Boosting child vaccines across the world
Vaccination is at a crossroads in the developing world, delegates were told at the recent International Paediatric Association congress in Johannesburg, South Africa.
It is the first time ever that this annual congress has been held in a sub-saharan country.
Although Johannesburg no longer echoes to the sound of vuvuzuelas, the football legacy is everywhere and there is a tangible feeling that the success of an African world cup means nothing is now impossible.
Vaccines are a key plank in meeting Millennium Development Goal 4 - to reduce child mortality by two thirds by 2015 - and many sessions at the congress were devoted to them.
Newer vaccines, such as those for rota virus and pneumococcus, are one way to reach the target.
"They could potentially prevent 40% of deaths from diarrhoeal disease and pneumonia," says Jane Schaller, a Canadian paediatrician and executive director of the IPA.
"But vaccines alone don't prevent disease, immunisation does," she points out.
It is about getting the basics right first, she says.
"In some countries less than 40% of children in some areas are vaccinated.
"That's not acceptable."
Logistics, infrastructure and political will are critical challenges in delivery of vaccines.
A cornerstone of the expanded programme on immunisation (EPI), started by WHO in 1974, which aims to get all the world's children vaccinated with the basic vaccines, is the pentavalent vaccine, a five in one shot containing tetanus, diphtheria, pertussis, hepatitis B and Haemophilus influenzae type B vaccine (Hib).
At the Congress, one manufacturer announced their intention to develop the use of Uniject for this vaccine.
Developed over 20 years ago by the non-profit organisation PATH, Uniject is a small bubble of plastic attached to a needle which can be used only once.
It is factory-filled with vaccine and can be used by health workers with less than two hours training, which potentially brings immunisation to areas currently without medical help.
A technical advance has made this possible - previously it had to be mixed on site.
Fewer steps mean less error and less elements to transport. Uniject is already widely used for hepatitis B vaccine in Asia.
One of its most important features is that it avoids waste, which is becoming a major issue.
Simona Zipursky works with Project Optimise, a WHO collaboration with PATH developing immunisation systems for tomorrow's world.
"Vaccination is at a crossroads in developing countries.
"Systems for delivering vaccines were developed in the mid-70s for vaccines which were cheap and packaged many doses to a vial.
"We could tolerate waste, which could reach 50%, if only a few children at a time were immunised from one vial."
"What we are seeing with new vaccines which cost many dollars each is that waste can no longer be tolerated so they are packaged in single dose presentations which means a much greater impact on the cold chain that transports them."
One striking example she gives is that a traditional fridge could easily hold 4,000 doses of traditional vaccines in multi-dose vials but would now hold just 600 doses of the newer vaccines.
"The answer is not to buy seven more fridges for each clinic.
"The answer is to improve our systems and packaging to better suit the needs of countries."
Health Check, Monday 16th August.