The Strategic Power of Vaccines
The second CSIS High-Level Forum on U.S. Leadership in Global Health placed a focus on vaccines as instruments of U.S. global leadership in pursuit of security and economic interests at home and abroad, in close enduring partnerships with corporations, foundations, multilateral organizations, and other countries.
The event opened with a screening of the extended trailer of The Strategic Power of Vaccines in Zambia, a piece that aims to portray the complexities of immunization in Zambia and to make broader points about global immunization efforts. The five minute trailer is a preview of a longer piece that will be completed in early 2012.
At the conference, the CSIS Global Health Policy Center released two reports centered on vaccines.
Role(s) of Vaccines and Immunization Programs in Global Disease Control
Given the relative successes of the GAVI Alliance (formerly, the Global Alliance for Vaccines and Immunisation) and the recent call by the World Health Assembly for a global vaccine action plan to guide the world for the next 10 years, the world is focusing much attention, justifiably, on various aspects of macropolicy and planning for the progressive expansion of global vaccine efforts. This brief report focuses on the “nuts and bolts” of the complex biological, epidemiologic, and risk management concepts that are the foundations of global and national “expert group” recommendations for specific target groups for currently available childhood vaccines and others. Using examples of specific vaccine successes and disease challenges, this report highlights the ongoing attention to detail required for the success of local, national, and global immunization efforts.
The Future of Global Immunization
In January 2010 at the World Economic Forum, the Bill and Melinda Gates Foundation launched the Decade of Vaccines by pledging $10 billion over the next 10 years to support worldwide efforts to develop and deliver vaccines to the world’s poorest countries. The foundation also challenged other global partners to demonstrate their continuing commitment and, in so doing, to dramatically reduce child mortality by the end of the decade. This is a tremendous opportunity for transforming global health and could have significant consequences for child survival while expanding the impact of vaccines across the lifespan, but there is no easy formula for success. How a number of challenges are addressed will be critical to success or failure in the next decade and to the most effective use of available resources. This report outlines 10 important issues facing the global vaccine and immunization agenda.
Event Multimedia
Following the video about Zambia, there were two keynote address and three panel discussions that focused on (1) vaccinology in the 21st century; (2) the private sector; (3) obstacles to immunization efforts; (4) vaccines and security; and (5) U.S. leadership in global immunization.
Part 1: CSIS Senior Vice President and Director of the Global Health Policy Center, J. Stephen Morrison, offers introductory remarks. Following his remarks and a short video, Anthony Fauci, Director of the National Institute of Allergies and Infectious Diseases at the National Institutes of Health, gave a keynote address entitled - Vaccinology: Considerations for the 21st century.
Part 2: J. Stephen Morrison discussed the importance of a robust private sector for the future of vaccines with panelists Julie Gerberding of Merck & Co.; Margaret McGlynn of the International AIDS Vaccine Initiative; and Regina Rabinovich of the Bill & Melinda Gates Foundation.
Part 3: Amanda Glassman of the Center for Global Development moderated a discussion about overcoming obstacles to immunization efforts with panelists Helen Evans of the GAVI Alliance; Orin Levine of Johns Hopkins University; and Anne Schuchat of the Centers for Disease Control and Prevention (CDC).
Download Helen Evans presentation.
Part 4: Admiral William Fallon led the final panel of the day for a dialogue on vaccines and security with panelists Stephen Cochi of CDC; Markus Geisser of the International Committee of the Red Cross; and Eric Schwartz of the Humphrey School at the University of Minnesota.
Part 5: Dr. Rajiv Shah of USAID gives the second keynote address of the event on U.S. Leadership in Global Immunization. Dr. Shah's keynote is followed by a brief Q & A with J. Stephen Morrison.
Over the past year, CSIS has worked with locally-based research centers in each of the BRICS to support shared research, facilitate discussion, and disseminate policy analysis to encourage greater understanding of the ways in which approaches to global health policy and cooperation are changing. Building on the outcomes of workshops held in Beijing, Moscow, Rio de Janeiro, and Johannesburg, the December 6 seminar will feature expert panelists whose presentations will highlight how each nation conceptualizes its current and future health outreach; identify new and evolving trends with respect to regional, South-South, and trilateral health cooperation; and articulate an agenda for future discussion and research.
The conference was held at the CIIS office in Beijing. Commissioned experts from China and the United States presented their preliminary findings on various aspects of the two countries’ presence in Africa, including advantages and effects of U.S. and Chinese efforts in Africa, U.S. and Chinese responsibilities in promoting global health programs, and the Chinese government’s domestic decision-making process on aid in Africa, among other topics. The discussion focused primarily on developing a practical roadmap on U.S.-China-Africa trilateral collaboration.
Following the Haiti earthquake of January 12, 2009, a variety of factors contributed to the atmosphere of ultimate chaos that reigned for the first few months of the relief effort. First and foremost were the circumstances of the disaster themselves – a major seismic event occurred in close proximity to the shoddily constructed capital city of the country, resulting in 230,000 deaths, hundreds of thousands of injuries, the literal (not to mention the functional) collapse of the government, and the abrupt end of whatever semblance of ‘normal’ life had previously existed. Major population movements both away from and towards the shattered city were impossible to track. Whatever health care facilities remained standing were absurdly and obscenely overcrowded, under-staffed, and inadequately supplied. 
Two things from the negative side of the ledger are also worth mentioning. The descent upon Haiti of hundreds of groups and thousands of people coming to ostensibly provide assistance to the beleaguered population had the undesirable effect of contributing to the chaos. While many of those who arrived were motivated by a laudable generosity of spirit, a selfless desire to help the unfortunate, and even, in many instances, a desire to put appropriate skills to good use, the inexperience of many of these newly-created “NGOs” slowed the ability of experts in international disaster relief to get organized, to rationally order priorities, and to provide appropriate supplies to the places that needed them most. Haiti – a country whose health services were already dominated by the presence of NGOs, both large and small, both competent and other – was newly deluged with groups from around the world. It is not clear why, in situations where one of the most important commodities is the good judgment that comes from long and hard-earned experience, the early days of large relief scenes tend to be dominated by the presence of young, idealistic, disaster ‘rookies’. If these people were working under the aegis of experienced organizations they could make a major contribution in both the present and the future; many, however, come either unattached or under the banner of NGOs that have formed overnight, that are under-resourced and under-equipped, and that have not taken the time to carefully consider whether or not they can actually make a useful contribution. Over 350 organizations were registered in the official “health cluster” – the coordinating mechanism of the UN relief operation – far too many to allow for the dissemination of any but the most superficial information. There are times, I find, when the most appropriate answer to the frequently posed question “we just got here last night – where can we go to help?” is blunt: “home”. Emergency relief, especially in the health sector, needs to become a more exclusive business, more the domain of experts than of volunteers. When so many lives depend on an efficiently operating system and when skilled personnel with adequate support are at a premium, some sort of licensing or certification should be required by the authorities. But no such system is in place and emergency relief remains, to an excessive degree, a business where amateurs are made welcome.
These included a slew of orthopedic and neurological surgeons who worked under the auspices of the US Department of Health and Human Services, the US Department of Defense, the public and private sectors of many other countries from around the world, a variety of major academic institutions and all of the most professional and experienced NGOs . The medical teams worked heroically, treating patients for injuries that could not have been treated successfully in pre-quake Haiti, given its state of poverty and under-development. But that was the problem. The new level of care that became available within weeks was far higher than what could be maintained. Patients who had suffered serious spinal cord injuries and severe head trauma who might not have survived were it not for the surge of external support, now required long-term rehabilitation and support that was simply not available. Hardly any of the organizations that provided the life-saving interventions were in a position to provide the long-term follow-up that became necessary. In other words, the rush to save lives in the immediate was undertaken (heroically) with insufficient regard for the longer-term consequences. Unfortunately no studies exist that document these consequences. Triage is one of the basic principles of emergency medicine, especially in situations of mass casualties, but based on what I saw, I do not feel it was it was applied well in Haiti. The power to decide who should live and who should die is something no one wants, but is, nevertheless, a function that had to be exercised in the horrible circumstances of post-quake Haiti. Guidelines for the provision of an appropriate level of care should be put in place prior to the next major disaster.
On the bright side, Nigeria, a country with a population greater than 140 million, appears to have made excellent progress in regaining control over paralytic polio. It had previously been the only African country that had not eliminated polio from within its borders, and as a consequence over the last several years, polio viruses spread from Nigeria to several other countries, some of which have not yet brought their polio outbreaks under control. However, the most recent data from Nigeria indicating few recent polio cases means that Nigeria has not only brought its own outbreak under control but also, there is now a lower risk of the spread of polio from Nigeria.
Preliminary results were presented from HIV prevention awareness surveys carried out by the Research Alliance to Control HIV/AIDS (REACH), a multi-year collaboration between Northwestern University (Evanston, IL) and Nigeria’s University of Ibadan. Data from these community studies confirmed the low HTC uptake and identified associated factors such as lower income levels and lower levels of completed schooling. Other factors linked to low HTC uptake included lack of awareness of nearby HTC sites, fear of stigma and fear of having to disclose results to family members and/or sexual partners. The youngest survey respondents, i.e., those 15-17 years old, had HTC rates much lower than older respondents, possibly because they were at lower actual risk of being HIV-infected. Another possible reason for this, though, could be that Nigerian law – requiring parental consent for medical procedures for those under 18 years – had been an obstacle to their seeking HTC. 
Though many themes arose throughout the event, I felt that each topic discussed, each challenge presented, and each lesson extrapolated all revolved around one central question: where does the money go? In fact, Mark Ward mentioned that in the countless interviews he’s participated in, he is asked this question in almost every single one.
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CSIS - We’re here today with Dr. Heidi Larson, Senior Lecturer at the London School for Hygiene and Tropical Medicine, beginning in October, and Executive Director of the aids2301 Project. Dr. Larson thank you so much for joining us today. Dr. Larson I’m wondering if you could begin by describing the origins and objectives of the aids2031 Project?
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