Immunize The World by Osa Rafshodia, MD For the Diseases Controls and strategies University of HeidelbergIs The Effort of the GAVI have to led to childhood diseases no longer beinga major public health problem in the world ?Background Immunization is the best of human effort to prevent diseases. So manydiseases could prevented by the immunization, but not every high mortalitydiseases have had their immunization as the choice of prevention. Immunization is provided by a vaccine, is a biological preparation thatimproves immunity to a particular disease. A vaccine typically contains anagent that resembles a disease-causing microorganism, and is often madefrom weakened or killed forms of the microbe, its toxins or one of itssurface proteins. The agent stimulates the bodys immune system torecognize the agent as foreign, destroy it, and "remember" it, so that theimmune system can more easily recognize and destroy any of thesemicroorganisms that it later encounters.1 Immunization is not only prevent human to get the diseases but toprevent the most important aspect of human life, is ﬁnancial burden of thediseases. Diseases as well have double burden to human life; healthcondition and ﬁnance condition. Many people in middle low incomecountries have their ﬁnancial burden or ‘get more poorer’ because of theirdiseases, as the health ﬁnancing schemes provided by their governmentdon’t cover most of diseases, so out of pocket is the choice for them whomnot covered. As a research in The US said that Spending $10 a year perperson would save the United States more than $16 billion annually withinﬁve years, the economists said, for a return of $5.60 on every $1 invested2,and in Middle Income Countries the cost is much more higher. The study was conceived in response to a growing recognition on thepart of the WHO that LMICs receive little support for their vaccinationprograms, despite having a heavy burden of disease and accounting for alarge share of the world’s poor.3 In Middle Low Income Countries,immunization is focusing to childhood. Because, they still has a high rate ofinfant mortality as well as below 5th years mortality. A total of 10.4 millionchildren died in 2004, mostly in low- and middle-income countries. Anestimated 39% of these deaths (4.1 million) were caused by micronutrientdeﬁciencies, underweight, suboptimal breastfeeding and preventable envi-ronmental risks. Most of these preventable deaths occurred in the WHOAfrican Region (39%) and the South-East Asia Region (43%).4
One of the International alliance for immunization is GAVI. GAVI is analliance of donor governments, developing countries, internationaldevelopment and ﬁnance organizations and the pharmaceutical industryinto one, decision-making body.5 Why GAVI ? GAVI is a decision-making body that combine betweenDonor - Developing Countries - Pharmaceutical Industry. No otherinternational organization just like GAVI. In GAVI, need and demand sittogether and discuss about the goal. GAVI has their own market, maintaintheir own health interest and all three aspect have their satisfaction. Donorcountries or donor organization meets their ﬁnance capacity, Developingcountries meets their needs, and Pharmaceutical industry meets their proﬁtmargins. According to GAVI annual report, each year 130 million childrenare born, 90 million of them in developing countries. Almost 30 millionchildren have no access to immunization.7ResultImmunization in Middle Low Income Countries Immunization cost to get the most coverage at MLIC needs a lot ofresources and some countries dont have too much to spend, yet theirhealth cost nationally will have burden to the vaccine prevented disease aswell, not mention about lost of productivity per person or other measuressuch as DALY. But, immunization could save 25 times more cost than totreat a disease, the cost effective of immunization is very high6. According to GAVI report, by 2002, 80% of developing countries withadequate delivery systems should have introduced hepatitis B vaccine, by2007 this should have been achieved in all countries7. By 2005, 80% ofdeveloping countries should have systematic immunization coverage of atleast 80% in all districts on the basis of diphtheria-tetanus-pertussis (DTP3)and measles vaccines7. By 2005, the vaccine efficacy and disease burden inrespect of rotavirus and pneumococcal disease should be known for allregions and a mechanism should have been identiﬁed to make the vaccinesavailable for the poorest countries7. According to UNICEF in 13 June 2011 atLondon, GAVI has a $4.3 billion to step up vaccination efforts over the nextfour years8. Middle Low Income Countries not only have coverages problems, butthey have more serious problems which one is the availability of HealthProviders in rural areas. Without Health Providers, people lived in ruralareas will have inequity in health, means no access to fulﬁll their needs ofhealth. The equity of health is the biggest problem that could makedisparities in immunization coverage exist within and among the world’sregions and countries. While DTP3 coverage is 96% in the industrializedcountries, none of the regions in south asia and sub saharan africa havebeen able to attain such high coverage, leaving large unimmunizatiedpopulations in the least developed countries. To make matters worse, an
inequity of coverage prevails within many countries, especially developingcountries.9 According to HDI UNDP report 2011, the highest of medium humandevelopment is Jordan, they still have 2% of under 1 year lack of DTP, 5% ofmeasles, and the lowest is Bhutan, with 4% lack of DTP, 2% lack ofmeasles10. These conditions described, many children below 1 year of ageare lack of access to immunization. Immunization by means to eliminatediseases or to prevent some kind of diseases in certain areas, is still a bigchallenge if there are many regions lack of health providers to delivervaccine. As described at the map, african countries, and south asia,immunization coverages are still a great challenge.Discussion If we look to the map describe above, economic and social status ofcountries are somehow related to their health status, in this case is theimmunization coverages. Just like Bostwana, the country which consider asthe one of the rich country in africa, the immunization coverages are equalto those in europe. Nigeria and Ethiopia, the countries which consider asthe poor countries in africa have the lowest coverages. There is no equality of access to vaccines for children in industrializedand developing countries, and there is a lack of equality between rural andurban areas within countries. It is estimated that a child in an industrializedcountry receives eleven vaccines on average, while a child from adeveloping country is lucky to receive half that number7.
The graphic describe, how much money has the GAVI to cover theimmunization programs around the world, but still as the UNICEF 2011report, and WHO 2011 declare that the Immunization is an emergency ofPublic Health concernConclusion The Immunization program of the world is growing toward positivedirection. Some of diseases would be a target to the program oferadication. Immunization related to many external and internal factor. Thesuccessful of immunization program not only to coverage matters, but howto deliver a wide good quality and supply vaccines, mainly at middle lowincome countries. The GAVI efforts is really appreciated and successfullyaround the world, but the immunization itself still need more effort to deal,mainly coverage problems at the african countries and south asia countries.References1. http://en.wikipedia.org/wiki/vaccine2. http://health.usnews.com/health-news/diet-ﬁtness/diabetes/articles/2008/07/17/disease- prevention-programs-worth-the-investment3. http://www.resultsfordevelopment.org/projects/constraints-vaccine-adoption-low-and- middle-income-countries-14. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf5. http://www.gavialliance.org/about/mission/what/6. http://asaltahuaja01.blogspot.com/2011/12/imunisasi-menghemat-biaya- kesehatan-25.html7. https://apps.who.int/inf-fs/en/fact169.html8. http://www.unicef.org/immunization/index_58888.html9. http://www.unicef.org/immunization/index_bigpicture.html10.http://hdr.undp.org/en/media/HDR_2011_EN_Tables.pdf