More than 1.5 mn children to be immunised against Japanese encephalitis in Lao PDR with GAVI support

First Gavi-funded doses will enable Lao PDR to complete national JE campaign against mosquito-borne disease

Lao PDR became the first country to use support from Gavi, the Vaccine Alliance to protect its children from Japanese encephalitis. The first doses of the vaccine to be funded by Gavi were given to children at an event held in the country’s capital, Vientiane.

Support from the Vaccine Alliance will initially enable Lao PDR to complete a nationwide campaign against the disease, which is spread by mosquitoes and can result in severe disability and death, by reaching more than 1.5 million children over one and under 15 years of age. From 2016, the country will use national funding to introduce the JE vaccine into its routine immunisation schedule. This means that all children born in Lao PDR will receive the vaccine at nine months old alongside other childhood vaccines.

Lao PDR’s JE campaign marks the first time the Vaccine Alliance has provided funding to enable a country to use a Chinese-manufactured vaccine. This was made possible by the World Health Organization’s decision to pre-qualify the vaccine, produced by Chengdu Institute of Biological Products (CDIBP), in 2013, the first time a Chinese manufacturer had achieved this standard.

The first doses of Gavi-funded JE vaccine were given at an immunisation session held in Vientiane attended by Deputy Prime Minister of Lao PDR H.E Dr Phankham Viphavanh, Gavi deputy CEO Anuradha Gupta, WHO representative in Lao PDR, Dr Juliet Fleischl and UNICEF Representative in Lao PDR, Ms Hongwei Gao.

“Japanese encephalitis takes a terrible toll on its victims,” said Anuradha Gupta. “It has a devastating impact on families who are left helpless as their children often die or are left severely disabled and unable to care for themselves. It is encouraging to see that Lao PDR is taking positive steps to protect its children from the dreadful consequences of JE and I am pleased that Gavi is able to offer its support.”

Juliet Fleischl applauded the Government of Lao PDR for introducing JE vaccine in the country. “Protecting the children of Lao PDR from this vaccine-preventable disease for which no specific treatment is available is another step forward towards attaining the MDG4,” she said. Fleischl also reiterated that WHO will work with the Ministry of Health so that the benefit reaches all sections of the community and thereby ensuring equity in service delivery.

“UNICEF would like to acknowledge Lao PDR’s commitment to children through this large scale immunisation campaign,” said Hongwei Gao, UNICEF Representative in Lao PDR. “UNICEF is very pleased to be part of this great collaborative effort by providing technical and procurement services for logistics and vaccines that will reach children living in remote and hard to reach areas.”

WHO estimates that around three billion people living in Asia are at risk of JE, with 24 countries in the South-East Asia and Western Pacific regions considered to have endemic transmission. Children are at the highest risk of JE as most adults build up natural immunity following childhood infection.

There is no cure for JE so treatment is focused on supporting the patient to overcome the infection and management of complications.

Although most JE infections have only minor symptoms, approximately 1 in 250 results in severe disease which is evident through high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and – in approximately 30 per cent of such cases – death

The most recent review of data on JE cases shows that there are almost 70,000 clinical JE cases globally each year, leading to around 20,000 deaths.

Of those who survive severe JE, 20-30 per cent suffer permanent intellectual, behavioural or neurological problems such as paralysis, recurrent seizures or the inability to speak.

The use of a Gavi-funded JE vaccine marks a significant achievement for CDIBP and a number of global health partners, including Gavi, PATH and the Bill & Melinda Gates Foundation, aiming to support a low-cost, effective vaccine against JE.

Following a severe JE outbreak in 2005 which killed nearly 2,000 people in India and Nepal, PATH began evaluating the potential for JE vaccines that were easier to administer and more cost effective than those that were commonly used. Their research found that CDIBP already had a safe, effective and affordable vaccine that had been given to almost 200 million people in China.

PATH collaborated with the manufacturer, WHO, and ministries of health on clinical trials to add to a growing collection of data documenting the safety and efficacy of the vaccine. Also, because the vaccine needed to be affordable for use in low-income countries, a special, public health-sector price was negotiated with CDIBP.

PATH also helped CDIBP achieve WHO pre-qualification, a critical milestone that provides at-risk developing countries with greater access to the vaccine. Both the vaccine and CDIBP underwent rigorous inspections to ensure they met international standards of quality, safety, and efficacy. CDIBP received technical and financial support to meet these standards, which included the design and financing of a new manufacturing facility to ensure high-quality, adequate, stable, and affordable vaccine supply.

“For years, PATH and its partners have been laying the groundwork to help countries plan for introduction and now scale up of JE vaccination to protect vulnerable children from the deadly disease,” said Dr Kathleen Neuzil, Director of PATH’s Vaccine Access and Delivery Global Programme. “These efforts to expand the vaccine’s reach and ensure sustainable, quality supply have helped vaccinate an estimated 221 million children throughout the JE endemic region. Now, with Gavi’s help in expanding vaccine support, we can reach millions more.”

Last year, through PATH’s support and funding from Microsoft, Lao PDR forged ahead to launch JE immunisation campaigns in two new provinces, with the goal of reaching 170,000 children in two weeks.

Following the WHO’s decision to approve the vaccine for global use, Gavi was able to make funding available for countries at risk of JE. So far two countries, Lao PDR and Cambodia, have been approved to receive Gavi support for JE vaccine.

Gavi’s support for Lao PDR’s JE campaign means that Vaccine Alliance is now funding vaccine programmes covering 15 antigens. Since 2000, Gavi has supported the world’s poorest countries to immunise an additional half a billion children, helping save seven million lives.