Humanity has made extraordinary progress in the fight against infectious diseases due in large part to vaccines. Despite their widespread availability in developed countries, the world’s poor do not have equal access and continue to be burdened significantly by vaccine-preventable diseases.
The Center for Vaccine Equity (CVE) was founded in 2011 to provide all people – regardless of socioeconomic status – with equal access to vaccines and to reduce the burden of vaccine-preventable disease. CVE works collaboratively with a wide range of partners to develop and implement strategies to increase access to vaccines and to expand the capacity of countries to deliver the vaccines.
CVE has three current areas of focus: Influenza & Pandemic Response; Polio Eradication Support Center; and Immunization Advocacy & Education. Our work focuses on expanding availability, supporting vaccine impact studies, and building delivery systems that facilitate access in developing countries.
In addition to our deep scientific expertise in vaccines, we play vital convening roles in bringing our partners together. CVE serves as Secretariat for a number of global health partnerships that advance our mission. We host regular meetings to address technical, scientific, and resource challenges to polio eradication, and access to influenza vaccine in developing countries. Through The Task Force, CVE also hosts the Global Funders Consortium for Universal Influenza Vaccine Development (funded by the Bill & Melinda Gates Foundation). The Consortium is a mechanism to bring together thought leaders to discuss how to most effectively collaborate toward the goal of creating a universal influenza vaccine.
CVE also hosts the Coalition for Global Hepatitis Elimination (www.globalhep.org). The Coalition will be a collaborative environment where partners share program experiences, learn best practices, receive technical assistance and participate in the operational research to successfully eliminate hepatitis B virus and hepatitis C virus transmission and disease.
Coalition for Global Hepatitis Elimination
Globally, 328 million people are infected with hepatitis B (HBV) and hepatitis C (HCV) viruses and millions of new infections occur annually. HBV and HCV cause 1.3 million deaths annually and are the leading cause of mortality from primary liver cancer and the fourth leading cause of cancer deaths globally. If left unchecked, by 2040, deaths from HBV and HCV will exceed the number of deaths from HIV, TB, and malaria combined. The burden of HBV and HCV varies with 75% of HBV and HCV-related deaths occurring in low and middle-income countries (LMIC). With the availability of reliable diagnostic tests, highly effective vaccines and curative antiviral therapies, the WHO has targeted HBV and HCV for elimination by 2030.
Nations are in various stages of planning and implementing programs to eliminate HBV and HCV. However, public health and clinical data are often not available to guide program development or build a case for investment. Most programs are expected to achieve elimination by strengthening existing health systems with interventions to prevent transmission and disease including vaccination, blood safety, clinical infection control programs, and HBV/HCV testing and treatment in primary care and other settings. To build capacity for HBV and HCV elimination, the International Task Force for Disease Elimination (ITFDE) and a recent Lancet Commission recommended that a global coalition be developed to help hepatitis elimination programs share knowledge and receiving technical assistance.
Modeled after it’s other disease elimination programs, The Task Force for Global Health in collaboration with WHO, CDC, and a broad range of other public and private partners is building the Coalition for Global Hepatitis Elimination (www.globalhep.org). The Coalition will begin operations in June 2019 and will deliver services along five strategic axes:
1. Engage partners in a community of practice to achieve elimination.
2. Build a trusted dynamic evidence base, HEPEXPERT, to guide program development and evaluation.
3. Provide expert technical assistance for governments and health systems.
4. Conduct operational research to improve program effectiveness.
5. Support global advocacy and community mobilization
The Coalition is led by Dr. John Ward, who served as the Director of the Division of Viral Hepatitis at CDC for over 13 years. Dr. Ward authored the first national action plan for viral hepatitis prevention in the US and provided technical consultation on hepatitis elimination programs in the Republic of Georgia, Egypt, and other countries. The Chief Technical Officer for the Coalition is Dr. Stefan Wiktor who was the Team Lead of the World Health Organization’s Global Hepatitis Programme where he led the development of several guidelines and policy documents and assisted countries in the implementation of comprehensive viral hepatitis prevention and control programs.
PIVI works in partnership with the Centers for Disease Control and Prevention (CDC), Ministries of Health, corporate partners and others to create sustainable, routine, seasonal influenza vaccination programs in low- and middle-income countries. This important work not only saves lives from flu every year, but helps develop the same vaccine delivery systems that will be needed to reliably and efficiently respond during influenza pandemics and other infectious disease epidemics.
PIVI works in concert with WHO programs to help countries prepare for pandemic influenza and to support countries’ efforts to control and prevent seasonal influenza. To date, PIVI has provided more than 3 million doses of flu vaccine to Ministries of Health in Albania, Armenia, Kyrgyzstan, Lao PDR, Moldova, Mongolia, Morocco, and Nicaragua with the goal of creating sustainable, seasonal influenza programs.
In addition to PIVI, the Center for Vaccine Equity and The Task Force for Global Health serve as the convening partner for a newly formed Consortium for global funders and thought leaders to come together to share thoughts, strategies and learnings related to the development of a “Universal Influenza Vaccine” that would provide better and more long-lasting protection from seasonal and pandemic influenza. These next-generation vaccines will be a vital step in protecting our world from a future influenza pandemic.
Polio Eradication Support Center
The Center for Vaccine Equity is involved in various aspects of the global polio eradication effort, primarily through its contribution to the four objectives of the Polio Eradication and Endgame Strategic Plan: Virus Detection and Interruption; Routine Immunization (RI) Strengthening and OPV Withdrawal; Containment and Certification; and Legacy Planning through support of the Transition Management Group (TMG).
Virus Detection and Interruption
CVE serves as the Secretariat for the Polio Antivirals Initiative (PAI). In this role, CVE identifies and convenes the PAI Steering Team of experts, works with partners and companies to develop antiviral agents to treat immune deficient patients excreting poliovirus.
Supporting the Eradication and Outbreak Management Group (EOMG), CVE helps coordinate across the EOMG membership and the UNICEF/WHO regional offices to develop documents, guidelines, protocols, products, and provide overall technical support.
Routine Immunization (RI) Strengthening and OPV Withdrawal
Through its support of the Immunization Systems Management Group (IMG), CVE contributed to the unprecedented rapid introduction of inactivated polio vaccine, to the global switch from trivalent OPV (tOPV) to a safter bivalent OPV (bOPV), and to the efforts to strengthen routine immunization services. These efforts included communications and advocacy, technical assistance in-country, and tracking progress against indicators.
Containment and Certification
CVE is assisting US Health and Human Services with polio eradication in the United States by serving as the secretariat for the U.S. National Containment Certification Committee. This work supports the effort to limit and contain poliovirus samples held in research institutions and laboratories globally. The NCC assures and validates compliance with the global policy among U.S. laboratories and institutions.
As the world nears polio eradication, traditional funding and support will wind down. CVE continues to provide support to the multi-partner Global Polio Eradication Initiative to help fragile countries prepare for this funding ramp down primarily through its support of the Transition Management Group which provides transition planning guidance to countries.
Immunization Advocacy and Education
CVE plays an important role at The Task Force, helping to educate as well as stem the tide of misinformation about vaccines that can often easily spread in both developed and developing countries.
Achieving Global Vaccine Action Plan (GVAP) Goals
In 2016, WHO’s Strategic Advisory Group of Experts (SAGE) determined the current pace of global progress must change if all the Global Vaccine Action Plan (GVAP) goals are to be achieved by 2020. In partnership with the Emory Vaccine Center and CDC, the Task Force for Global Health (TFGH) is providing leadership, Subject Matter Expertise (SME), and guidance to survey global partners to address the lack of progress and to provide recommendations on how to accelerate steps towards attainment of the GVAP goals.
In countries around the world, misinformation about the safety of vaccines has threatened progress made against vaccine-preventable diseases. Most recently, outbreaks of measles in the United States have occurred because some children have not been immunized because of their parents’ opposition to immunization.
Voices for Vaccines, a project hosted by TFGH, addresses questions about vaccines. The project is led by concerned parents who, in consultation with an Expert Advisory Committee, provide accessible, science-based information about vaccines and vaccine-preventable diseases. The project is funded by private donations, accepting no donations from governments or vaccine companies.
Scientific Conference Management
The Center provides planning support and logistics management for all aspects of large scientific conferences. In 2018 the Center is supporting CDC as co-conference organizer for the National Immunization Conference and the International Conference on Emerging Infectious Diseases (ICEID).
In 2010, a number of factors came together to raise the visibility and urgency of dealing with cholera: outbreaks of cholera in Africa, a massive epidemic of cholera in Haiti, and the development of new, effective oral cholera vaccines (OCV). Traditional effective means of cholera prevention and control include rapid detection and appropriate management of cases, provision of safe water and appropriate sanitation and hygiene (WaSH). These efforts have historically been under-resourced and often take years to demonstrate impact. Availability of effective OCV brought the prospect of having more rapid impact. However, supplies of the new vaccines and awareness of their potential were limited.
During 2011-2015, The Bill & Melinda Gates Foundation (BMGF) provided support to TFGH to bring together all stakeholders in cholera prevention and control to develop consensus and accelerate implementation of an integrated approach to address epidemic and endemic cholera. Through establishment of the Coalition for Cholera Prevention and Control (CCPC), collective action was mobilized to urge the deployment of cholera vaccine in Haiti, establishment of a vaccine stockpile to address cholera epidemics globally, and development and publication of a recommended framework for the prevention and treatment of cholera through a comprehensive integrated strategy.
In addition, the foundation further supported The Task Force in revitalizing the Global Task Force on Cholera Control (GTFCC), a WHO-based body that had become inactive since its establishment in 1991. Over a one-year period, through establishment of a working group, detailed recommendations were developed and presented to the WHO Director General. Most of the recommendations were accepted. The Task Force for Global Health is now a member of the revitalized GTFCC, an active and effective body coordinating global efforts on cholera prevention and control. Despite the increased activity and consensus on approaches, cholera prevention and control remains under-resourced and there is a great need for advocacy to mobilize additional resources to address this problem, which kills approximately 100,000 people each year.
Each of the six WHO Regions have now established targets for elimination of measles by 2020. Strategies to achieve elimination are widely agreed upon. Nonetheless, progress toward achieving these targets has been inadequate. During the period 2009-2012, BMGF provided support to TFGH to mobilize high-level support for measles activities in African countries.
Working with President Jimmy Carter and First Lady Rosalynn Carter, the initiative mobilized support through the UN, the Global Elders and the African Union, with Presidents and First Ladies of Sub-Saharan Africa in support of childhood immunization goals. As a result, First Ladies in seven Sub-Saharan African countries became engaged in national campaigns supporting measles elimination in their countries. In July 2010, the African Union issued a strong statement in support of childhood immunization.
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