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.