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FORUMAlliance Expands Global Vaccine Effort
One of the challenges post- 9/11 is remembering all the priorities we had on September 10, both personal goals and public issues of widespread importance. One of these concerns is the burden of disease in developing countries and how investments in the health of a population are intimately connected to overall social and economic development. Prior to the terrorist attacks, the global public health community, in partnership with the public and private sectors, had been making great strides with new and reinvigorated approaches to deadly diseases. The special United Nations session during the summer of 2001 highlighted the threat of AIDS and called for renewed support, financial and political. Despite the causes competing for our collective attention today, it is important that the momentum of the past several years be sustained. Preventing the PreventableWhile the exact relationship between health and wealth is the subject of debate, the fact remains that poorer countries tend to have a greater burden of disease than wealthier countries, especially infectious disease. Nowhere is this gap more evident than in the case of vaccine-preventable illnesses. Each year, there are 3 million totally preventable child deaths, due to diseases for which vaccines exist and have existed for years. Polio, diphtheria, pertussis, measles, tetanus, Haemophilus influenzae type b (Hib), hepatitis B, and yellow fever are all vaccine-preventable and, in most cases, the vaccines cost only pennies a dose.The World Health Organization, through the Expanded Programme on Immunization (EPI) and the former Children's Vaccine Initiative (CVI), has worked to get vaccines to all children in the world through a complex immunization network. This system, supported by the "cold chain"--an organizational coup that allows health workers to transport refrigerated vaccines from the manufacturing plant to rural villages--has worked for years and succeeded in vaccinating millions of children. But it cannot reach all of them. According to the WHO, one child in four is still not receiving routine immunization with the six basic vaccines against polio, diphtheria, whooping cough, tetanus, measles, and tuberculosis. Globally, immunization levels for children under 5 have hovered around 80 percent and, in recent years, have actually declined. The Global AllianceLimited financial resources, while critical, are not the only factor to blame. Lack of immunization structure (including infrastructure and workforce) and, in many areas, an unwillingness to choose health over other spending priorities have hampered efforts to bridge the gap between the developing and developed worlds.One innovative approach to the problem is the Global Alliance for Vaccines and Immunization (GAVI), launched in 1999 by the Bill and Melinda Gates Foundation with a contribution of $750 million. There are four renewable GAVI members: WHO, UNICEF, the World Bank, and the Gates Foundation, and eleven additional, rotating members who are responsible for representing the collective expertise and perspective of their constituencies. GAVI administers a global fund, dubbed the Vaccine Fund, which provides financial resources to countries for their immunization programs. Since its inception, government contributions have raised the Vaccine Fund's resources to $1 billion for the 2001-2005 period. GAVI aims to improve access to sustainable immunization services; expand the use of all existing, safe, and cost-effective vaccines in areas where they address a public health problem; accelerate the development and introduction of new vaccines and R & D efforts for vaccines geared toward developing countries; and make immunization coverage a centerpiece in international development efforts. Countries who seek the support of GAVI and the Vaccine Fund must go through a rigorous application process, meant to ensure that the requisite political will, commitment, and health infrastructure are present. The Vaccine Fund provides resources directly to national governments and seeks to demonstrate to manufacturers that a developing-country market exists for newer vaccines. Widespread perception of the lack of a market in the developing world has been widely cited as a major obstacle to investment by the pharmaceutical industry in therapies for diseases that primarily affect developing countries. Since the Vaccine Fund's inception, of the 74 eligible countries, 52 have received awards, totaling more than $600 million in commitments to national immunization programs. GAVI's reliance on the expertise and commitment of partners on all levels, and its focus on sustainability after its relationship with each country has ended, is a model for other global efforts. --Erica Seiguer, a third-year MD-PhD student at HMS
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The Second-year Show: "Viva Las Vagus"It is a yearly tribute to the characters of the HMS landscape, and this year's second-year show, "Viva Las Vagus: the Angina Monologues," marked the 100th anniversary of this long-standing showpiece.
HMS professor Julian Seifter (with bottle, portrayed by Mike Powell) and associate professor Richard Schwartzstein (portrayed by Suzanne Miller) lead their team of mismatched female football players to victory. Photo by Steve Gilbert As centennial celebrations go, this one was hardly typical. Directed by Chris Boulton, Lori Coburn, Loretta Erhunmwunsee, and Sabrina Vineberg, the cast and crew included many members of the second-year class. The dancing was nearly nonstop; the music was varied and, for the most part, beautifully adapted; and the acting was, well, over the top since second-years, preferring to memorize, practice, and study anything but Human Systems I, put their all into the performance while occasionally baring all for the audience of faculty, staff, and wide-eyed first-years. The result of the 14-hour rehearsals, numerous weeks of rewrites and readjustments, and more than a few moments of high-pitched emotion paid off on opening night when the show played at MassArt to a packed house. "Below the belt" would be the best way to describe the insults, jokes, and puns throughout the three-and-a-half-hour production. But in the time-honored fashion of HMS and other sadomasochistic societies, those pelted the most left the theater the most satisfied with the show's hilarious portrayal of the best and worst of HMS. The breadth of the production, considering the other demands on student time (classes, significant others, sleep) was impressive. Well choreographed and costumed dance numbers dominated every scene and almost every moment between scenes. The orchestra did a beautiful job, and the overworked and incredibly dedicated technical staff proved their mettle throughout the production. No genre was spared by the show's effort to alter great works from Beethoven, ABBA, Cypress Hill, and more for the pleasure of all in the audience and the roasting of the HMS faculty and staff. The now century-old mockery makes play out of the work at HMS--and a heck of a play it was. --Tarayn Grizzard, a second-year medical student at HMS |
