PNEUMOFOCUS

BULLETIN OF GAVI'S PNEUMOADIP AT JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
PNEUMO ADIP: PNEUMOCOCCAL VACCINES ACCELERATED DEVELOPMENT AND INTRODUCTION PLAN

Volume 1, No. 6 June, 2004
EXECUTIVE DIRECTOR'S NOTE
As you’ll see in this issue, May and June marked the launching of new PneumoADIP initiatives for identifying promising research sites and studies. The deadline for our Small Grants Program is rapidly approaching and more recently, we’ve started a process designed to identify potential sites for large-scale evaluation of pneumococcal vaccine effectiveness. We’re pleased to be able to help enthusiastic South Asian collaborators to link up India and two of its neighbors, Sri Lanka and Nepal, in a surveillance network using common methods. You’ll also hear about a promising initiative called the International Financing Facility (IFF) that could potentially bring billions of additional funds into global immunizations, including funding for accelerated introduction of new vaccines.



Orin Levine
Executive Director
FUNDING INFORMATION
Small Grants Program
PneumoADIP’s first Small Grants Program deadline is June 15th. Please visit us online at www.preventpneumo.org for more information about the program and application procedures.

Solicitation for Potential Asian Field Sites
Our website provides information about PneumoADIP’s request for letters of interest for potential sites in the Asian and Pacific regions to conduct large-scale vaccine evaluations. Brief (4 pages) letters of interest are due September 1st, 2004.
PneumoADIP COMMITS TO PNEUMOCOCCAL DISEASE SURVEILLANCE NETWORK IN SOUTH ASIA
PneumoADIP is nearing completion on an agreement to help local investigators expand an already established disease surveillance network in India to include institutions from neighboring Sri Lanka and Nepal. In addition to establishing this network the project aims to perform a range of surveillance and research activities designed to determine the burden of pneumococcal infections among children in these countries.

The existing Indian network, the Invasive Bacterial Infections Surveillance (IBIS) network, is supported by the Indian Council of Medical Research (ICMR). IBIS includes 7 hospitals from throughout India. PneumoADIP funding will help to link IBIS with an additional 1-4 hospitals in Nepal and Sri Lanka. This expanded surveillance network will be known as the South Asian Pneumococcal Alliance or SAPNA – the Sanskrit word for dream.

PneumoADIP funding will allow IBIS and SAPNA to coordinate their activities as closely as possible to one another and thereby improve the comparability of the data from all the sites in south Asia. Funding will be used to allow clinicians to systematically collect blood and CSF specimens from severely ill children, laboratorians to use optimal methods for isolating S. pneumoniae, Hib, and other bacterial causes of pneumonia and meningitis, and epidemiologists to share high quality data throughout the network.

The outputs of the IBIS/SAPNA network will include information on the number of specimens collected and the characterization of invasive S. pneumoniae isolates by surveillance site, antibiotic resistance and serotype distributions. If successful, SAPNA aims to assess 7,000 blood and CSF cultures in Sri Lanka and almost 10,000 blood and CSF cultures in Nepal over an 18-month surveillance period.

This network would involve one of the largest children’s hospitals in the world and serve an important purpose – shaping a picture of the burden of pneumococcal disease and serotype distribution in one of the world’s most populous areas. This is a crucial step towards accelerating introduction of the pneumococcal conjugate vaccine in South Asia.
PNEUMOCOCCAL CONJUGATE VACCINATION CLOSES RACIAL HEALTH GAP IN USA

May 12, 2004 – Pneumococcal conjugate vaccines may play an important role in reducing racial disparities in invasive pneumococcal disease, according to a study presented in the Journal of the American Medical Association. Dr. Brendan Flannery and his colleagues at the US Centers for Disease Control and Prevention examined data from the Active Bacterial Core Surveillance/Emerging Infections Program Network from pre-vaccine years 1998 and 1999 and compared invasive pneumococcal disease incidence to those of post-vaccine year 2002. They found that although incidence of pneumococcal disease in blacks remained higher vaccine introduction significantly reduced the disparity between whites and blacks.

Health disparities between US non-Hispanic whites and US minorities – especially non-Hispanic blacks – have been at the forefront of the national public health dialogue in the United States lately. In December 2003 the US Agency for Healthcare Research and Quality (AHRQ) released the first National Healthcare Disparities Report which reported on the unequal care received by minorities in the US. The report pointed out the opportunity for improvement if clinicians made vaccinations a priority.

Blacks in the United States have historically had higher rates of pneumococcal disease than whites, and so it made sense that newly available pneumococcal conjugate vaccines could be an important tool in reducing this disparity. The results of Dr. Flannery’s study are impressive: pneumococcal disease incidence for blacks went from 54.9 cases per 100,000 population pre-vaccine to 26.5 after vaccine implementation. For whites rates went from 19.0 cases per 100,000 population to 12.1. By 2002 pneumococcal disease incidence for children under five for all races and ethnicities had already fallen below the Healthy People 2010 targets.

For more information and to read the complete article please see the May 12, 2004 issue of the Journal of the American Medical Association.

THE INTERNATIONAL FINANCING FACILITY:
A Potentially Innovative Solution to Development Financing

The Millennium Development Goals are an ambitious set of eight development goals put forth by the United Nations General Assembly as essential to achieving the Millennium Declaration. The goals are: 1)Eradicate extreme poverty and hunger, 2)Achieve universal primary education, 3)Promote gender equality and empower women, 4)Reduce child mortality, 5)Improve maternal health, 6)Combat HIV/AIDS, malaria, and other diseases, 7)Ensure environmental sustainability, and 8)Develop a global partnership for development. But in order to achieve these goals by the target date of 2015 more money than has ever been pledged before must be spent on development in the upcoming years.

In January 2003, Gordon Brown, the United Kingdom's Chancellor of the Exchequer proposed an innovative solution to this problem now known as the International Financing Facility (IFF). The IFF would act to "frontload" aid - an estimated increase of $50 billion a year is needed - to developing countries in order to meet the MDGs. IFF would accomplish this dramatic funding increase by borrowing through bonds issued in the international capital markets against legally binding long-term commitments made by donors. The IFF would not require the creation of an additional disbursement mechanism; instead, it would distribute resources through existing multilateral and bilateral structures.

A dramatic increase in funding through the IFF would make vast improvements in child health in developing countries possible in a much shorter amount of time than previously feasible. Millennium Development Goal #4, to reduce by two-thirds the mortality rate of children under five, will be difficult to accomplish by 2015 but could be achieved if a true commitment is made by the international community and if resources are used wisely. Currently discussions are underway to use immunizations as a ‘pilot’ for this innovative concept. New vaccines such as the pneumococcal conjugate vaccines will be important tools in achieving these goals, and GAVI’s PneumoADIP is working to assure that pneumococcal vaccines are included in the strategic thinking and planning for an IFF focused on vaccines and immunization.