Key Facts
Created in 1999 and formally launched in January 2000, Gavi, the Vaccine Alliance (Gavi) is an independent public-private partnership and multilateral funding mechanism that aims to save lives and protect peoples health by increasing coverage and equitable and sustainable use of vaccines. Gavis main activities include supporting low- and middle-income countries access to new and underused vaccines for vulnerable children through financial support, technical expertise, and market-shaping efforts, such as negotiating with manufacturers, to help lower the cost of procuring vaccines. Gavi operates in five-year funding cycles, with a revised strategy and goals for each cycle. Each five-year strategy is accompanied by a vaccine investment strategy, which determines which vaccines will be made available to countries.
Gavis current five-year strategy, for the 2021-2025 period, which is its fifth strategy, includes four core goals:
1. introduce and scale-up vaccines,
2. strengthen health systems to increase equity in immunization,
3. improve sustainability of immunization programs, and
4. ensure healthy markets for vaccines and related products.
The current strategy emphasizes reducing the number of zero-dose children with the goal of reaching no zero-dose children by 2030; prioritizing programmatic and financial sustainability of country immunization programs; supporting countries that have phased out of Gavi support or have never been eligible for Gavi support; and providing more tailored approaches for Gavi countries to reach under-vaccinated populations, such as those living in remote or conflict settings, by encouraging countries to adopt strategies that reduce potential barriers to vaccination. Gavi is currently in the process of developing its sixth strategy.
In addition to Gavis role in routine childhood immunizations, Gavi was one of the organizations leading COVAX, a multilateral effort that supported the equitable development, procurement, and delivery of COVID-19 vaccines globally that began in 2020 and ended in 2023. Gavis role in COVAX was to facilitate the procurement and delivery of COVID-19 vaccines, with particular emphasis on low- and middle-income countries. Provision of COVID-19 vaccines and funding support to countries has now been integrated into Gavis regular programming; however, COVID-19 vaccine support will be discontinued after 2025.
Gavis Secretariat, with its main headquarters in Geneva and an office in Washington, D.C., carries out the day-to-day operations of the partnership. Gavi does not have program offices or staff based in recipient countries but rather relies on country health ministries and World Health Organization (WHO) regional offices to implement programs. Gavi is led by a Chief Executive Officer (CEO), currently Sania Nishtar.
The 28-member Gavi Board sets Gavis funding policies and strategic direction, and monitors program implementation. It includes 18 representative seats, nine seats for independent individuals, and one ex-officio non-voting seat for Gavis CEO. The 18 representative seats, as specified in Gavis statute, are as follows: donor country governments (5), implementing country governments (5), the WHO, the United Nations Childrens Fund (UNICEF), the World Bank, and the Bill & Melinda Gates Foundation, and one seat each for civil society groups, the vaccine industry in industrialized countries, the vaccine industry in developing countries, and technical health/research institutes. Additionally, several Board committees guide and advise the Board and the CEO on Gavi activities under their purview. The U.S. government is currently represented on Gavis Board as the Board member for the donor country government constituency and is a member of the Audit and Finance Committee, Programme and Policy Committee, and the Market-Sensitive Decisions Committee.
Since its 2000 launch, Gavi has received approximately $30 billion in financing, not including funding for COVAX (see Table 1). Approximately four-fifths (80%) of Gavis funding came from contributions provided by donor governments and private organizations and individuals. The top three government donors were the United Kingdom, the U.S. and Norway, while the largest private donor was the Gates Foundation.
Donors support Gavi through direct contributions as well as funding commitments to innovative financing mechanisms, the proceeds of which help support Gavis overall financing. These innovative financing mechanisms include the International Finance Facility-Immunisation (IFFIm) and the Pneumococcal Conjugate Vaccine (PCV) Advance Market Commitment (AMC). The IFFIm was created in 2006 and uses donor funding commitments to back the issuance of special bonds in capital markets, essentially providing up-front financing to Gavi. The PCV AMC began in 2010, and though it ended in 2020, it supported accelerated access to pneumococcal vaccines through up-front funding commitments from donors and continues to do so through contracts with manufacturers that extend until 2029. The U.S. does not provide support to either of these mechanisms.
In addition to financing Gavis regular activities, donors pledged additional resources to support the Gavi COVAX Advance Market Commitment (COVAX AMC), a financial mechanism within COVAX that supported low- and middle-income countries through procurement and distribution of COVID-19 vaccines; through 2023, Gavi received $12.3 billion from donor governments, private philanthropy, and innovative financing mechanisms for the COVAX AMC for vaccine procurement, delivery, and logistics.
Only low- and middle-income countries with a Gross National Income (GNI) per capita below or equal to $1,730 on average over the last three years are eligible for Gavi support. In 2023, 54 countries were eligible for Gavi support; these included 23 of the 25 U.S. priority countries for maternal and child health assistance.
Recipient countries governments are expected to share responsibility for funding their national immunization efforts through Gavis co-financing requirements (introduced in 2008), determined according to country income level and transition status.As countries develop economically, they are expected to contribute a greater share of the funding required for immunization programs.Countries below the threshold (average of $1,730 GNI per capita over the past three years) and classified as low-income by the World Bank are initial self-financing countries, while countries below the threshold and classified as lower-middle income by the World Bank are in preparatory transition. Initial self-financing countries are responsible for co-financing the equivalent of $0.20 per dose each year. Countries in preparatory transition gradually increase their co-financing contribution each year. When a countrys income rises above the GNI per capita threshold, it moves into an eight-year accelerated transition period of increasing domestic financing share, after which the country is expected to fully fund its own immunization programs. As of 2023, 19 countries have transitioned out of Gavi financial support.
Additionally, as part of its 2021-2025 strategy, the Gavi Board approved limited support for countries that have transitioned out of Gavi eligibility and for middle-income countries (MICs) that have never been eligible for Gavi support. Recognizing that many formerly and never Gavi-eligible countries experience low coverage rates and have yet to make key vaccine introductions, an initial investment of $281 million was approved to provide limited support for 19 former and 26 never Gavi-eligible countries for political advocacy related to immunization, technical assistance, targeted assistance to reach under-vaccinated communities, and financial support for one-off costs and vaccine introductions.
Gavi provides grant financing to country programs in the following five areas:
Country allocations include funding ceilings, representing the maximum available funding each country can apply for during the 2021-2025 period, for all areas of support except vaccines. These ceilings are formulated based on a countrys number of zero-dose children, under-immunized children, birth cohort, and GNI per capita. For vaccines, all countries are required to pay a share of the cost of their Gavi-supported vaccines.
Additionally, Gavi has provided country support through emergency response funding, including: support for Ebola vaccination, allowing for up to $200 million in reprogrammed Gavi support for the COVID-19 response in Gavi-eligible countries, and other support for the COVID-19 response including the creation of COVAX (which helped expand access to COVID-19 vaccines in lower-income countries) and the COVID-19 Vaccine Delivery Partnership (CoVDP, which aimed to improve COVID-19 vaccine coverage in certain COVAX countries, with a particular emphasis on countries that were below 10% coverage in January 2022). In 2022, Gavi supported 40 outbreak response vaccination campaigns.
Since its launch in 2000, Gavi has provided approximately $23 billion to support country immunization programs (not including funding for COVAX). Over the past three years, 2020-2023, more than $7.3 billion has been disbursed, most of which has been for vaccine support (60%), followed by health systems strengthening (13%) (see Table 2).
Gavi reports it has helped to immunize more than 1 billion children in supported countries, including more than 68 million in 2022 alone, and supported 40 different vaccine introductions and preventive campaigns and 40 outbreak response campaigns in 2022. Additionally, Gavi support has helped avert more than 17.3 million deaths and contributed to more than $220 million in economic benefits, since its launch in 2000. Additionally, according to Gavi, its support has led to improved child health and immunization indicators across its supported countries. For example, the average vaccine coverage across multiple key Gavi-supported vaccines including the human papillomavirus (HPV) vaccine, inactivated polio vaccine, and pentavalent vaccine (the vaccine providing protection against diphtheria, tetanus, pertussis, hepatitis B, and Hib), among others was 56% in Gavi-supported countries in 2022, up from 48% in 2019 and higher than the global average of 53%. Lastly, Gavis work has contributed to vaccine market-shaping; for example, Gavi reports that its influence has helped lower the cost of the HPV vaccine from a price per dose of $4.50 in 2015 to $2.90 in 2022.
The U.S. government has supported Gavi since its creation. President Clinton made the initial U.S. pledge to the newly formed partnership in 2000, and the U.S. provided its first contribution in 2001. Currently, the U.S. supports Gavi through financial contributions, participation in Gavis governance, and by providing technical assistance. It also supports other global immunization that complement Gavis activities.
The U.S. has supported Gavi through direct contributions every year since 2001. Over the last 10 years, U.S. contributions grew from $175 million in FY 2014 to $300 million in FY 2024, which is the highest amount appropriated to Gavi thus far (see figure). Additionally, the U.S. recently pledged at least $1.58 billion to Gavi over the next five years as a sign ofsupport for Gavis upcoming replenishment. Congress provides funding for U.S. contributions to Gavi through the Global Health Programs account at the U.S. Agency for International Development (USAID), specifically within the maternal and child health budget line. See the KFF budget tracker and the KFF fact sheet on the U.S. Global Health Budget: Maternal & Child Health (MCH) for details on historical appropriations for Gavi.
Additionally, in response to the COVID-19 pandemic, the U.S. provided $4 billion in FY 2021 emergency funding to Gavi COVID-19 vaccine procurement and delivery support under COVAX, making the U.S. the largest donor to COVAX (33% of $12.3 billion received overall). In addition to its financial support for COVAX, the U.S. donated the largest number of COVID-19 vaccines to other countries.
A U.S. government representative (from USAID) is currently a Board member of the donor government constituency on the Gavi Board. The U.S. government is also represented on the Gavi Boards Audit and Finance Committee, Programme and Policy Committee, and Market Sensitive Decisions Committee.
The U.S. also provides Gavi with technical support and expertise in the design, implementation, and evaluation of its programs in the field through partnerships with several U.S. agencies. For example, Gavis accelerated vaccine introduction programs have been conducted with technical support from the Centers for Disease Control and Prevention (CDC) and USAID, along with other partners.
Multilateral support of Gavi is one component of a broader set of global immunization activities of the U.S. government. The U.S. also provides bilateral (country-to-country) support for immunization through USAID, CDC, and other agencies, which focuses on strengthening routine immunization systems to deliver vaccines. U.S. multilateral and bilateral vaccine support are intended to be complementary. Indeed, many of the countries in which the U.S. carries out bilateral global immunization activities (provided as part of USAIDs maternal and child health efforts) also receive support from Gavi. See the KFF fact sheets on U.S. global MCH efforts and U.S. global polio efforts.
Routine vaccination rates for kindergarten children ticked down during the COVID-19 pandemic and have yet to rebound while exemptions from school vaccination requirements have increased, likely contributing to a recent surge in measles cases. At the same time, vaccine hesitancy, fueled in part by vaccine misinformation, increased during the pandemic, and public opinion on vaccine requirements has become increasingly partisan. Vaccine policies have emerged as an election issue, with both former President Trump and Independent candidate Robert F. Kennedy (RFK) Jr. embracing anti-vaccination attitudes and contributing to vaccine misinformation. This is in sharp contrast to current President Biden who has supported vaccine mandates and taken action to expand access to vaccines for both children and adults. This issue brief further explores this changing landscape by examining the latest trends in childrens routine vaccination rates, the factors contributing to recent vaccination trends, and policy approaches to increasing vaccination rates as children head into a new school year. Key takeaways include:
The share of kindergarten children up to date on their vaccinations ticked down during the pandemic and has yet to rebound back to pre-pandemic levels. Datacollected and aggregated annually by the CDC from state and local immunization programs found that, during the 2022-2023 school year, 93% of kindergarteners had been vaccinated with all state-required vaccines, including MMR, DTaP (diphtheria, tetanus, and acellular pertussis), polio, and varicella. This is similar to the previous school year but lower than pre-pandemic levels (95%). For the third year in a row, the MMR vaccination rate fell below the Healthy People 2030 target rate of 95%, the level needed to prevent community transmission of measles, a highly contagious and life-threatening virus. This means approximately 250,000 school children were unvaccinated and unprotected against measles, and research shows the more unvaccinated children in a school, the larger risk of an outbreak becomes. While noting that widespread measles transmission risk remains low, the Centers for Disease Control and Prevention (CDC) reported 97 cases of measles in the first quarter of 2024, which is seventeen times more than the number in the first quarter of 2023.
Nearly three-quarters (37) of states had MMR vaccination rates below the target rate of 95% for the 2022-2023 school year, an increase from 28 states during the 2019-2020 (pre-pandemic) school year. Further, 12 states and D.C. reported rates below 90% for the 2022-2023 school year; in the 2019-2020 school year, only three states had MMR vaccination rates below 90%. Overall, MMR coverage rates among kindergarteners for the latest school year ranged from 81.3% in Idaho to 98.4% in Mississippi. There can also be variation in vaccination coverage within states, and, when there are clusters of unvaccinated people within a specific community, the risk of an outbreak is higher, as occurred in New York City in 2018-2019.
Changes in state vaccination policies can have implications for childrens vaccination rates. As of 2023, all states and DC require children to be vaccinated against certain diseases, including MMR, in order to attend public schools, though exemptions are allowed in certain circumstances. All statesallowa medical exemption, and 46states(including D.C.) allow for a religious or personal belief exemption (or both).In recent years, some groups and state legislators have pushed to relax requirements and expand vaccine exemptions for school children. For example, some states have proposed requiring schools to include exemption information in all communications about vaccines, eliminating non-medical exemptions in child-care settings, and establishing a childrens vaccination Bill of Rights that emphasizes religious freedom. While many of these efforts have been unsuccessful or are still pending, some bills have become state law. Debate and hesitancy over COVID-19 vaccine mandates has spilled over into attitudes towards requiring vaccines for public schools, likely increasing exemptions and challenges to school vaccine requirements.
As vaccination rates for kindergarten children slightly declined, the share of kindergarten children with an exemption from one or more required vaccination slightly increased. The share of children claiming an exemption from one or more vaccinations rose from 2.5% in the 2019-2020 (pre-pandemic) school year to 3.0% in the 2022-2023 school year, the highest national exemption rate to date. While a seemingly very small increase, any increases in exemptions limit the overall share of children able to be vaccinated and make it more difficult to reach vaccination rate goals. Non-medical exemptions accounted for most of the exemptions. Non-medical exemptions increased from 2.2% to 2.8% while medical exemptions actually declined slightly from 0.3% to 0.2% from 2020-2021 to 2022-2023. The 2020-2021 school year was the lowest point for exemptions claimed during the pandemic era, with the share of children reporting any exemption dipping to 2.2% before rising to 3.0% by the 2022-2023 school year.
Overall, most states (36) have experienced an increase in the share of kindergarteners claiming an exemption for one or more vaccines since the pandemic began. Ten states in the 2022-2023 school year had exemption rates over 5%, meaning those states could not reach vaccination coverage rates at or above 95% even if all non-exempt children were vaccinated. However, rates shown here are for exemptions to one or more vaccines, so potentially achievable coverage rates could vary by vaccine type. In the reporting of this data, the CDC notes they did not asses the cause of the rise in exemptions, meaning the increases could mean a rise in vaccine hesitancy or an increase in issues accessing vaccines. Higher exemption rates are associated with lower vaccination coverage rates, meaning states with more children claiming exemptions report lower vaccination coverage rates. Studies have also shown that increases in exemption rates are associated with increased risk for disease outbreaks.
The impact of the pandemic on vaccination rates for other age groups (beyond kindergarteners) is more mixed, but data show widening disparities. The latest data from a CDC surveyof teens ages 13-17 (National Immunization Survey (NIS) -Teen) shows that vaccination coverage rates have lagged for some birth cohorts but not others. The latest data for young children (aged 24 months) from another CDC survey(NIS Child) shows that overall vaccination rates remained stable during the pandemic but disparities persisted, with the gap in vaccination rates between children living below poverty and children with higher household incomes widening. Another literature review found pandemic-related declines in routine vaccinations across a number of age groups and noted that the pandemic exacerbated existing disparities in vaccination rates.
Flu vaccination rates for children are over three times higher than COVID-19 vaccination rates. While both the flu and COVID-19 vaccines are included in the Advisory Committee on Immunization Practices (ACIP) recommended pediatric immunization schedule, they are not required for school attendance, and some states have even banned student COVID-19 vaccine mandates. The cumulative share of children ages six months through 17 with a flu vaccine during the 2023-2024 season was 54% while share with the updated 2023-2024 COVID-19 vaccine was 15%. Some of this variation in uptake may reflect parental views and concerns.KFFs COVID-19 Vaccine Monitorfrom September 2023 found most parents said they would not get their child the new COVID-19 vaccine including six in ten parents of teenagers (those between the ages of 12 and 17), and two-thirds of parents of children ages 5 to 11 (64%) and ages 6 months to 4 years old (66%). Larger shares of parents said they were confident in the safety of both the flu vaccine (68%) and the RSV vaccine (63%) compared to the COVID-19 vaccine (48%). Further, overall childrens flu vaccination coverage declined during the pandemic and has yet to rebound back to pre-pandemic levels.
There are a number of factors contributing to recent vaccination trends, including shifts in public opinion and rising vaccine hesitancy, potentially fueled by vaccine misinformation. A KFF Health Misinformation Tracking Poll in March 2024 found that about one in five parents had heard the false claim that a measles vaccine is more dangerous than getting the measles. While most of the public correctly viewed the claim as probably or definitely false, a majority expressed at least some uncertainty. This echoes findings of previous KFF research and highlights the pervasiveness of false and inaccurate informationand its impact on vaccination rates. While confidence in vaccines remained high, KFF polling in September 2023 found that three in ten adults said parents should be able to decidenot to vaccinate their children against MMR, even if that may create risks for others. This was up from 16% who said the same in anOctober 2019 Pew Research Center poll. While vaccine hesitancy has always been a challenge, early data show misinformation related to the COVID-19 vaccine increased vaccine hesitancy and may be impacting broader vaccine uptake.
Views and refusal of childhood vaccines have also become more partisansince the COVID-19 pandemic. The same KFF poll found 40% of Republicans said parents should be able to decide not to vaccinate their children (up from 20% in 2019), compared with 14% of Democrats. Further, former Republican President Donald Trump is the first president to openly support anti-vaccination attitudes and share vaccine misinformation. In his recent campaigning, Trump has continued to share anti-vaccine attitudes and stated he will not give one penny to any school that has a vaccine mandate (his campaign later said he meant COVID-19 mandates only). Independent candidate RFK Jr. also has a long record of opposing immunizations and spreading vaccine misinformation, making candidate vaccine attitudes one of many key topics this election.
In addition to rising vaccine hesitancy, disruptions that led to missed or delayed preventive care appointments early in the pandemic likely contributed to declines in vaccination rates. For example, for children enrolled in Medicaid or CHIP, well-child visit rates declined during the pandemic, and declines in vaccination rates may be, in part, associated with declines in well-child visits. Even before the pandemic, many children in Medicaid or CHIP did not receive a well-child visit within a year period, signaling children may also be experiencing barriers to accessing care.
There are a number of policy options and strategies that can be used to increase vaccination rates, including media outreach, incentives, parent-friendly websites, school-based vaccination clinics, and school vaccination requirements.Preventive care visits are also an importantcomponentwhen addressing routine vaccination rates, and efforts to promote access to care and increase well-child visits could potentially improve vaccination rates. To increase access to vaccines, some states have expanded the scope of pharmacists practice to include administration of routine vaccinations for children, and others are working to address rural health workforce shortages. Establishing and fostering trust between parents and providers, community leaders, and public health departments can also help to combat vaccine hesitancy. KFF polling has found pediatricians areconsideredhighly trusted sources of information by parents, and strong provider recommendations can help reduce disparities in vaccination coverage. School vaccine mandates and limiting exemptions can also be a tool to increase vaccine uptake, though recent trends show more states are working to loosen exemption requirements.
Medicaid coversfour in tenchildren in the U.S., including 8 in 10 children living inpovertyand overhalfof Black, Hispanic, and American Indian and Alaska Native (AIAN) children, making Medicaid an important tool for facilitating access to vaccines for children and reducing disparities in vaccination rates. There have been a number of recent state and federal actions aimed at improving access to care in Medicaid and CHIP, which could in turn help provide timely access to vaccines. This includes provisions to strengthen access to comprehensive health services, expand Medicaid coverage of school-based care, and promote stable coverage for children. The federally fundedVaccines for Children program(VFC) provides vaccines at no cost for children who are uninsured or underinsured, AIAN children, and children with Medicaid, and Bidens latest budget also proposes expanding the program to children in separate CHIP programs.
The Centers for Disease Control and Prevention recommends everyone six months and older should stay up-to-date with COVID-19 vaccines. And the state health department is bringing back a program to get more Arizonans vaccinated.
In 2021, when COVID-19 vaccines first became widely available, the Arizona Department of Health Services launched a mobile vaccine program, but it has been on pause since 2023. Now, the department is starting up the CDC initiative again.
Jessie Barbosa, health equity program manager with the health department, said the mobile program brings free vaccines vulnerable groups who might have barriers to accessing the shots.
"Perhaps theyre homebound and need a vaccine administered in their home or they're living in a long-term care facility or skilled nursing facility or they live in a rural area, which is considered a vaccine desert," Barbosa said.
Barbosa said the program will continue at least through 2025.
Long-term care facilities or community-based organizations can request to host a pop-up vaccine event through the health department website.
In the US, more than 13,000 recipients of COVID-19 vaccines have filed injury claims with the federal government. In India, Venugopalan Govindans daughter Karunya died in July 2021 after taking the Covishield vaccine that was co-developed by AstraZeneca and Oxford University. He is contemplating moving the courts even though the national committee set up by the Indian government did not find sufficient evidence to conclude that her death was caused by the vaccine.
A new controversy has arisen in respect of Covishield because in February 2024 AstraZeneca admitted to a court in the UK that in very rare cases the vaccine can cause thrombosis with thrombocytopenia syndrome (TTS), in which blood clots form in unusual places, such as the brain and abdomen, with reduced blood platelet count. The patient suffers from many problems, including severe headache, shortness of breath, blurring of vision, and chest and abdominal pain. AstraZeneca informed the court that the causal mechanism is not known, that is, the biological process by which Covishield can cause TTS is unknown. Further, the company said that TTS is known to happen even in individuals who may not have taken Covishield. Incidentally, TTS has also been linked to Johnson and Johnsons vaccine Janssen.
The side effects of vaccines require serious attention. Apoorva Mandavilli, a reporter on science and global health and a member of the team that won the 2021 Pulitzer Prize for Public Service for coverage of the pandemic, wrote an article on May 3, 2024, in The New York Times, on the basis of her conversations with dozens of experts in vaccine science, policymakers, and people who said they had experienced serious side effects after receiving a COVID-19 vaccine.
Also Read | Has COVID truly exposed the broken global order?
I was touched when I read the experience of Gregory Poland, a very well-known vaccine researcher whom I know personally. Dr Poland and I were members of a global consortium that carried out research on various aspects of different vaccines, including response, side effects, and so on, funded by the US National Institutes of Health. Dr Poland later served as the chief editor of the journal Vaccine. He told Mandavilli that he might never hear silence again; a loud whooshing sound in his ears has accompanied every waking moment since his first shot of a COVID-19 vaccine. He has written to the US Centers for Disease Control and Prevention (CDC) about his condition but has only received polite responses. If an internationally renowned vaccine researcher such as Dr Poland gets only a lukewarm response from the CDC, one wonders whether the common man facing a vaccine-related health problem will even elicit a response.
On May 5, 2023, the WHO declared that COVID-19 was no longer a public health emergency of international concern. But the virus is still killing people around the world. Various strains of SARS-CoV-2, the coronavirus that causes COVID-19, continue to circulate in most populations, including in India. There is always a chance that new variants will emerge and cause new cases and fatalities. One recalls that SARS-CoV-2 emerged in late 2019, and there have been seven million reported deaths from COVID-19. Because of weak systems of death registration, the number of reported deaths during the pandemic was a gross underestimate. A study published in the medical journal The Lancet found that although 5.94 million deaths due to COVID-19 were reported between January 1, 2020, and December 31, 2021, the estimated actual number of deaths in that period was between 17 and 20 million. The extent of underestimation varied across countries; India was among the top. For improved monitoring of pandemics in the future, it is necessary to strengthen death registration systems globally.
Due to weak systems of death registration globally, the number of reported deaths during the pandemic was a gross underestimate. | Photo Credit: Niranjan Shrestha/AP
The COVID-19 pandemic witnessed the triumph of science and technology. Multiple safe and effective vaccines were developed in record time and first authorised for emergency use in December 2020. Bharat Biotech developed an indigenous vaccine in collaboration with the Indian Council of Medical Research-National Institute of Virology. A wholly new class of vaccines (mRNA vaccine) was developed for human use, which resulted in the award of a Nobel Prize in 2023 to Katalin Karik and Drew Weissman. However, the scaling up of vaccine production took time. Therefore, the global distribution of vaccines was far from equitable, and overcoming it was a major challenge. India (notably, Serum Institute of India) played a major role in the scale-up operations to make the vaccine widely available.
Vaccine hesitancy was also a serious challenge. A systematic study on vaccine uptake published in March 2023 in Journal of Infection and Public Health found that [c]oncerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. False stories that COVID-19 vaccines are ineffective or that their side effects far exceed their benefits have been promoted by many influential people, including politicians. Facts indicate otherwise. A study by The Lancet Infectious Diseases estimated, on the basis of official reported COVID-19 deaths, that vaccinations prevented 14.4 million deaths from COVID-19 in 185 countries and territories in 2021. But, because many countries had banned the use of Covishield citing side effects, people in India have asked why the government here did not ban its use. Delhi Health Minister Saurabh Bharadwaj correctly demanded on April 30, 2024: The Central government should urgently address the alleged side effects of the vaccine because millions of people in India have been vaccinated with Covishield. As on that date, over 1.7 billion doses of Covishield had been administered in India.
The only way to prevent adverse events arising from vaccination and improve vaccines is by conducting scientific studies on vaccine safety, not by banning a vaccine because of the occurrence of very rare side effects. After all, no drug or vaccine is completely safe. Yet, we use these when the benefit of usage far outweighs the risk.
Of course, it is sad that Karunya died not long after taking Covishield. However, in order for her family to get compensation for her death, it must be proved on the basis of reliable and valid scientific evidence that her death was the direct result of the vaccine. This is not an easy task, particularly because an adverse outcome of vaccination, which may sometimes also result in death, is very rare. The WHOs Global Advisory Committee on Vaccine Safety calculated that the risk of TTS for a person living in the UK is 1 in 2,50,000 recipients of the AstraZeneca-Oxford vaccine, while for a recipient in the EU it is 1 in 1,00,000. We do not have an estimate for India, but it is expected to be similar.
Also Read | Katalin Kariko and Drew Weissman win Nobel Prize in Medicine
Occasionally, an adverse health outcome usually encountered after vaccination is also observed in people who did not take the vaccine. The background rate of TTS in the non-vaccinated population may be similar as reported in a study involving the health records of 38.6 million people in six European countries. Therefore, to scientifically prove that an adverse outcome is due to vaccination is inordinately difficult. Unfortunately, in India or even globally, there is not a central database where reports of adverse outcomes of vaccination are available. It is extremely important to create such national databases and preferably a global database. Fortunately, an international network has been formed with experts in vaccine safety, biology, and other relevant disciplines to conduct scientific studies on reported side effects of vaccines.
Also, fortunately, in spite of misinformation about vaccines and occasional reports of adverse events encountered after vaccination, the vast majority of people around the world still trust vaccines. The results of a survey conducted on 23,000 adults in 23 countries, published in Nature Medicine on April 29 stated: A total of 60.8 percent expressed being more willing to get vaccinated for diseases other than Covid-19 as a result of their experience during the pandemic. Based on a detailed analysis of the responses obtained in the survey, this report concluded that vaccine hesitancy and trust challenges remain for public health practitioners, underscoring the need for targeted, culturally sensitive health communication strategies. An even greater challenge is possibly overcoming the barriers of poverty and inequity in access to vaccines. The global health system must wake up to this challenge so that future pandemics can be prevented or if they occur can be, handled with less misery for humankind than one witnessed during the COVID-19 pandemic.
Partha P. Majumder is a National Science Chair (Scientific Excellence), government of India, and a former president of the West Bengal Academy of Science & Technology and the Indian Academy of Sciences.
With COVID-19 cases on the rise, Quebec's immunization committee has released its recommendations on administering vaccines this fall.
In a report published Monday, the committee recommends that the same groups as it did last year get a booster dose. They include:
People aged 60 and over.
People living in long-term care homes.
People who are immunocompromised, undergo dialysis or live with a chronic illness.
Pregnant people.
Health-care workers.
Adults living in isolated areas.
Quebec had790 positive COVID-19 casesin the week of July 14, according to the latest data from the Institut national de sant publique du Qubec (INSPQ). About 820 patients were hospitalized due to COVID-19 that same week, nearly twice as many since the end of April.
The positivity rate for COVID-19 tests jumped to 16.3 per cent in July from 2.3 per cent in April.
People who have never had COVID-19 are more likely to develop complications following their first infection with SARS-CoV-2 despite good vaccination coverage, the immunization committee report says. That's because the effectiveness of the vaccine tends to wane after several months, especially when new variants emerge.
The committee says the likelihood of experiencing severe COVID-19 symptoms leading to hospitalization is much higher for elderly people, and that risk is compounded when a person has a chronic illness.
Preliminary analyses conducted on people who were 60 years old and older during the 2023 vaccination campaign show that they were 43 per cent more protected than people who only received a booster dose in 2022.
Young adults in good health may get another dose, but the committee says a booster dose for thatgroup would have few benefitsgiven the group'slow risk of developing COVID-19 complications.
"The vaccine is very effective to prevent severe hospitalization. It's not as effective to prevent transmission," said Dr. Nicholas Brousseau, a public health physician at theINSPQ."That's why our recommendations target at-risk people."
New variants
The committee is also recommending that the government wait for the availability of vaccineswhich are better adapted to new strains circulatingbefore launching the next vaccination campaign.
It iscalling on the government to withdraw its preference for mRNA vaccines over Nuvaxovid (Novavax) so that Quebec may recommend the vaccine that "offers protection against variants that are closest to those circulating" and look into offering booster doses along with the flu shot.
The virus SARS-CoV-2 continues to produce new variants since it was first detected in 2019, with the JN.1 strain being the most prominent in Quebec and Canada as of March 13, 2024.
The last provincial vaccination campaign targeted the XBB.1.5 variant.
"By fall 2024, it is expected that new versions of COVID-19 vaccines, targeting one or more strains closer to those currently in circulation, will be developed and authorized," the report says.
In a recent study published in the journal BMJ, researchers conducted a registry-based study comprising 343,066 infants across Denmark, Sweden, and Norway to investigate if COVID-19 infections or vaccinations during the first trimester were associated with increased risk of congenital anomalies. Of the 11 anomaly subgroups investigated, 10 had adjusted odds ratios (aORs) < 1.04 highlighting no statistically significant risk increases.
Study: Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study. Image Credit:Unai Huizi Photography/ Shutterstock
Pregnant women represent a high-risk population, with disease contractions during pregnancy often adversely affecting pregnancy and birth outcomes. Observational accounts and recent research have revealed that Coronavirus disease 2019 (COVID-19) infections during pregnancy comply with this trend, increasing the risk of severe illness and pregnancy complications. Given this knowledge, governments of most nations recommend that pregnant women receive COVID-19 vaccinations.
The first trimester represents a critical period of pregnancy, with most congenital anomalies developing during these first three months. Unfortunately, pregnant women are rarely subjected to randomized controlled trials, preventing robust scientific evidence for the safety of vaccinations in this high-risk group. Encouragingly, observational evidence and registry-based studies conducted across Scotland, Israel, Switzerland, France, and the United States (US) of America failed to find evidence for the increased risk of congenital anomalies following COVID-19 infection or vaccination.
Since these studies suffered from the shared limitations of inadequate sample sizes, a lack of first-trimester focus, or inadequate anomaly subgroup analysis, a study accounting for these limitations is necessary. Furthermore, given differences in race/ethnicity-specific COVID-19 outcomes and a shortage of information for Nordic countries, the present study aims to assess risk associations between COVID-19 infections or vaccinations during the first trimester and congenital anomalies across Sweden, Denmark, and Norway.
This study compiled data from liveborn singleton infants from the Medical Birth Registry of Norway, the Danish National Patient Register, and the Swedish Pregnancy Register between March 2020 and February 2022. Inclusion criteria comprised mothers and infants who were followed up for at least nine months (275 days) following birth, while preterm births were excluded to avoid confounds.
Data collection included maternal socioeconomic information and COVID-19 infection or vaccination status. The exposures of interest were COVID-19 infections of vaccinations during the first trimester, with each exposure (infection and vaccination) analyzed independently. Notably, combined exposure (vaccination followed by infection) was excluded from the analysis.
The European Surveillance of Congenital Anomalies (EUROCAT guide version 1.5) was used to define major congenital anomalies. This study categorized anomalies into 11 subgroups 1. any, 2. heart, 3. nervous system, 4. eye, 5. ear, neck, or face, 6. respiratory, 7. oro-facial clefts, 8. abdominal wall defects, 9. kidney or urinary tract, 10. genital, or 11. limb anomalies.
Covariates of interest included maternal age, parity, education level, household income, maternal region of birth, pregnancy start date, smoking status, preexisting chronic disease status, and body mass index (BMI), all of which were used as potential confounders during analysis.
Statistical analysis comprised random effects meta-analysis conducted independently for infections and vaccinations and subgrouped by country (Sweden, Norway, or Denmark). Between-country heterogeneity was assessed using I2 tests. Sensitivity analyses were conducted in two stages 1. Infants with a minimum of 12 months of follow-up were included, and 2. Infants with genetic-associated congenital anomalies were excluded.
Of the 343,066 infants included in the study, 17,704 presented at least one major congenital anomaly. Of these, 4.2% (n = 737) presented more than one major congenital anomaly. COVID-19 infections were observed for the mothers of 10,229 (3%) of infants, but analysis revealed no additional risk of congenital anomalies in this group (adjusted Odds Ratios [aORs] = 0.96). On a per-subgroup basis, aORs ranged from 0.84 (eye) to 1.12 (oro-facial clefts), but these results did not indicate increased infection-associated risk statistically.
COVID-19 vaccinations were observed for the mothers of 152,261 infants, of which 29,135 (19%) were vaccinated during the first trimester and hence included in subsequent analysis. Once again, the analysis revealed no additional risk of vaccination-associated anomalies, with aORs ranging from 0.84 (nervous system) to 1.69 (abdominal wall defects). Abdominal wall defects were the only statistically significant subgroup, with the remaining 10 subgroups presenting aORs < 1.04.
The present study represents the largest (n = 343,066) assessment of COVID-19 infection or vaccination-associated congenital anomaly risk, with the most prolonged follow-up period (9-12 months). It is also the first to investigate these associations in Nordic populations.
Study findings support previous literature highlighting no association between COVID-19 infection or vaccination and subsequent congenital anomaly risk. However, COVID-19 infections are known to result in other pregnancy and birth complications, supporting governments recommendations for pregnant women to receive vaccinations.
Journal reference:
northjersey.com wants to ensure the best experience for all of our readers, so we built our site to take advantage of the latest technology, making it faster and easier to use.
Unfortunately, your browser is not supported. Please download one of these browsers for the best experience on northjersey.com
Sinovac Photo: VCG
Reuters reported in June that the US military had launched, at the height of the COVID-19 pandemic, a secret campaign to counter what it perceived as China's growing influence in the Philippines, a nation hit especially hard by the deadly virus.
The US government's disinformation campaign against China's anti-COVID vaccine "has caused significant damage in the Philippines on so many levels," a Filipino infectious diseases expert Edsel Salvana was cited by the Manila Times on Saturday.
The campaign "led to unnecessary suffering and deaths among those who were hesitant to take the available vaccines as the anti-Sinovac propaganda forced people to wait for the arrival of the American-made alternative," Salvana said, adding that it was also "disheartening to learn the US, as an ally, would do such a thing at the height of the COVID-19 pandemic that killed millions worldwide."
The US Marine Corps has recently published a doctrine titled "Deception," according to the US website Military.com, which is a tactic used to deceive enemy and create disinformation. Jeffrey Hill, a US intelligence officer and the lead author of the doctrine, reportedly said that "if you ain't deceiving, you ain't fighting."
Commenting on the series of actions, a spokesperson from the Chinese Embassy in Manila said that from former US Secretary of State Mike Pompeo publicly saying "we lied, we cheated, we stole," to the recent revelation of Pentagon disinformation campaign against Chinese vaccines, and to the latest military doctrine "Deception," facts have shown time and again that to advance selfish agenda in the name of justice, to spread disinformation through deceptive propaganda, and to frame and suppress other countries through manipulating public opinion and perception have become the US' go-to tactics.
"What the US has been doing is not unknown to the world who is wary against such tactics," the spokesperson noted. "Long gone are the days when the US could deceive the world into serving its selfish agenda."
The embassy urged the US to end this kind of wrongful approach at once, stop manipulation through lies, and halt smearing and vilifying other countries.
What's more, the US should give "a long-overdue explanation" to the international community both for its dissemination of disinformation over the years and for the severe damage inflicted by the US "Deception" strategy and anti-Sinovac propaganda on the Philippines.
Global Times
By David Dodd, CEO, GeoVax Labs, Inc.
Is anyone talking about COVID-19 anymore? The answer is yes.
In April, a group of new virus strains known as the FLiRT variants, based on the technical names of their two mutations, began to spread, followed in June by a variant known as LB.1. The FLiRT strains are subvariants ofOmicron, and together they accounted for the majority of COVID cases in the U.S. at the beginning of July.
This news comes after the variant JN.1 spread rapidly this year, indicating its either more transmissible, or just better at evading the immune system, according to health officials. The CDC reports COVID-19 is still claiming the lives of hundreds of Americans a week. Thankfully, the virus is not overwhelming our health systems anymore, due to the scientists, researchers and developers, and clinicians that brought the vaccines to the public in record time in less than a year to protect us.
The public health emergency has ended, but the WHO still calls COVID-19 a pandemic. As long as variants to SARS-CoV-2 continue to emerge, there remains a risk of a highly variant form causing epidemic life-threatening infections throughout the world. This is why with COVID-19, few would consider the current situation back to normal.
Yet one year after the Biden administration ended the COVID-19 public health emergency, the CDC estimates only 23% of adult Americans have received the updated 2023-24 COVID-19 vaccine, compared to approximately 80% who received the initial dose. Its safe to say vaccine apathy is rampant. Most people will tell you they are tired of playing catch up with vaccines, or they dont think the vaccines will protect them, even though the virus continues to evolve and poses a critical threat to various patient populations, especially those who are the most vulnerable.
People with compromised immune systems resulting from cancers, immune deficiency diseases, diabetes, kidney disease, autoimmune diseases, those with organ transplants, and other immune-depleting conditions are at extreme risk in their everyday lives.
In the U.S. alone, there are between 20-25 million adults, and worldwide over 250 million, for whom the currently authorized vaccines are inadequate due to underlying medical conditions. In fact, since the beginning of the pandemic, approximately 80% of deaths ascribed to COVID-19 were among those ages 60 and above, as well as those having compromised immune systems due to various medical conditions. For many of such populations, the threat of severe infection, hospitalization, and the risk of death remains.
Even for healthy patients, the COVID-19 vaccines require continued reconfiguration to address new variants, and their durability, which is unfortunately less than six-months. The emergence of new variants is difficult to predict, but scientists have estimated that over the next two years, we are likely to experience another Omicron-like wave. The COVID-19 vaccinations are the most important tool we have and are proven to reduce the risk of severe disease, hospitalization and death.
Getting ahead of COVID-19 means vaccine developers have to remain committed to updating the makeup of these vaccines, making sure they are administered efficiently, and sharing them globally as quickly as possible. The White House initiative, Project NextGen, was designed to coordinate a government effort aimed at accelerating the clinical development of new vaccines and therapies with the potential to provide more robust and durable protection. This initiative is focused on providing the public with vaccines and therapies that break the cycle of constantly having to continuously reconfigure vaccines and therapies in response to new variants. This means creating next-generation COVID-19 vaccines that address a breadth of virus strains, including variants yet to emerge.
Through Project NextGen, the Biomedical Advanced Research and Development Authority (BARDA), a DHS agency, is dedicating five billion dollars to producing vaccines that are broader and more durable, including COVID-19 vaccine candidates that are delivered intranasally, orally, or have the potential to provide protective immunity to variants yet to emerge.
Project NextGen aims to ensure that next-generation safe and effective COVID-19 vaccines are brought to the public as quickly as possible and that they can be produced in a manner that meets the public needs. Vaccine candidates that have been funded thus far under Project NextGen include COVID-19 vaccines providing novel delivery such as intranasal (Codegenix; CastleVax) and oral (Vaxart), as well as providing increased variant coverage and greater durability (GeoVax; Gritstone).
We lost millions of people in the pandemic, and many millions more were left with long COVID. Our healthcare systems are fundamentally changed, and we are still learning how to augment and assess data for diseases, viruses, and other potential threats.
We are far from being in the clear with COVID-19. With nearly as many hospitalizations in January 2024 as in January 2023, COVID is not becoming milder, or fading away. The real question, then, is not whether COVID is still a pandemic, but how much COVID illness and death it will take to convince people that vaccinations still matter: perhaps more now than ever.
About The Author:
David Dodd is the CEO of GeoVax Labs, Inc. a clinical-stage biotechnology company developing novel vaccines for many of the worlds most threatening infectious diseases and therapies for solid tumor cancers. During his career, he has overseen the approval of over 10 NDAs, over 15 acquisitions/divestitures, in excess of $2.5 billion in financial transactions, and led over $5 billion in incremental enterprise growth.
By Amy Maxmen Updated July 19, 2024 Originally Published July 15, 2024
Six people who work at a poultry farm in northeastern Colorado have tested positive for the bird flu, the Centers for Disease Control and Preventionreported July 19. This brings the known number of U.S. cases this year to 10.
The workers were likely infected by chickens, which they had been tasked with killing in response to a bird flu outbreak at the farm.The endeavor occurred amid a heat wave, as outside temperatures soared to 104 degrees Fahrenheit.
The barns in which culling occurs were no doubt even hotter, said CDC principal deputy director Nirav Shah at a July 16 press briefing. Wearing N95 respirators, goggles, and other protective gear was a challenge. Industrial fans whipped feathers around the facility that could have carried the virus, Shah added.
In this environment, the farmworkers collected hundreds of chickens by hand and placed them into carts where they could be killed by carbon dioxide gas within two minutes.
If a farm worker gets severely ill or dies from an H5N1 infection, it will be a stain on US public health that we didnt do more with the tools we have, Jennifer Nuzzo, director of the Pandemic Center at Brown University, posted on X. You dont send farm workers in to cull H5N1 infected birds without goggles and masks. Period. If its too hot to wear those protections, its too hot to cull. We need vaccines to be made available to farm workers. We have to stop gambling with peoples lives.
More than 99 million chickens and turkeys have been infected with a highly pathogenic strain of the bird flu that emerged at U.S. poultry farms in early 2022. Since then, the federal government has compensated poultry farmers more than $1 billion for destroying infected flocks and eggs to keep outbreaks from spreading.
As summer temperatures rise across the country, Shah said, the agency is contending with how to offer farmworkers safety from the virus, as well as safety from extreme heat.
The H5N1 bird flu virus has spread among poultry farms around the world for nearly 30 years. An estimated 900 people have been infected by birds, and roughly half have died from the disease.
The virus made an unprecedented shift this year to dairy cattle in the U.S. This poses a higher threat because it means the virus has adapted to replicate within cows cells, which are more like human cells. The four other people diagnosed with bird flu this year in the U.S. worked on dairy farms with outbreaks.
Scientists have warned that the virus could mutate to spread from person to person, like the seasonal flu, and spark a pandemic. Theres no sign of that, yet.
So far, all 10 cases reported this year have been mild, consisting of eye irritation, a runny nose, and other respiratory symptoms. However, numbers remain too low to say anything certain about the disease because, in general, flu symptoms can vary among people with only a minority needing hospitalization.
The number of people who have gotten the virus from poultry or cattle may be higher than 10. The Centers for Disease Control and Prevention has tested only about 60 people over the past four months, and powerful diagnostic laboratories that typically detect diseases remain barred from testing for bird flu. Testing of farmworkers and animals is needed to detect the H5N1 bird flu virus, study it, and stop it before it becomes a fixture on farms.
Researchers have urged a more aggressive response from the CDC and other federal agencies to prevent future infections. Many people exposed regularly to livestock and poultry on farms still lack protective gear and education about the disease. And they dont yet have permission to get a bird flu vaccine.
Nearly a dozen virology and outbreak experts recently interviewed by KFF Health News disagree with the CDCs decision against vaccination, which may help prevent bird flu infection and hospitalization.
We should be doing everything we can to eliminate the chances of dairy and poultry workers contracting this virus, said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. If this virus is given enough opportunities to jump from cows or poultry into people, it will eventually get better at infecting them.
To understand whether cases are going undetected, researchers in Michigan have sent the CDC blood samples from workers on dairy farms. If they detect bird flu antibodies, its likely that people are more easily infected by cattle than previously believed.
Its possible that folks may have had symptoms that they didnt feel comfortable reporting, or that their symptoms were so mild that they didnt think they were worth mentioning, said Natasha Bagdasarian, chief medical executive for the state of Michigan.
In hopes of thwarting a potential pandemic, the United States, United Kingdom, Netherlands, and about a dozen other countries are stockpiling millions of doses of a bird flu vaccine made by the vaccine company CSL Seqirus.
Seqirus most recent formulation was greenlighted last year by the European equivalent of the FDA, and an earlier version has the FDAs approval. In June, Finland decided to offer vaccines to people who work on fur farms as a precaution because its mink and fox farms were hit by bird flu last year.
The CDC has controversially decided not to offer at-risk groups bird flu vaccines. Demetre Daskalakis, director of the CDCs National Center for Immunization and Respiratory Diseases, told KFF Health News that the agency is not recommending a vaccine campaign at this point for several reasons, even though millions of doses are available. One is that cases still appear to be limited, and the virus isnt spreading rapidly between people as they sneeze and breathe.
The agency continues to rate the publics risk as low. In a statement posted in response to the new Colorado cases, the CDC said its bird flu recommendations remain the same: An assessment of these cases will help inform whether this situation warrants a change to the human health risk assessment.
We encourage organizations to republish our content, free of charge. Heres what we ask:
You must credit us as the original publisher, with a hyperlink to our kffhealthnews.org site. If possible, please include the original author(s) and KFF Health News in the byline. Please preserve the hyperlinks in the story.
Its important to note, not everything on kffhealthnews.org is available for republishing. If a story is labeled All Rights Reserved, we cannot grant permission to republish that item.
Have questions? Let us know at KHNHelp@kff.org
