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Biography |
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Mr. Stephen W Jarrett
Global Director, Gracious International Shanghai
Former UNICEF Principal Adviser
Mr. Jarrett recently retired after completing 38 years of service with UNICEF, which included diverse field assignments in Latin America in the 1970s, and as senior health officer in China in the 1980s supporting the achievement of universal child immunization. He has worked as a senior adviser to UNICEF on health systems strengthening, with a focus on drug supply systems in sub-Saharan Africa and other low-income countries. More recently he was in the Management Team of UNICEF Supply Division for 12 years, engaged in strategic issues related to supply support to children’s programs in 160 countries with over $1 billion procurement value annually.
Before retiring, Mr. Jarrett coordinated the UNICEF response to the 2008 global food crisis and its impact on children and vulnerable populations, working in close collaboration with the United Nations Secretariat and other United Nations agencies. Additionally, he led UNICEF efforts at scaling up the global supply of ready-to-use therapeutic foods.
Currently, he is consultant to UNICEF on strategic planning related to vaccines and immunization. He is associated with a company in Shanghai developing smart fabrics repelling insects and eliminating bacteria. He continues to provide advice on child nutrition and is on the Board of Directors of a health products franchising non-profit (www.livinggoods.org).
Mr. Jarrett holds a Bachelor of Sciences degree in Civil Engineering from Southampton University, U.K. and a Masters in Public Health degree from Columbia University, New York, U.S.A. He has published numerous articles on issues concerned with immunization, health services strengthening and public health ethics. He is a guest lecturer at Johns Hopkins University School of Public Health, USA, and a regular guest speaker at BioVisionAlexandria, Alexandria Library, Egypt.
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Abstract |
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Equity in the delivery of vaccines and vaccination in developing countries |
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Equity in the delivery of vaccines and vaccination in developing countries
Vaccination has arguably been one of the most successful public health interventions, with an estimated 2.5 million deaths prevented annually. Deaths from diphtheria, tetanus, pertussis, polio and measles have fallen to 600,000 a year, down by 60% just in the last decade. At the same time, newer vaccines, such as hepatitis B and Haemophilus influenzae type B vaccines have been widely introduced. Pnuemococcal and rotavirus vaccines are also now being introduced into developing countries.
UNICEF is the largest supplier of vaccines to developing countries, reaching one third of the global birth cohort, but destined for children in low and lower-middle income countries. In 2011, around 64% of the volume of vaccine purchased was polio vaccine for the continuing eradication programme; the rest was for both traditional and newer vaccines. In the same year, 62% of UNICEF purchases of vaccines of close to one billion US dollars were funded by the GAVI Alliance, with the remaining split between country funding and UNICEF’s own funding. Value wise, this still only represents about 5% of the total vaccine market, showing the persistent gulf between developed and developing vaccine markets.
More than 20 million infants still remain unvaccinated every year, due to geographic, social and economic factors. Around 2 million deaths a year still occur from infections for which vaccines currently exist. Equity in the delivery of vaccines and vaccination has to be a primordial objective of all countries. Governments have an obligation to provide vaccination which is an essential component of the right to health. Individuals have a responsibility to be vaccinated, or ensure their children are vaccinated, to stop the spread of infection. Society has to respond in two ways; ensure that Governments meet their obligations to provide vaccination, and ensure that individuals in the society understand their responsibility to be vaccinated.
Significant challenges exist in country-level delivery systems. Cold chain systems, which are essential to protect vaccine quality during storage, distribution and use, are deficient in many countries. A review of 24 countries found only 2 having effective vaccine management systems, while 3 were ineffective and the rest mediocre. This deficiency is particularly serious considering that new vaccines are more expensive than traditional vaccines by a multiplier of 10 or more, heightening the risk to quality and wastage. At the same time, while many countries are increasing their budgets for vaccines, they are still dependent to a large extent on external funding of newer vaccines, leading to doubts about long-term sustainability.
Many of the newer vaccines, particularly pneumococcal and rotavirus vaccines and the same will be almost certainly be true of a malaria vaccine, do not protect completely against disease, unlike traditional vaccines such as measles and tetanus. They need to be combined with other primary health care interventions in order to prevent, protect and treat specific diseases. The cost-effectiveness of these vaccines, therefore, may not be directly associated with decreased disease burden and deaths averted.
Without serious investment in national delivery systems, additional vaccines cannot be introduced and equity in delivery is unlikely to be achieved. This implies not only infrastructure improvement but also enhancing the skills and motivation of the health work-force, which is continuously being asked to deliver more service often without additional benefits.
Science has to act on multiple fronts simultaneously, advancing the development of new vaccines to tackle remaining disease burdens, but also addressing their improved thermostability, as well as ways to ensure quality maintenance during delivery and use and to reach those currently unreached achieving equity among all populations targeted for vaccination.
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