China immunizes 11.1 million
children against Hep B
Since 2002, China
has immunized 11.1 million children in the country's poorest and most remote
western and central provinces against hepatitis B, reducing their risk of
developing a deadly and common liver cancer, according to an announcement made
by the Chinese government and the GAVI Alliance.
The boost in immunizations in China represents a 60 percent
increase in hepatitis B vaccine doses delivered to children in target provinces.
The children reached include newborns, who receive a “birth dose” of vaccine
plus two more doses at one and six months of age, as well as previously
unvaccinated children under five, who must also receive a full three-dose
vaccine series, according to a release from GAVI.
“Our goal is to protect all the babies at birth from this
virus,” said the Chinese minister of health, Gao Qiang. “The China-GAVI
hepatitis B Immunization Project has propelled us forward on this path, covering
one-third of all children born in China since the project began in 2002.”
According to an estimate based on a 1992 national hepatitis
epidemiological survey, 120 million people in China are chronically infected
with hepatitis B (HepB). Those infected are at risk of liver cancer or failure,
and can spread the disease to others. In the western provinces, the campaign,
with technical guidance from the World Health Organization (WHO) and UNICEF, has
reached almost 70 percent of newborns with a birth dose of vaccine in 2005, up
from 47 percent in 2002. Newborns are a key target of the effort, since
vaccination within the first 24 hours of life is the only way to protect an
infant from transfer of virus from an infected mother.
Since its inception, the campaign has averted over 200,000
future deaths due to the chronic consequences of hepatitis B, mainly from cancer
of the liver and cirrhosis. Death typically comes decades after children are
exposed to the virus during childbirth or in their first years of life.
The breakthrough is the result of a five-year $76 million
project, co-funded equally by the government of China and the GAVI Alliance
(formerly the Global Alliance for Vaccines and Immunization). Known as the China
Ministry of Health/GAVI hepatitis B Vaccination Project, the GAVI-supported
campaign has targeted newborns and children under five across an area that
encompasses 470 million people, including six million newborns every year. It
has reached babies born in hospitals, as well as those born at home in mountain
villages or in the tents of nomadic herders on the vast steppes.
“This breakthrough was 20 years in the making,” said
Julian Lob-Levyt, executive secretary of the GAVI Alliance. “That is how long
children in the industrialized world have had a vaccine to fight this virus,
but, until recently, progress in emerging countries and poor remote areas, such
as western China, had been painfully slow. China's success is a model for
other countries still struggling to stop the spread of the hepatitis B virus and
other vaccine-preventable diseases.”
According to preliminary data, provincial governments have
added to the funds provided by GAVI and the central government, contributing
more than $10 million in co-payments. Lob-Levyt noted as well that the support
of the World Health Organization (WHO) and UNICEF has been critical.
“Worldwide, GAVI's support has made it possible to immunize 90 million
children against hepatitis B and avert an estimated 1.4 million deaths from this
disease alone,” he added.
Homegrown vaccine and dedicated partners
Progress in China has been the
result of national commitment to control this disease; strong partnerships; new
national laws; and a homegrown vaccine industry able to supply the huge
quantities of vaccine needed.
The government of China and the GAVI Alliance embarked on
the five-year project in 2002, with the goal of reaching 75 percent of newborns
with a birth dose of vaccine and 85 percent of children under the age of 12
months with all three doses of Hep B vaccine necessary to prevent infection.
GAVI financial support was used to purchase and distribute 55.39 million doses
of hepatitis B vaccine and 145.6 million safe, auto-disable (AD) syringes. That
financial support was also designed to catalyze national action and sustained
commitment to Hep B vaccination in China.
In 2002 the Chinese national government added hepatitis B
to all routine childhood immunizations (known as EPI vaccines). Then, in March
2005, it passed a new regulation stating that all EPI vaccines be given at no
cost to parents. The ministry of health also designated hepatitis B as one of
four high priority diseases for national control and developed a national
hepatitis B control plan for 2006-2010, with the goal of reducing to less than
one percent the proportion of children under the age of five who are carriers of
the hepatitis B surface antigen.
The Chinese vaccine industry, which has produced Hep B
vaccines since the 1980s and had a licensed vaccine since 1990, was also
prepared to scale up. The GAVI-supported project used this vaccine, purchased
through a national bid and tender process with international observers.
Success has also been bolstered by China's Safe
Motherhood Initiative, which urges mothers to give birth in hospitals. In
addition, unprecedented cooperation between grassroots vaccination staff and
child and maternal health staff in hospitals has fostered the approach of
“whoever delivers the infant should give the immunization.”
As a result, today more than 90 percent of the babies in
the project area hospitals receive their birth dose of hepatitis B vaccine on
time-within 24 hours of delivery.
The biggest challenges remain reaching babies born at home
in the most remote rural areas. Efforts to scale-up immunization there include
increased coordination between village doctors, vaccinators, midwives and
mothers, as well as regular vaccine deliveries to remote areas.