China Immunises Millions of Children Against Hepatitis B in Historic Collaboration Between Government and GAVI Alliance

China Immunises Millions of Children Against Hepatitis B in Historic Collaboration Between Government and GAVI Alliance

July 25, 2006

WHO, UNICEF Helping China Battle Cause of Deadly Liver Cancer, Achieving Dramatic Increase in Delivery of Vaccines to Most Remote Provinces

    BEIJING, July 25 /Xinhua-PRNewswire/ -- Since 2002,
China has immunised 11.1 million children in the country's
poorest and most remote western and central provinces
against hepatitis B, reducing their risk of developing a
deadly and common liver cancer, according to an
announcement made today by the Chinese government and the
GAVI Alliance. 

    Following a ceremony in Beijing, held to commend the
Chinese for their dramatic progress, GAVI and Chinese
health officials told journalists that the boost in
immunisations represents a 60 percent increase in hepatitis
B vaccine doses delivered to children in target provinces. 
The children reached include newborns, who receive a
"birth dose" of vaccine plus two more doses at
one and six months of age, as well as previously
unvaccinated children under five, who must also receive a
full three-dose vaccine series. 

    "Our goal is to protect all the babies at birth
from this virus," said China Minister of Health Gao
Qiang.  "The China-GAVI Hepatitis B Immunisation
Project has propelled us forward on this path, covering
one-third of all children born in China since the project
began in 2002."

    According to an estimate based on a 1992 national
hepatitis epidemiological survey, 120 million people in
China are chronically infected with hepatitis B (HepB). 
Those infected are at risk of liver cancer or failure, and
can spread the disease to others.  In the western
provinces, the campaign, with technical guidance from the
World Health Organization (WHO) and UNICEF, has reached
almost 70 percent of newborns with a birth dose of vaccine
in 2005, up from 47 percent in 2002.  Newborns are a key
target of the effort, since vaccination within the first 24
hours of life is the only way to protect an infant from
transfer of virus from an infected mother.  

    Since its inception, the campaign has averted over
200,000 future deaths due to the chronic consequences of
hepatitis B, mainly from cancer of the liver and cirrhosis.
 Death typically comes decades after children are exposed to
the virus during childbirth or in their first years of life.


    The breakthrough is the result of a five-year US$76
million project, co-funded equally by the Government of
China and the GAVI Alliance (formerly the Global Alliance
for Vaccines and Immunization).  Known as the China
Ministry of Health/GAVI Hepatitis B Vaccination Project,
the GAVI-supported campaign has targeted newborns and
children under five across an area that encompasses 470
million people, including six million newborns every year. 
It has reached babies born in hospitals, as well as those
born at home in mountain villages or in the tents of
nomadic herders on the vast steppes.

    "This breakthrough was 20 years in the
making," said Julian Lob-Levyt, Executive Secretary of
the GAVI Alliance.  "That is how long children in the
industrialised world have had a vaccine to fight this
virus, but, until recently, progress in emerging countries
and poor remote areas, such as western China, had been
painfully slow.  China's success is a model for other
countries still struggling to stop the spread of the
hepatitis B virus and other vaccine-preventable
diseases."

    According to preliminary data, provincial governments
have added to the funds provided by GAVI and the central
government, contributing more than US$10 million in
co-payments.  Lob-Levyt noted as well that the support of
the World Health Organization (WHO) and UNICEF has been
critical.

    "Worldwide, GAVI's support has made it possible to
immunise 90 million children against hepatitis B and avert
an estimated 1.4 million deaths from this disease
alone," he added.

    WHO and UNICEF are among the GAVI partners and other
key immunisation groups(*) in China that support the China
National Immunisation Programme efforts to reach all
children with life-saving vaccines and technologies, as
well as with polio eradication, measles control, and new
vaccine introduction.  WHO and UNICEF have supported the
development and implementation of the China-GAVI project,
through the national Interagency Coordinating Committee and
project Operations Advisory Group.   

     (*) US Centers for Disease Control and Prevention,
Australian Agency for 
         International Development, World Bank, Government
of Luxemburg, the 
         PATH Children's Vaccine Program, the Japanese
International 
         Cooperation Agency, and the China Foundation for
Hepatitis Prevention 
         and Control.


    GAVI's efforts are critical to achieving the Millennium
Development Goal on child health, which calls for reducing
childhood mortality by two-thirds by 2015.  Of the more
than 10 million children who die before reaching their
fifth birthday every year, 2.5 million die from diseases
that could be prevented with currently available or new
vaccines.  Since 2000, the catalysing efforts of the GAVI
Alliance have ensured that 90 million children in the
world's poorest countries were immunised against hepatitis
B. 

    New Laws, Home-Grown Vaccine, and Dedicated Partners

    Progress in China has been the result of national
commitment to control this disease; strong partnerships;
new national laws; and a home-grown vaccine industry able
to supply the huge quantities of vaccine needed.

    The Government of China and the GAVI Alliance embarked
on the five-year project in 2002, with the goal of reaching
75 percent of newborns with a birth dose of vaccine and 85
percent of children under the age of 12 months with all
three doses of HepB vaccine necessary to prevent infection.
 GAVI financial support was used to purchase and distribute
55.39 million doses of hepatitis B vaccine and 145.6
million safe, auto-disable (AD) syringes.  That financial
support was also designed to catalyse national action and
sustained commitment to HepB vaccination in China.

    In 2002 the Chinese national government added hepatitis
B to all routine childhood immunisations (known as EPI
vaccines).  Then, in March 2005, it passed a new regulation
stating that all EPI vaccines be given at no cost to
parents.  The Ministry of Health also designated hepatitis
B as one of four high priority diseases for national
control and developed a national hepatitis B control plan
for 2006-2010, with the goal of reducing to less than one
percent the proportion of children under the age of five
who are carriers of the hepatitis B surface antigen.

    The Chinese vaccine industry, which has produced HepB
vaccines since the 1980s and had a licensed vaccine since
1990, was also prepared to scale up. The GAVI-supported
project used this vaccine, purchased through a national bid
and tender process with international observers.

    Reaching Babies with Safe Injections Wherever They are
Born

    Success has also been bolstered by China's Safe
Motherhood Initiative, which urges mothers to give birth in
hospitals.  In addition, unprecedented cooperation between
grassroots vaccination staff and child and maternal health
staff in hospitals has fostered the approach of
"whoever delivers the infant should give the
immunisation."

    As a result, today more than 90 percent of the babies
in the project area hospitals receive their birth dose of
hepatitis B vaccine on time-within 24 hours of delivery.

    The biggest challenges remain reaching babies born at
home in the most remote rural areas.  Efforts to scale-up
immunisation there include increased coordination between
village doctors, vaccinators, midwives and mothers, as well
as regular vaccine deliveries to remote areas.

    In addition, a key component of the project has been
ensuring safe injections through the use of auto-disable
(AD) syringes.  By design, these syringes cannot be reused,
thus eliminating the danger of spreading multiple diseases
through injections given with dirty needles.  As a result
of the project, today all childhood vaccines in the
targeted regions are delivered using AD syringes.

    Challenges Remain

    About three-quarters of the 1301 project counties have
reached the target of 85 percent of children receiving the
complete HepB vaccine series, and half have reached the
timely birth dose target.  However, over one million babies
born each year in GAVI project counties are still not
receiving a timely birth dose.

    In the project's final years, it will concentrate on
achieving those targets in every county, both through
reaching more babies born at home and by waging a
"catch-up" campaign to reach still unvaccinated
children.  The project will also focus on enhancing
injection safety through wider use of AD syringes, and will
encourage the expanded use of AD syringes for all
immunisations given in China. 

    "Finally, long-term success depends on assuring
that no new financial barriers arise to block HepB
immunisation in the future," Lob-Levyt said. 
"This is one of the greatest challenges, and the
solution lies not just within China, but with a global
community mobilised to ensure access to vaccine financing
for all developing nations."

    The GAVI Alliance

    An alliance of all the major stakeholders in
immunisation, the GAVI Alliance includes among its partners
developing country and donor governments, the World Health
Organization (WHO), UNICEF, the World Bank, the vaccine
industry in both industrialised and developing countries,
research and technical agencies, NGOs, and the Bill &
Melinda Gates Foundation.  It is estimated that more than
1.7 million early deaths will have been prevented as a
result of support by GAVI up to the end of 2005. 

    GAVI's efforts are critical to achieving the Millennium
Development Goal on child health, which calls for reducing
childhood mortality by two-thirds by 2015.  Of the more
than 10 million children who die before reaching their
fifth birthday every year, 2.5 million die from diseases
that could be prevented with currently available or new
vaccines 

    Notes to Editors:

    The GAVI Alliance

    THE NEED

    Immunisation prevents millions of deaths every year and
reduces the costs of treatment and of disability caused by
infectious diseases.  Immunisation also has the potential
to significantly boost economic growth(1).  By improving
the health of a population, immunisation also improves its
education and work prospects.

    Yet in many countries, efforts to increase immunisation
coverage are hampered by weak health systems, conflict, and
the high cost of some vaccines. As a result (according to
the most recent available data(2)):

    -- More than 27 million children missed out on
immunisation during their 
       first year of life - leaving them vulnerable to
infectious diseases 
       both in childhood and during the productive adult
years (2004 data).
    -- 1.4 million children under five died from
vaccine-preventable diseases 
       for which vaccination is already included in most
immunisation 
       schedules (2002 data).
    -- More than 1 million children died from pneumococcal
disease, 
       meningococcal disease, and rotavirus diarrhoea --
diseases for which 
       vaccines are likely to become available in the near
future (2002 data).

    THE RESPONSE

    The GAVI Alliance is a public-private global health
partnership committed to saving children's lives and
protecting people's health through the widespread use of
vaccines.

    GAVI was launched in 2000 to improve access to
immunisation for children in impoverished countries. 
Governments in industrialised and developing countries,
UNICEF, WHO, the World Bank, the Bill & Melinda Gates
Foundation, non-governmental organisations, vaccine
manufacturers from industrialised and developing countries,
and public health and research institutions work together as
partners in the Alliance.

    Key to achieving the goals of the Alliance is a
dramatic increase in new funding for immunisation. 
Building on the resources already provided by individual
partners in the Alliance, GAVI partners created The GAVI
Fund to help fill critical gaps in the overall global
effort and to maintain a significant source of new and
additional financial support from public and private
donors.  GAVI resources help strengthen health and
immunisation systems, accelerate access to selected
vaccines and new vaccine technologies-especially vaccines
that are new or underused, and improve injection safety.
These areas will remain a crucial focus as the GAVI
Alliance moves into its second phase (2006-2015).

    GAVI has been financed by ten governments to date --
Canada, Denmark, France, Ireland, Luxembourg, the
Netherlands, Norway, Sweden, the United Kingdom, and the
United States -- as well as the European Union, private
contributors, and the Bill & Melinda Gates Foundation. 
It provides multi-year grants to more than 70 of the world's
poorest countries.  Grants are made based on a rigorous
application process in which country proposals are reviewed
by a panel of independent experts drawn from a wide
geographic base.

    A total of almost US$ 3.3 billion has since been raised
in traditional funding from government and private sources,
including US$ 1.7 billion actually received.  In addition,
commitments by France, Italy, Spain, the UK, Sweden, Norway
and Brazil have been secured through the new International
Finance Facility for Immunisation (IFFIm), which will yield
more than US$ 4 billion in additional disbursements before
2015 and additional funds after 2015 as the debt is paid
off.

    The resources that have been received have been used in
order to help countries with a GNI of US$ 1000 or less:
  
    -- strengthen healthcare delivery systems;
    -- boost coverage with established vaccines (against
diphtheria, tetanus, 
       pertussis, tuberculosis, measles and polio);
    -- introduce underused vaccines where needed (hepatitis
B, Hib and yellow 
       fever);
    -- ensure immunisation safety;
    -- accelerate the development of, and affordable access
to, priority new 
       vaccines for developing countries (e.g. against
rotavirus, pneumococcal 
       disease and meningitis types A and C);

    FUNDS DISBURSED

    As of December 2005:

    Total funds committed by GAVI over five years: more
than US$ 1.6 billion

    GAVI has disbursed US$ 672 million (as of 30 September
2005) as follows: (3) (in US$)

    -- Vaccines/supplies: 419 million
    -- Accelerated development of priority new vaccines
(ADIPs): 32 million
    -- Yellow fever vaccine stockpile: 11 million
    -- Immunisation safety: 83 million
    -- Immunisation services support: 120 million
    -- Introduction of new vaccines 7 million

    GAVI ACHIEVEMENTS

    More than 1.7 million future deaths averted through
GAVI support(4)

    It is projected that by end-2005, nearly 1.7 million
future deaths from Hib disease, pertussis and hepatitis B
will have been averted through GAVI support.  Some of those
deaths would have occurred in childhood and others (e.g.,
from hepatitis B) in the most productive adult years.

    Increasing routine immunisation coverage

    In the countries receiving funding to help strengthen
immunisation services:

    -- An additional 8.3 million children were immunised
with DTP3 by December 
       2004(5).
    -- It is projected that approximately 13 million
additional children will 
       have been immunised with DTP3 by the end of 2005.

    Support for underused vaccines

    As of December 2005, it is projected that the number of
children immunised through the introduction of underused
vaccines in GAVI -supported countries will include(6):

    -- hepatitis B vaccine: 
        approximately 90 million

    -- Hib vaccine: 
        approximately 14 million

    -- yellow fever vaccine: 
        more approximately 14 million

    MAKING A DIFFERENCE: 

    HEPATITIS B VACCINE

    With support from the GAVI Alliance:
   
    -- More than more than 1 million future deaths (from
HepB, Pertussis and 
       Hib) have been averted through GAVI support as of
December 2004. It is 
       projected that this number will reach 3.6 million by
the end of 2008.
    -- 56 of the more than 70 eligible countries have been
approved for 
       funding for hepatitis B vaccine so far - up from
only 7 before the 
       launch of GAVI.
    -- 32 (57%) of the countries approved for funding for
hepatitis B vaccine 
       have opted to use combination vaccines - thereby
avoiding an increase 
       in the number of immunisation injections needed
during the first year 
       of life.

    SAFE INJECTIONS
   
    -- More than 1 billion single-use auto-disable syringes
have been supplied 
       for immunisation (as of December 2005).

    SUSTAINABILITY

    -- All the 15 countries where GAVI support for
injection safety has now 
       ended have already secured funding for continued
injection safety 
       support.
    -- Of the countries receiving GAVI support for new
vaccines, 11 have 
       already begun co-financing their vaccine supply as
of 2005.

    ACCOUNTABILITY

    -- To date, 30 countries have successfully undergone an
external data 
       quality audit (DQA) to verify the accuracy and
completeness of their 
       administrative reporting system.
    -- Of the 48 countries eligible for rewards for
increased DTP3 coverage 
       (as of December 2004), 27 have received at least one
reward.  A further 
       21 have not yet received rewards (11 because they
failed a DQA and 10 
       due to weak performance).

    STATUS OF COUNTRY SUPPORT: 

    -- Number of countries currently eligible for GAVI
support: 73 (as of June 
       2006)
    -- Number of countries that have applied: 73 (as of
December 2005)
    -- Number of countries that have had at least one type
of support 
       approved: 73 (as of December 2005)


    NUMBER OF COUNTRIES SUPPORTED FOR:

     -- DTP-HepB combination: 14
     -- DTP-Hib combination: 1
     -- DTP-HepB-Hib combination: 16
     -- monovalent hepatitis B: 23
     -- yellow fever: 15
     -- immunisation services support: 53
     -- immunisation safety: 69

    References

     (1) David Bloom, David Canning and Mark Weston,
"The Value of 
         Vaccination", World Economics (Vol. 6, No. 3,
July-September 2005
     (2) WHO data.
     (3) Includes some long-term funding not yet received
by countries.
     (4) WHO estimate.  Includes both deaths averted among
children under five 
         years and deaths from hepatitis B that would have
occurred in 
         adulthood.
     (5) WHO estimates
     (6) WHO estimates


    For more information, please contact:  

     Jean-Pierre LeCalvez, 
     GAVI Alliance
     Tel:   [phone]
     Email: [e-mail] 

     Roy Wadia, 
     WHO China
     Tel:   [phone] x681
     Email: [e-mail] 

     Charles Rycroft, 
     UNICEF China
     Tel:   [phone]
     Email: [e-mail]

SOURCE  World Health Organization