Butan Drolma is the first woman in her family to give birth in a hospital. Just hours after the 23-year-old Tibetan women's son is born, the little boy is vaccinated against Hepatitis B. His chances of survival have now been dramatically boosted.

Butan Drolma and her son live in the impoverished Guinan County of Hainan Prefecture, in Northwest China's Qinghai Province. The baby boy is one of more than 11 million poor rural children who have been immunised in a special project launched four years ago.

The project is co-funded by the Global Alliance for Vaccines and Immunisations (GAVI) and the Ministry of Health, as well receiving support from rural co-operative medical insurance. The programme has stretched across 1,301 counties in central and western China and health experts estimate the effort has prevented about 200,000 deaths from liver cancer originating from Hepatitis B.

Project helps the poor

The Hepatitis B Virus (HBV) is the most widespread epidemic in China. Research shows that more than 120 million people in China are infected with the disease, accounting for more than one third of the world's total Hepatitis B sufferers. Hepatitis B patients are at risk of liver cancer or failure, and can spread the disease to others. Doctors say vaccination of newborns is the best way to prevent the disease.

In 1992, the Chinese Government added the Hepatitis B vaccine in the Expanded Programme on Immunization (EPI). The vaccines were supplied at cost price and mothers were obliged to vaccinate their newborns.

"But for the poor rural residents in our province, even the less than 20 yuan (US$2.5) price for three injections of the vaccine is still too expensive," said Zhang Yongquan, director of the Institute of Immunisation at Qinghai provincial centre for disease control.

As a result, the vaccination rate of Hepatitis B remained as low as 47 per cent in western and central China in 2002, 10 years after it was included into EPI.

The GAVI project now offers hope to more poor families. The Geneva-based organization has helped immunise 90 million children worldwide against Hep B. It is funded from organizations, such as the Bill & Melinda Gates Foundation.

The Chinese Government and GAVI decided in 2002 to jointly invest US$76 million targeting newborns and children under five across all the 10 western provinces of China and key poor counties in central China. The area encompasses 470 million people, including six million newborns every year. The campaign also received technical guidance from the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF).

Four years after the project, the immunisation rate of newborns in central and western Chinese provinces has reached 85 per cent and 75 per cent of newborns have received the first injection of the Hepatitis B vaccine within 24 hours of their birth, according to Vice-Health Minister Jiang Zuojun.

More than money

UNICEF China health and nutrition section chief Koen Vanormelingen said the GAVI project had help leverage the additional funding from the Chinese Government to the vaccination programmes.

Besides the money from the health ministry, local governments in central and western China have co-invested more than US$10 million to support local infrastructure since the project was launched. Meanwhile, the richer provinces in East and South China uncovered by the GAVI project have funded the Hep B vaccination with their own budgets.

Doctor Steve Hadler, an expert at WHO China, said the project had also brought international guidelines to the bidding and tender process of vaccines. Chinese vaccine makers supplied the Hepatitis B vaccines through a national bid and tender process, which was monitored by international observers. Doctors and nurses, at the grass-roots level, have also received training, while local people have attended classes to learn about health benefits.

Both Vanormelingen and Hadler said the strong commitment of the Central Government and the close co-operation of local governments are the keys for the GAVI project to achieve its expected results.

Wider impacts

Yu Jingjin, deputy director of the Bureau of Disease Prevention and Control at the Chinese Health Ministry, said besides expanding the Hepatitis B vaccination, the GAVI project has expanded the idea of clean injection by widely promoting auto-disable syringes.

Many of the auto-disable syringes have been used for other vaccines, such as measles, greatly reducing the chances of cross infection, Yu said.

The project has boosted the vaccinations against other diseases. "The people have learned the benefits of vaccination and the fact that the government is now providing free vaccines, so even the local budget is very tight, it will manage to find the money to continue, if the international funding could not be sustained," Zhang said.

Vanormelingen said income disparities between Chinese regions and between urban and rural residents promote UNICEF to lobby the GAVI board to continue its support to China, despite the country's fast economic growth,

Despite the achievement, more than one million babies born each year in the GAVI project counties are still not receiving a timely birth dose, mostly because they are not registered, or their locations are too remote to reach.

Meanwhile, Chinese experts say the vaccination for children of huge migrant population in the Chinese cities, commonly uncovered by the city welfare programmes, remains a big challenge.

"Of course there are many problems. We believe with the strong commitments from the governments and the close co-operation between international and national partners in expertise and organizations, we will have a bigger chance to work out solutions," Badler said.

(China Daily 08/02/2006 page13)