CHILDREN’S VACCINATION INITIATIVE AGAINST HEPATITIS B IN RUSSIA, LAUNCHED WITH USDA SUPPORT, BECOMES SELF SUSTAINING
Vishnevskaya-Rostropovich Foundation, Russia, 2002, FFP
With initial funding generated by the successful monetization of soybean meal under the 416(b) and Food For Progress programs of the United States Department of Agriculture (USDA), the Vishnevskaya-Rostropovich Foundation (VRF) has been conducting a children’s vaccination initiative against hepatitis B in the Russian Federation that has become the largest public health initiative in Russia since the collapse of the Soviet Union. Now the Russian government has announced that it will assume full financial responsibility for sustaining the vaccination initiative throughout the country after the direct funding from the VRF ends in 2006.
Hepatitis B, a highly infectious disease of the liver, can cause scarring of the liver, liver cancer and death. Although there is no treatment for the disease, the vaccine is highly effective in preventing it. The Russian Ministry of Health (MOH) had begun vaccinating newborns against hepatitis B in 1999 but lacked funding to vaccinate adolescents and health care workers at risk of contracting the disease. In early 2000 the MOH turned to the VRF for help in addressing this serious threat to public health.
From its inception in 2000 as a regional program in central Russia, the VRF vaccination initiative grew over the next four years to include 19 regions stretching from European Russia across Siberia to the Russian Far East. Other donors joined USDA in financing the effort, including the energy giant BP, the Norwegian Government, and USAID. By 2004 nearly 2.5 million children and 100,000 at risk health care workers were targeted for vaccination under the initiative.
From the beginning the enduring strategic goal of the VRF vaccination initiative has been to reduce the number of unvaccinated children in each region to a level that could be managed and financed with local and national resources within three years of each regional program’s inception. This requires close collaboration between the VRF and national and local health authorities. Thus each regional vaccination program is designed jointly by local epidemiologist and VRF staff with the aim of strengthening the existing health care infrastructure and avoiding the creation of parallel structures. Staff training and public awareness campaigns are undertaken. Locally manufactured refrigerators and thermal containers for the safe storage and distribution of vaccine are distributed to facilities with outdated equipment. Close monitoring of record keeping and timely vaccine distribution is carried out jointly by VRF and local health officials. Wherever possible, adolescents are vaccinated in their schools, which typically results in average coverage rates in excess of 95%. As a comparison, routine immunization programs in the West are considered successful if they achieve a coverage rate of 90%.
2003 marked the successful completion of the VRF-financed hepatitis B program in the Nizhniy Novgorod region, where the VRF vaccination initiative was first launched, followed in 2004 by the completion of the programs in St. Petersburg and the Novosibirsk region in western Siberia. These early regional programs, financed entirely with funding from USDA, provided for the vaccination of all school-aged adolescents aged 13 – 18 years, all orphans, and at-risk medical workers. Since that time local and federal funding continued these vaccination programs by providing the hepatitis B vaccine every year to the rising 13-year-olds. The remaining VRF programs in Russia were completed by the end of 2005 and the first half of 2006.
The announcement by the Russian MOH that it will assume full financial responsibility for vaccinating all 13-year-olds throughout Russia against hepatitis B in 2006 is a clear demonstration that the VRF children’s vaccination initiative, launched with USDA support, has proven to be a model of a sustainable public health program. However, the success of this model is not limited to Russia. With financing from additional 416(b) agreements concluded with USDA, the VRF has been able to implement similar children’s vaccination programs in Azerbaijan and Georgia to protect hundreds of thousands of children in these countries against vaccine-preventable diseases, thereby giving even more children the chance to become healthy adults.