introduction of haemophilus influenzae vaccineSupporting decision-making on the introduction of Haemophilus influenzae type b vaccine in low-and middle-income countries

In 2008 Haemophilus influenzae type b (Hib) was the third biggest cause of vaccine preventable deaths in children under the age of five years.

A vaccine against the disease was licensed in the United States in 1987. During the 1990s, researchers at the School undertook a large body of research in The Gambia to prove the efficacy of the vaccine for the prevention of invasive Hib disease and Hib pneumonia in Africa.

In 2000, the Gavi Vaccine Alliance, a partnership aimed at increasing access to immunisation in the poorest countries, began offered countries eligible for its support the Hib vaccine for free for five years. However, by 2005 only 14 countries had taken up the offer, due to lack of awareness and concerns about financial sustainability.

Kim Mulholland, professor of child health and vaccinology at the School, in partnership with colleagues at Johns Hopkins University, the World Health Organization and the US Centers for Disease Control and Prevention, established the Hib Initiative, winning a US$37 million (£25m) grant from Gavi in 2005 for a project to increase the uptake of Hib vaccine, based on evidence-based decision making.

The School’s role within the group was to lead epidemiological and economic studies. Our research showed that the vaccine could prevent 371,000 deaths every year and that it was highly cost-effective in developing countries.

Studies in Mozambique, Ethiopia, Pakistan. Bangladesh, Vietnam, Belarus and Uzbekistan began in 2007, with a view to determining the benefit of the vaccine. Mozambique introduced the vaccine in 2009 and saw rates of invasive Hib disease fall by 91% in children under the age of one and by 85% in children under the age of five.

The School’s research helped health ministers in developing countries understand the burden of the disease and make evidence-based decisions for the introduction of a vaccine. The team presented their findings to ministries of health and international meetings. Ulla Griffiths presented at nine international meetings between 2008 and 2012.

In 2007, 24 out of 73 countries eligible for Gavi support had introduced the vaccine and by 2013 this had number had increased to 71. Some 153 million children in developing countries received the vaccine between 2000 and 2012, preventing approximately 658,000 deaths.