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Chapter 27 : Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries

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Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, Page 1 of 2

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Abstract:

This chapter reviews some of the specific challenges to the introduction of pneumococcal conjugate vaccines into the developing world and ways in which these challenges may be met. In many developing countries, the epidemiology of pneumococcal disease differs from that in industrialized countries in ways that may influence both the uptake of the vaccine and the overall health impact of its widespread use. Coincidental malaria is likely to be more of a problem for programs that aim to vaccinate older children (e.g., catch-up campaigns). In areas where malaria is seasonal, it would be prudent to conduct any catch-up campaigns outside of the period of maximum malaria transmission to avoid this potential effect. Malnutrition, low birth-weight, and anemia may be anticipated to diminish the immune response to pneumococcal conjugate vaccines. The introduction of new vaccines, such as pneumococcal conjugate vaccine, provides opportunities as well as challenges for the immunization and health systems. Innovative mechanisms of financing like the Advance Market Commitment (AMC) show the ability of vaccines to generate this kind of change. Success will require continued efforts to increase the value assigned to vaccines by donors, developing countries, and individual citizens so that people and governments are prepared for prices of dollars, not pennies, per dose.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27

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Figures

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Figure 1

Projected number of pneumonia deaths among children less than 5 years old. Projections are for the year 2005 and are based on WHO estimates published in reference . The size of each circle corresponds to the projected number of child pneumonia deaths in that country.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
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Figure 2

Net storage volumes of vaccines per child. Calculations were provided by Souleymane Kone, WHO, Geneva, Switzerland. Rota, rotavirus vaccine; PCV-7, seven-valent pneumococcal conjugate vaccine; penta, pentavalent vaccine; DTP, diphtheria-tetanus-pertussis vaccine; Hep B, hepatitis B vaccine; Hib mon, monovalent Hib; TV, tetanus vaccines; BCG, BCG; OPV, oral polio vaccine; TT, tetanus toxoid; YF, yellow fever vaccine; pneumo, pneumococcal vaccine.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
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Figure 3

Without active management, supply and demand forces can lead to challenges in obtaining affordable, sustainable vaccine supplies for developing countries.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
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Figure 4

Prevention of pneumococcal disease occurs when willingness of donors, countries, and suppliers overlaps.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
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Figure 5

Impact of accelerating pneumococcal vaccine introduction on child mortality in GAVI countries.

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
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References

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Tables

Generic image for table
Table 1

Summary of tested vaccines and vaccines under development

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
Generic image for table
Table 2

Factors that influence the uptake and impact of pneumococcal vaccines in low- and middle-income countries

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27
Generic image for table
Table 3

Proportion of IPD serotypes included in leading vaccine formulations, by region (based on data available between 1980 and 1999)

Citation: Levine O, Greenwood B. 2008. Opportunities and Challenges for Pneumococcal Conjugate Vaccines in Low- and Middle-Income Countries, p 405-418. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch27

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