Vaccines: Life-Saving Tools

Transforming Development Through Science, Technology & Innovation

Smallpox

Photo: Free Nigeria from smallpox and rabies
As the largest international contributor, USAID and the CDC provided $32 million to worldwide smallpox eradication efforts that ended successfully after only 11 years.x

Smallpox is a contagious disease that is one of the most devastating known to humanity. For centuries, repeated epidemics swept across continents, decimating populations and changing the course of history. Smallpox fatalities numbered in the billions, including an estimated 300 million in the 20th century.i As recently as the late 1960s, there were 10–15 million cases of smallpox a year and more than 2 million deaths.ii In 1967, the World Health Organization (WHO) found that the disease threatened 60% of the world's population, killed one out of four victims, scarred or blinded the majority of survivors, and evaded any treatment solution.iii

Campaign for Global Eradication

When international smallpox eradication efforts began in the 1960s, the disease was still prevalent in over 30 developing countries. In 1966, USAID provided financial assistance to smallpox eradication programs in 20 West and Central African countries, managed by the Centers for Disease Control and Prevention (CDC).iv v These USAID-supported programs achieved rapid success and WHO adapted these interventions to eliminate smallpox in Asia and the rest of Africa.vi One of the activities partially funded by USAID adapted the mechanics behind U.S. military jet injectors for application of the smallpox vaccine (1963), using high pressure rather than a needle to force the vaccine through the skin, and subsequently eliminated the need for electricity to power the device (testing a foot-powered injector in 1965).vii As the largest international contributor, USAID and the CDC provided $32 million to worldwide smallpox eradication efforts that ended successfully after only 11 years.viii

A Smallpox-free World

The last naturally occurring case of smallpox was recorded in Somalia in 1977 and WHO declared the world smallpox-free in 1979.ix USAID lent expertise, funding, and guidance to the eradication process from the outset.

Polio

Photo: Doctor and infant
USAID's initial large-scale financial investment to support polio programs in Latin America and the Caribbean contributed to its eventual eradication in the region.

Polio is a highly infectious, incurable disease caused by a virus, which mainly affects children under the age of 5.xii It primarily afflicts the nervous system, and can lead to complete paralysis in a matter of hours. WHO estimates that one in 200 infections leads to irreversible paralysis (usually in the legs) and becomes fatal in 5 to 10% of those paralyzed due to immobilized breathing muscles. However, also according to WHO, polio vaccination, if given multiple times, can provide lifelong protection for children.xiii

Global Polio Eradication Initiative

Beginning in the mid-1980s, USAID provided $50 million, about one-half of the total donor assistance to polio eradication programs in the Latin America and Caribbean region.xiv Following successful investments in eradicating polio in the Americas from 1988 -1994, in 1996 USAID joined the global Polio Eradication Initiative (PEI), a public-private partnership with international organizations; civil society and governments. PEI eradication strategies include planning and monitoring of national immunization days, surveillance and laboratory analysis of stool samples and communication and social mobilization activities.xv Data from the polio program helps inform decisions regarding routine immunization and identifying immunity gaps in under-served populations. The United States government, with USAID contributing $32 million per year, is currently providing 28% of global funding for polio through USAID and CDC.

A Polio-free Western Hemisphere

By 1994, the Western Hemisphere was certified polio-free, followed by the Western Pacific Region (2000) and the European Region (2002).xvi xvii USAID’s initial large-scale financial investment to support polio programs in Latin America and the Caribbean contributed to eventual eradication of the disease in the region. Polio cases have decreased by over 99% since 1988, from an estimated 350,000 cases in more than 125 endemic countries, to 1997 reported cases in 2006.xviii In 2008, only parts of four countries - Afghanistan, Pakistan, India and Nigeria - remain endemic for the disease.xix In collaboration with WHO and other partners, USAID continues to provide technical and financial assistance to achieve global polio eradication with an estimated $500 million invested to date.

Ensuring Safe Injections

WHO has estimated that at least 16 billion injections are administered in developing and transitional countries every year. Of these injections, approximately 95% are given in curative care, around 3% for immunization, and the remainder for other purposes, including transfusion of blood and blood products and contraceptives. Reuse of unsterilized needles can cause the spread of life-threatening disease. To be completely safe, single-use injection devices must be designed to automatically and irrevocably inactivate after a single cycle of filling and injection.xx The WHO/Expanded Program on Immunization (WHO/EPI) called for the design of such devices in 1987.xxi

Pioneering Single-use Syringes

In response to WHO’s call, in the late 1980s, the USAID-funded HealthTech program, implemented by PATH, developed and introduced low-cost, auto-disable single-injection syringes. One type of auto-disable syringe that was developed through USAID’s funding is known as SoloShot,™ which is fitted with a fixed needle that automatically locks after a single injection. To demonstrate the acceptability and design of the SoloShot™, the device was field tested in Pakistan with USAID funding.xxii

The Immunization Standard

Since the commercial introduction of SoloShot in 1992, 5.4 billion immunizations have been delivered using these syringes by public health programs in more than 40 countries in Africa, Asia, Eastern Europe, and Latin America. United Nations Children’s Fund (UNICEF) now provides only auto-disable syringes to countries requesting disposable syringes, many of which are SoloShot syringes. Auto-disable syringes are now routinely used in immunization programs throughout the world.xxiii

Ensuring Safe Transport and Storage

Vaccines require careful storage and transport to the point of use to avoid harmful heat exposure. In the past, there was no way to detect whether individual vials had been exposed to heat.xx

Vaccine Vial Monitors

The use of VVMs can save money, reduce waste and increase effectiveness of immunization programs worldwide.xxix
The use of VVMs can save money, reduce waste and increase effectiveness of immunization programs worldwide.xxix

In 1985, through the USAID-funded HealthTech project, PATH developed vaccine vial monitors (VVM) by adapting technology from the food industry used to detect heat exposure.xxv A VVM is a label containing a heat sensitive material that is placed on a vaccine vial to register cumulative heat exposure. The combined effects of time and temperature cause the inner square of the VVM to darken, gradually and irreversibly. The use of VVMs can save money, reduce waste and increase effectiveness of immunization programs worldwide.xxvi

Ensuring Quality, Raising Coverage

Since their introduction in 1996, VVMs have helped to ensure that only potent vaccine is used to immunize children and to help manage and improve vaccine distribution. As of 2007, close to 2 billion units of VVMs had been used on WHO prequalified vaccine products.xxvii The presence of VVMs made it possible for WHO to implement the “multi-dose vial policy” that allows health workers to use opened vials of some liquid vaccines for more than one day.xxviii This has markedly reduced vaccine wastage, saving millions of dollars in immunization programs throughout the world.

Last updated: January 14, 2014

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