Millions of lives saved, Rohingya refugees and many more

The risk of a deadly epidemic of cholera in massive refugee camps set up in Bangladesh in great haste following the sudden exodus of more than 600,000 Rohingya over recent months has eased dramatically.

Gavi, the non-government group that helps deliver vaccines to the world's poorest countries, provided a million doses of a cholera vaccine to the government for health workers in and around refugee camps for Rohingya.

Aid groups and journalists who went to Cox's Bazar voiced fears that thousands could be killed if there was an outbreak of the disease – as in Yemen – given the dire circumstances in which the refugees, half of them children, suddenly found themselves, lacking both clean water and proper sanitation.

Dr Seth Berkley, head of the global vaccine group, said the cholera vaccines delivered to the Rohingya camps in Bangladesh "protect not only the refugees, but all the surrounding communities" from the disease.

Speaking at a press conference in Bangkok and in an interview with Asia Times, Dr Berkley said Gavi had stockpiles of vaccines for emergencies for different parts of the world and these were a "really important" facet of the group's work.

The organization has stockpiles of vaccines for yellow fever, meningitis and has ordered an advance purchase of a vaccine for Ebola, which he said, appeared to be very effective but was yet to be certified.

Angola had one of the worst outbreaks of yellow fever in decades, which ran for at least a year before being contained in December last year. Twelve people traveled to China with the disease, Dr Berkley said, but health officials were able to deal with them and prevent a global health crisis. "Luckily, it didn't transmit here," he said.

Another "old" disease – typhoid – "which had almost disappeared in the West" had also made a resurgence, he said, because of increasing anti-microbial resistance. There were about 12 million cases around the world last year and over 128,000 deaths.

The Gavi board held its annual general meeting in Vientiane, the capital of Laos, this week and approved funds for a new typhoid vaccine made in India which is currently being reviewed by the World Health Organisation. The new vaccine was expected to be more effective than the previous one and should be available for millions of people in late 2018 and 2019, he said.

A short video by Gavi of vaccination work in Vientiane province, Laos.

Gavi is a public/private body funded largely by governments around the world, plus private donors such as the Bill and Melinda Gates Foundation. It has provided vaccines to over 640 million children since it was set up in 2000 – and is believed to have prevented at least nine million deaths.

This year it had a budget of about US$2 billion and 75% was spent on vaccines, while the remaining 25% went toward "delivery services", which includes strengthening local health services. The money bolsters public health in poor countries, those where citizens have an average annual wage less than US$1,580.

One new and unexpected "disease" that Gavi has to battle – mainly in wealthy countries free of most the worst infectious diseases – is misinformation "spread at the speed of light, via the internet", he said.

"In countries with a high incidence of disease it's not a problem, as many people have lost friends or family members or seen the risk of diseases. But in countries where diseases have largely disappeared it has become a problem… The solution is trusted information."

Dr Berkley, 61, has a long and impressive history as doctor and medical epidemiologist. He worked for many years to try to develop a vaccine for HIV/Aids and his interest in public health led to work in many developing countries.

Time magazine listed him in the top 100 most influential people and he is unequivocal about his endorsement of vaccines as "the most effective intervention for human health". Misinformation is as old as humans are, but some people in high-income countries simply lacked knowledge about the risks of infectious diseases.

"I believe in the power of science," he said in our interview.

A bigger concern was raised by Medicins Sans Frontieres, the highly regarded humanitarian group, which issued a press release last week warning that millions of children could lose access to life-saving drugs because of Gavi's funding model.

It feared that children in 20 countries were set to be "pushed off a cliff" – that is, they could lose access to cheap vaccines because the average annual income in their countries would pass the Gavi threshold of $1,580 by 2020.

However, Berkley said while the Gavi philosophy was "there is no free lunch" and it wanted to encourage all countries to pay their way, the board had agreed to be flexible given some countries' income statistics were inflated by oil or mining wealth, such as Papua and New Guinea and Nigeria.

It had made a further US$30 million through till 2020 to countries challenged by the transition process. There would also be tailored post-transition support in Angola, the Congo and Timor-Leste. South Sudan would also continue to receive support.

Not all countries are struggling, of course. Some were learning new ways to fight disease amid the "revolution in information systems and innovation".

In Rwanda, he said, officials were expanding the use of drones to deliver blood to people in emergencies in rural areas. Currently, this was possible in 42% of the small nation in central Africa, but the government hoped to cover the entire country by the end of next year.

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