The Accelerated Rollout of Pneumococcal Conjugate Vaccine: Its Impact on Health and Global Equity Meghan L Stack1 & Orin S Levine1 1 InternaJonal Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health METHODS •  Data on country demographics, disease burden, vaccine introduc)on status, projected introduc)on dates, and infants with access were gathered from the Vaccine InformaJon Management System (VIMS), a database maintained by IVAC at Johns Hopkins University.1 T o l e a r n m o r e a b o u t V I M S v i s i t hVp://www.jhsph.edu/ivac/vims.html •  PCV acceleraJon was measured as the difference in infants with access to Hib vaccine over the first 20 years of use and infants with access to PCV over the first 20 years its use (projected aMer 2011). •  Mortality impact from PCV accelera)on was es)mated using the number of deaths averted per 1,000 infants fully vaccinated modeled by the Lives Saved Tool (LiST)2 and applied to the number of addi)onal children with access compared to Hib vaccine rollout. Equity of AcceleraJon Figure 3 compares the rela)onship among vaccine introduc)on status, GNI, mortality risk and crude number of deaths due to Hib (red) and SP (blue) for all countries. Bubbles that are filled in represent countries that introduced the vaccine less than 16 years aMer it became available. Countries with lower GNI per capita and higher disease burden introduced PCV sooner than Hib vaccine, reducing global disease faster. FIGURE 3 AcceleraJng Access to the Most Vulnerable 1000
450
400
SP Mortality Rate per 100,000
Historically, it takes approximately 15 years for new, life-­‐saving vaccines to reach low income countries where they are oMen needed the most. Recently, new financing mechanisms such as the GAVI Alliance and the Advanced Market Commitment (AMC) for pneumococcal conjugate vaccines (PCV) have helped low-­‐income countries overcome financial barriers to the uptake of new vaccines. In this project, we compare the rate of introduc)on and distribu)on of Hib vaccine and PCV to demonstrate the poten)al health impact of accelerated PCV introduc)on and lessons for the rollout of future vaccines. In the first 20 years of use, 887 million infants are projected to gain access to PCV. In contrast, only 418 million infants had access to Hib vaccine during its first 20 years. The difference is shown in Figure 2. Vaccina)ng 469 million more infants against pneumococcal disease has the poten)al to avert 2 million child deaths over the next decade.2 Hib Mortality Rate per 100,000
INTRODUCTION 350
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Hib 15 years
Hib Not Introduced
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-200
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PCV 15 years
Not Introduced
RESULTS Size of bubble indicates number of deaths due to disease in each country(2000) Projec)ons of PCV introduc)on were used for years 2012-­‐2015 Accelerated IntroducJon of PCV Figure 4 shows the rate of PCV introduc)on by income group. It projects GAVI countries, generally with the highest disease burden, soon surpassing middle-­‐income countries in level of introduc)on. FIGURE 1 FIGURE 4 100% 80% Rate of PCV IntroducJon: Middle income countries are being leY behind 7 years 60% 10 years 40% 80% 60% 20% 40% 0% 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Year since first global introducJon (1982 for HepB, 1989 for Hib, 2000 for PCV) PCV Hib 22 HepB As seen in Figure 1, the accelerated rollout allowed PCV to reach 50% of low-­‐income countries 10 years faster than the Hepa))s B vaccine and be introduced in 70% of low-­‐income countries seven years faster than Hib vaccine. Impact of AcceleraJon FIGURE 2 Global Impact of Accelerated IntroducJon 120 100 80 60 40 20 -­‐ 7 8 9 10 11 12 13 14 15 16 17 18 19 Year since first global introducJon (1989 for Hib, 2000 for PCV) PCV Hib Infants with access to vaccine annually Millions 100% Percentage of countries universally introduced PCV Percentage of LIC that have introduced the vaccine The AcceleraJon of New Vaccine IntroducJon in Low-­‐Income Countries 469 million addiJonal vaccinated infants 20 By accelera)ng introduc)on to PCV over the historical trend of Hib vaccine introduc)on, 469 million more infants may be vaccinated. 20% 0% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 PCV HIC Year since first introducJon (2000) PCV UMIC nonGAVI PCV LMIC nonGAVI PCV GAVI Note: Limited projec)ons are available for PCV introduc)on in HIC, and non-­‐GAVI UMIC, LMIC CONCLUSION •  The use of financing mechanisms have helped to bring life-­‐saving pneumococcal conjugate vaccine to countries with the highest burden of disease faster than historical precedents. •  As compared with Hib, the accelera)on of PCV introducJon in low-­‐ & middle-­‐ income countries is projected to save over 2 million addiJonal lives by vaccina)ng an addi)onal 469 million children. •  Financing or distribuJon methods that provide the most vulnerable popula)ons, wherever they live, with vaccines first would greatly increase global equity and have a much faster impact on global disease reduc)on. REFERENCES 1 IVAC, Johns Hopkins Bloomberg School of Public Health. Vaccine Informa)on Management System (VIMS) hVp://www.jhsph.edu/ivac/vims.html. Accessed February, 2012. 2 Lives Saved Tool (LiST), Johns Hopkins Bloomberg School of Public Health. October, 2011. Available at: hVp://www.jhsph.edu/dept/ih/IIP/list/index.html © Interna)onal Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health 2012 Al Rights Reserved