading non-profit organization dedicated to promoting American Rhone varietal wines.. And so began the idea of wine partnerships.

In staying with Eric Asimov’s original blog, we’ve developed a promotion to help increase sales of Syrah.  Participating members of the Rhone Rangers will offer $10 for every case of Syrah sold during the month of November (in honor of World Pneumonia Day, November 12) to the GAVI Campaign.  A donation of just $10 can protect a child against multiple causes of pneumonia.  It’s a win-win scenario.  People get to try great wines, and help protect children in the process.  Now that’s something to raise a glass to!

So now, an invitation for you.  Please be my guest from 6-8 pm on Monday, September 20 at the New York Times Center for Pneumonia’s Last Syrah. The event, held in conjuction with the UN Summit on Millenium Development Goals, will include a wine tasting with 12 wineries and moving photo exhibit judged by Nick Kristof of The New York Times and Ann Curry of The Today Show.  Please be sure to RSVP, as space is limited.   

I look forward to meeting you as we enjoy great wine, help bring attention to the problem of child pneumonia, and celebrate the new partnership that is a win for all us, especially the children of the developing world.

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When lack of trust puts us at risk

Lois Privor-Dumm

Earlier this week Dr. Margaret Chan, Director General of the World Health Organization, addressed the World Health Assembly in Geneva and brought up the topic of vaccines. She noted some of the successes in addressing the world’s health and development issues and stated that “vaccines are among the best life-saving buys on offer, preventing an estimated 2-3 million deaths per year.” In the next minutes, however, she also addressed the setbacks – occurring when people decide that vaccines are too risky. She counted the problems with measles, pandemic vaccines and polio.

In fact, I just finished reading a unique recount of the measles vaccine controversy. Something that wasn’t a paper at all, but a comic strip type account that said it all. I highly you encourage to read this. For those of you not familiar with the Andrew Wakefield measles saga, the British doctor claimed the administration of MMR vaccine was linked to autism.

The media was all over this and picked it up everywhere. Unfortunately, despite a lack of evidence to support his claims, co-authors who later removed their names claiming the study was flawed and a retraction from the Lancet in Feb 2010 after the General Medical Council in the UK found his conduct “dishonest and irresponsible” (more than a decade later), the damage was done and continues to be felt. Fueled by sensationalist media reports, many parents in the UK and around the world chose not to vaccinate their children and outbreaks of measles began to occur. The misinformation was further propagated by celebrities who get more TV coverage than the scientists who have shown through studies that there is no link between autism and vaccines.

Every adult has the right to consider what is best for themselves or their child. But shouldn’t more be done to consider the impact of disregarding the evidence has on others? There will always be risks with vaccines and science can’t always find or predict every risk. The experience with measles vaccines and the supposed link with autism shows that there also health consequences when individuals refuse to accept the findings of rigorous research.

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Can a picture make a difference?

Lois Privor-Dumm

By Lois Privor-Dumm. How many times have you seen a single photograph that has caused you to stop what you’re doing and find out more, tell a friend or donate money?  We read so much about the problems of the world today and, if you’re like me, unless the issue is already close to your heart, words alone may not be enough to register.

Salim Khan, 3 year old pneumonia survivor from Bijnor, India by Ándre J. Fanthome

A photo contest seems like such a simple thing, but it’s a way to enable a problem to reach into our hearts and minds.  Pneumonia is a leading killer of the world’s young children, but the disease has very real and practical solutions.  Although I see the statistics and understand the scientific pathways, nothing impacts me more than seeing how the disease affects families and children or reaches the heart of a pediatrician.  These moments are often captured powerfully with the click of a camera.  While one child with pneumonia may seem just like a number to many, it is these stories and images that can make a difference.

Photoshare, Kids 4, Health, the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health and The Global Coalition Against Child Pneumonia are sponsoring a photo contest to find the image that will make a difference in our minds.  Nikon will award digital cameras to category winners.  And, if you’re fans of Ann Curry of the Today Show and Nicholas Kristof of the New York Times, you’re in luck.  They, along with a professional photographer, are the judges.   Submitting a photo that jumps off the page and tells an important story would be a great way to get your experience and talent, or that of a friend, family or colleague in front of our celebrity panel.  For more information, click here.  Details on the time and place of the photo exhibit to unveil contest winners and finalists will be announced shortly. (more…)

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Can 30 seconds of your time change a child’s life?

Lois Privor-Dumm

Editor’s note: This past December, the Disruptive Women in Health Care blog launched a series on The Value of Health: Creating Economic Security in the Developing World. In addition to Disruptive Women’s own pool of experts, a number of guests were invited to post on this critically important topic. We invite you to download the ebook or read the original posts.

By Lois Privor-Dumm. It’s really simple.  8.8 million children die every year.  Not here in the US, but in developing countries where they don’t have access to the same care that we do here.  How much of our global health budget goes to address these basic needs?  Less than $1 of every $10.

Children are the future of every country.  Providing them with basic care to ensure they survive until their fifth birthday doesn’t seem to be that much to ask.  And, it’s a good investment.  Simple antibiotics or oral rehydration solutions along with the basic vaccines that children receive in the US every year are available at a cost that is around many people’s co-pay for a single prescription.


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If he could speak, what would he tell our leaders? Tell them for him.

Lois Privor-Dumm

As we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Sources: US Global Health and Child Survival Budget, 2009 and UNICEF, State of the World’s Children, 2008

Sources: US Global Health and Child Survival Budget, 2009 and UNICEF, State of the World’s Children, 2008

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

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Saving Money while Saving Lives: The Economic Argument for Childhood Vaccination

Lois Privor-Dumm

The following post by Lois Privor-Dumm, IMBA, Director of Alliances and Information for the PneumoADIP at Johns Hopkins Bloomberg School of Public Health, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Lois heads up several vaccine projects related to advocacy and communications as well as access and implementation. She is currently working as Director, Large Country Introduction for the Accelerated Vaccine Introduction Technical Assistance Consortium (AVI TAC), a GAVI-funded project with an aim to accelerate introduction of pneumococcal and rotavirus vaccines in low-income countries. Lois has been at Johns Hopkins since 2005 helping guide strategies and accelerated uptake on both the Hib Initiative and PneumoADIP and has been leading projects in developing and donor countries to support strengthening of policies and awareness for childhood pneumonia as part of a global World Pneumonia Day Coalition effort.

Hib, pneumococcal and rotavirus vaccines that have long been available in the US, offer significant promise to the children in developing countries. Not only could these vaccines, save millions of lives over the course of the next couple of decades, but they also have the potential to add to the wealth of nations. Yet, despite enormous promise, there are still delays 1-2 decades before children in developing countries have access.

Vaccines have long been considered one of the most affordable and cost-effective public health interventions available today. Historically, they have been pennies per dose. According to the World Bank’s Disease Control Priorities Report, at $7 per DALY averted in Sub-Saharan Africa for the Expanded Program on Immunization (EPI), a package of six WHO recommended vaccines including diphtheria, tetanus, pertussis, polio, measles and represents excellent value for money. By comparison, statin with aspirin, beta blocker and ACE inhibitors for ischemic heart disease costs $2,028/DALY averted.

However, with newer vaccines costing not pennies, but dollars per dose, do we need to reestablish our paradigm for affordability?

A recent review of the economic case for expanding vaccination coverage of children done by researchers at Harvard and Johns Hopkins suggests that new vaccines are a good investment. Cost-benefit analyses of Hib vaccination, for example, indicate that the cost of vaccination is less than the savings accrued by preventing mortality, lowering future health care costs, and reducing productivity losses among parents (who no longer have to stay home with a sick child). However, even these analyses may underestimate the true economic benefits of childhood vaccination.

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Getting life-saving vaccines to those who need it most: the nuanced solution for access

Lois Privor-Dumm

Why is it that you can buy a Coke or mobile phone refill cards in a remote African village but in these same villages, you cannot consistently get basic lifesaving medicines? Why are pneumonia and diarrhea still the biggest infectious disease threats for children when effective and affordable solutions to prevent and treat a large portion of deaths already exist?  What is the contribution of vaccines in creating a more productive society and wealth of nations?  These are just a few of the questions asked at the new International Vaccine Access Center (IVAC), launching on Monday December 7th at the Johns Hopkins Bloomberg School of Public Health. IVAC seeks to translate evidence into policy, and policy into access to life-saving vaccines for all children.

Indeed, access is a hot topic. When I told several people about IVAC, the most common reaction is great – we really need this! There are many groups working in research or policy or in program implementation, but the bridge to ensuring access remains a challenge. On the surface, solutions can seem simple – show the need, build awareness and provide the solution at a low enough price and it will reach those that need it most.  Some try to help by providing vaccines, medicines or supplies, but that often creates more challenges than benefit because of concerns about sustainability.    Even with country level policies and commitments from donors to fund new interventions, implementation can see many stumbling blocks with uptake not reaching forecasted levels.  Sometimes it is because the health system is not strong enough.  Should that be a reason for delay of a life-saving intervention if the delivery platform is imperfect?  If the implementers are not entirely convinced, it is a strong barrier and one with the potential to impact manufacturers’ willingness to supply or donors’ willingness to fund if countries can’t show that they are appropriately using resources.  This must be played against the potential to save lives, however.


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