Copyright 2000 Federal News Service, Inc.
Federal News Service
April 12, 2000, Wednesday
SECTION: PREPARED TESTIMONY
LENGTH: 1461 words
HEADLINE:
PREPARED TESTIMONY OF WILLIAM FOEGE MD, MPH PROFESSOR OF INTERNATIONAL HEALTH,
EMORY UNIVERSITY AND ADVISOR, THE BILL AND MELINDA GATES FOUNDATION
BEFORE THE SENATE COMMITTEE ON APPROPRIATIONS
BODY:
THE PROBLEM
Only 15 years ago,
the single most lethal agent in the world was the measles virus, killing some 3
million children a year. The use of measles vaccine has reduced that toll by
about 2/3, demonstrating the power and potential of vaccines. On the other hand,
the promise has obviously been unrealized when a million children still die each
year because of a disease like measles that could easily be prevented by an
inexpensive vaccine.
The world loses a million children a month because
of simple disease problems, and a quarter of them could be saved by the use of
vaccines already available. The world made great progress from 1985 to 1990,
increasing global coverage for six basic vaccines from about 15% to a high of
80%. Since then, the gap between potential lives saved and actual lives saved,
has widened for two reasons. The immunization infrastructure has weakened with
falling immunization rates, especially in Africa. Second, there has been an
increase in the number of effective vaccines available, but this new generation
of vaccines has been unavailable to poor countries. THE SCIENCE
The 20th
century saw a remarkable explosion of medical science. Some is expensive and
difficult to use widely. Vaccines on the other hand are relatively inexpensive
and easy to use anyplace. While many diseases, such as heart disease, cancer,
malaria and tuberculosis, require a multi-factorial approach, for many of the
vaccine preventable diseases the vaccine is a sufficient tool, unto itself, to
prevent suffering and death. Unlike antibiotics, microorganisms, to date, have
not developed resistance to vaccines. The vaccine has to be perfected only once
in the history of the world. In addition, a single encounter with the vaccine,
or a series of encounters, will provide life-long immunity. And often, as in the
case of smallpox, polio and measles, the genius of mass production at
pharmaceutical companies has made the vaccine available for pennies, rather than
dollars, for each child. Vaccines are remarkable and powerful inventions; they
are also underutilized. Even though underused, immunization programs provide the
backbone of public health programs around the world. Immunization is frequently
the only asset that a program has to offer. Immunization requires the
development of all components of public health, from surveillance, to a
logistics system, health education, delivery programs, and evaluation.
Therefore, immunization programs provide valuable experience for the development
of other public health programs. Finally, it should be noted that if the public
health program of a country cannot deliver vaccines it is unlikely to be able to
deliver other benefits.
RESULTS
In 1966, the World Health
Assembly resolved to use the gift of smallpox vaccine, to rid the world of the
disease forever. A coordinated effort, with strong leadership from the United
States, led to the last case of smallpox 11 years later. It is now over 20 years
since that last case, completing the prediction of Thomas Jefferson, in 1806, in
a letter to Edward Jenner. Jefferson wrote, "Future generations will know by
history only that this loathsome disease has existed." The United States
investment in smallpox eradication is recovered by this country every 3 months
and our annual savings exceed our dues to the World Health Organization. This
would be true even if the United States consistently honored its obligation to
pay its dues! We are pleased by the elimination of suffering and death that has
resulted, but it should also be apparent that disease control programs represent
a strong investment opportunity. The monetary returns exceed the investment.
While measles, pertussis, diphtheria and tetanus rates have all
declined; the exciting prospect of eliminating polio from the world is currently
receiving great attention. Once again, it will be possible to provide a gift to
the future so that, "Future generations will know by history only that this
loathsome disease has existed."
THE FUTURE
The current
accomplishments are but a harbinger of what is to come. It is anticipated that
the future will hold new vaccines to counter a host of diseases, including
AIDS, tuberculosis and malaria. Vaccine delivery mechanisms
will improve, first by eliminating the need for refrigeration, and then by
eliminating needles and syringes. Children of the future will receive oral
vaccines or vaccines included in food products such as potatoes or bananas.
Vaccines will be given simultaneously, necessitating fewer contacts with each
child.
THE CURRENT GLOBAL IMMUNIZATION INITIATIVE
WHAT HAS BEEN
DONE? In the past year there has been a revival of interest in immunization. The
Global Alliance for Vaccines and Immunization (GAVI), is the
expression of that interest, having brought to the table global agencies,
industry, bilateral agencies and non-governmental organizations. It provides for
a coordinated effort worldwide and organizes a spectrum of groups around a
shared goal.., the protection of all children through immunization.
Two
windows of opportunity are being pursued initially. First, for countries that
may be poor but have demonstrated the capacity to provide immunization, there is
an effort to provide them with the new generation vaccines now used routinely in
industrialized countries, vaccines such as Hepatitis B and Hemophilus influenza
B. In addition, this effort will include Yellow Fever, a vaccine not needed in
the industrialized countries but underused where needed. Already, 54 of the 74
poorest countries have made application, through UNICEF, for funds to expand the
number of vaccines that they are providing. These applications are being
processed in an attempt to provide resources based on the health needs of
children rather than the politics beyond the control of those children. For this
effort trust fund monies will be provided largely for vaccine purchase.The
second opportunity now being pursued is improvement of the immunization
infrastructure to provide for better coverage of both the traditional and new
generation vaccines. This may be the most difficult, and protracted, of all the
challenges facing GAVI. A country unable to deliver six vaccines is not helped
by having more vaccines, unless the delivery system can be strengthened. The
focus for resource expenditures will be on adequate logistic support but
especially on achieving the best possible outcomes. Supervision, evaluation,
incentives and rewards will be high priorities.
WHAT IS PLANNED? The
highest priority will be given to achieve maximum coverage with the traditional
and the new generation vaccines. When these activities are felt to be
progressing in an adequate fashion, GAVI will be able to focus on research and
development. This will include promotion of new vaccines for diseases of
developing countries, easier delivery methods, better surveillance approaches
and improvements in evaluation techniques.
IMPLICATIONS
The
convergence of many factors makes this the opportune time to provide major
global health improvements. A global coalition in the 1980's demonstrated it was
feasible to organize global immunization programs that could reach most
children. The scientific advances of the past decade have provided new vaccines
and the world is on the threshold of improved delivery systems. The resources
have increased with the attention of Rotary International, the United Nations
Foundation and the Gates Foundation building on the traditional interests of UN,
bilateral and non-governmental organizations. And now there is a global
coalition that includes all of the public and private immunization interests. In
addition, the World Bank and academic economists have made the case that health
is an important causative component of development, that there is a positive
benefit cost ratio to immunization expenditures and that therefore immunization
programs should be viewed as an investment.
CONCLUSION
GAVI is
determined to achieve synergism by combining the efforts of all who wish to
improve immunization. GAVI is also determined to achieve equity with all
children receiving the benefits of vaccines regardless of their social or
geographic residence. Finally, GAVI is determined to accelerate the development
of new vaccines, streamline delivery techniques and demonstrate that it is
possible for the world to organize effectively to improve global health,
specifically to improve global immunization efforts.
The world has never
had so much power to improve the health of children everywhere. The US, because
of its science base, its experience in immunization programs, and its monetary
and public health resources, will be key to the realization of that dream.
Thank you.
END
LOAD-DATE: April 13,
2000 
