Vaccines – an end and a beginning

Polio eradication efforts are pushing toward the end. The New York Times, in discussing setbacks in the mostly successful eradication effort such as outbreaks in Tajikistan and emergence of a mutated attenuated vaccine virus that has caused some cases, stressed the importance of ‘more aggressive’ campaigns with the oral virus.

eritrea-polio-immu.jpgTiming is crucial for any eradication effort, since a disease can get an upper hand again if efforts stall. An example of the aggressive and timely response is a donation by Rotary International of $500,000.00 immediately to UNICEF & WHO in equal parts to contain the current outbreak in DRC and take preventive measures.

The economic benefits of achieving eradication are spelled out in an article in the current issue of Vaccine. The study estimates net benefits of at least US$40-50 billion if transmission of wild polioviruses is interrupted within the next five years and $17-90 billion in benefits from add-on campaigns such as the life saving effects of delivering vitamin A supplements. Awareness of these benefits should add further impetus to wrapping up of the polio eradication program.

Annually, we are now numbering polio cases in the hundreds and guinea worm cases in the dozens, while still malaria numbers in the millions. We are only at the beginning of the road to an effective malaria vaccine. While researchers and program managers worry about whether vaccine efficacy will be proven in ongoing phase 3 clinical trials in sub-Saharan Africa, Rebecca Voelker has pointed out an equally serious problem, developing and implementing an effective malaria vaccine delivery system.

Regulatory approval is just the first step, according to Voelker.  A functional procurement and supply management (PSM) system is needed to ensure that the malaria vaccines get to the point of delivery. Plans are needed to ensure social acceptability and timely uptake.

Malaria programs have an advantage over polio in that there are several different technologies available from which appropriate package of national and local interventions can be planned. Still, we face PSM challenges with the nets and medicines. Hopefully effective malaria vaccines will come along soon, and that as delivery systems are strengthened for nets and medicines, these too, can smooth the way for introduction of the malaria vaccines.

… and of course, we should learn lessons from the global polio vaccination effort, such as the fact that the last stages of an eradication campaign require constant vigilance.

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