2014 was an exciting year for the Partnership for Influenza Vaccine Introduction (PIVI) with new partners, expanded geographic reach, and more than 980,000 seasonal flu vaccines provided to high-risk populations, including pregnant women and healthcare workers, in four countries. Much of the growth of the partnership came during the last few months of the year thanks to a generous donation from a new contributing partner, South Korean biopharmaceutical company Green Cross.
The PIVI team at The Task Force for Global Health (TFGH) and the Centers for Disease Control and Prevention (CDC) was introduced to Green Cross by the Pan American Health Organization (PAHO) in early fall 2014. As PIVI stakeholders, PAHO and its Revolving Fund played a key role in facilitating PIVI’s work in Nicaragua earlier in 2014. PAHO learned that Green Cross had doses of seasonal flu vaccine available to donate and connected the TFGH/CDC team to the biopharmaceutical company. Green Cross agreed to provide the doses and become a PIVI contributing partner.
With a new manufacturer on board, the TFGH/CDC team began working to identify two low- or middle-income countries who would be able to use the Green Cross vaccine prior to the start of the Northern Hemisphere flu season. Because of the short timeline between securing the donation from Green Cross (October) and getting the vaccine into arms before the start of the flu season (December/January), the focus was on selecting countries that had existing seasonal influenza vaccination campaigns. Countries with existing vaccination campaign infrastructure are equipped to effectively accept, manage, and distribute the vaccine. Working closely with the World Health Organization (WHO), CDC recommended Morocco and Armenia as countries interested in expanding their limited seasonal influenza vaccine use to provide greater coverage for high-risk populations.
When approached with the opportunity, the Ministries of Health of Morocco and Armenia were eager to join the partnership. According to the WHO, respiratory disease was the third leading cause of death in lower-middle income countries worldwide in 2012.* In Morocco and Armenia, both classified by the World Bank as lower-middle income countries, the most recent death rates for respiratory infections were 25.7 and 33.9 per 100,000 respectively.** As a result, the contribution of more than 183,000 doses of Green Cross flu vaccine provided a welcome boost to both countries’ existing efforts to combat seasonal influenza.
With the country partners selected, it was time to arrange for transport: the vaccine doses were stored in South Korea and needed to arrive in Morocco and Armenia as soon as possible in order to be administered prior to the start of the upcoming flu season. As the PIVI team at TFGH worked with Green Cross to coordinate the logistics for the vaccine shipments (consisting of 123,310 doses for Morocco and 60,000 doses for Armenia), the PIVI team at CDC worked with the Ministries of Health in Morocco and Armenia as well as their respective WHO Regional Offices to confirm each country’s cold chain capabilities and review their plans for vaccine distribution.
The WHO’s Strategic Advisory Group of Experts’ (SAGE) recommends focusing influenza vaccination on five high-risk groups in particular: pregnant women, healthcare workers, children, the elderly, and those with underlying health conditions (e.g. diabetes). Both Morocco and Armenia had these groups in mind when planning for the distribution of the Green Cross vaccine. The Ministry of Health (MoH) in Morocco partnered with a number of nongovernmental organizations to leverage World Diabetes Day (November 14) programming. As a result, the MoH was able to vaccinate a large number of people with diabetes who were already gathered for diabetes-related health testing and education. The Moroccan MoH also vaccinated healthcare workers, elderly people, and medical and nursing students. For some of the students, this provided the opportunity to be vaccinated themselves as well as to practice giving vaccinations.
The MoH in Armenia focused vaccination efforts on pregnant women, children in orphanages, intensive care unit patients, elderly people, and military personnel. Given that the MoH in Armenia received their shipments of Green Cross vaccine in mid-December and had only a few short weeks to distribute the vaccine before the flu season began, they chose to focus on the military, with its solid infrastructure and communication channels. This was an excellent way to ensure the most effective distribution of the vaccine in a short period of time.
Despite the tight timeline – just a few short months between learning of availability of the vaccine to putting in place an effective vaccination campaign – both Morocco and Armenia were able to successfully utilize the vaccine from Green Cross prior to the start of the flu season. And those were not the only country partners to benefit from the generosity of PIVI contributing partners in 2014. Thanks to contributions of vaccine, ancillary supplies, and funds from Walgreens, ASD Healthcare, bioCSL, and Becton, Dickinson and Company, PIVI was able to provide a combined total of nearly 800,000 doses of seasonal flu vaccine to Laos and Nicaragua. In the three years PIVI has been facilitating influenza vaccine contributions, more than 1.54 million doses have been distributed to the country partners. More details from Morocco and Armenia, as well as an update on the 2014 contributions to Laos and Nicaragua, will be available in the coming months as PIVI continues to work with each country’s MoH to evaluate their respective vaccination campaigns.
*WHO Fact Sheet, The Top 10 causes of death: The 10 leading causes of death by country income group (2012); retrieved from http://www.who.int/mediacentre/factsheets/fs310/en/index1.html
**WHO Estimated Total Deaths (‘000), by cause, sex, and WHO Member State, 2008(a); retrieved from http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/