RESULTS works with AusAID to tackle diseases of poverty

LAST week RESULTS had the ear of the Executive Director of the Australian Agency for International Development (AusAID), Mr. Peter Baxter.

Maree Nutt and Rachel Achterstraat from RESULTS, along with Rob Lake, Executive Director of the Australian Federation for AIDS Organisations, met with Peter Baxter in Canberra to talk Global Fund and TB-HIV.

The meeting began with an energetic debate on Australia’s commitments to the Global Fund to Fight AIDS, TB and Malaria. The Global Fund is one of the world’s most successful instruments in the fight against the diseases of poverty. This was noted in our discussions and also reflected in the Australian Multilateral Assessment of the Fund (release April 2012), in which it was ranked strongly on impact but below average on some aspects of organizational behavior.

Since the Assessment was performed, the Global Fund has made significant progress in its reforms. Over coming months RESULTS will be keen to monitor and promote further progress with its members and their Parliamentarians to enable future Australian funding for the Global Fund to increase with renewed confidence.

Also raised in discussions was an issue very close to RESULTS heart – that of tuberculosis (TB). RESULTS volunteers have worked for years to raise the profile of TB amongst Australian and international decision makers – a disease that all in the meeting agreed was a major concern in our region and which required greater attention.

Acknowledging the efforts of RESULTS members to speak on behalf of people suffering from TB, Mr. Baxter suggested that we work together to further shine the light on this often overlooked disease.

An area for further discussion was the concept of a regional stakeholder meeting on tuberculosis in 2013. RESULTS would welcome working with AusAID on any initiative that has the potential to raise the profile of the disease and improve outcomes for people living with or at risk of contracting TB especially in the Asia Pacific region.

With the need to appoint a new Australian AIDS Ambassador in the near future, RESULTS may also look to support the broadening of this role to encompass both TB and Malaria. This would further demonstrate recognition of the combined impact these diseases on people living in poverty and their significance in Australia’s aid efforts.

Well done to our RESULTS members for your passion and determination to speak on behalf of the families, individuals and communities who needlessly battle against TB each day. Your advocacy over the years is inspirational in meetings such as these.

Speed up testing for TB to save lives

LAST Friday, June 8, the Ministry of Health in China released a report stating that the nation is facing a "serious epidemic" of multidrug-resistant tuberculosis (MDR-TB).

Using World Health Organisation figures as a basis for comparison, the report found that China has the highest annual number of cases of MDR-TB in the world, with a prevalence of 5.7 per cent amongst TB patients. That’s nearly twice the global average.

Another shocking piece of new information was that one in 10 Chinese patients recently treated for TB, actually had a drug-resistant strain of the highly contagious lung disease. These people would have suffered the cost and side-effects of the TB drug treatment, without any real hope of recovery.

The reason for this gross diagnostic oversight is that the current technology being used for TB diagnosis is inadequate. ‘Smear microscopy’ fails to diagnose TB in 1.8 million people every year, especially cases among women, children, and people living with HIV. In a nutshell, we are failing to detect TB amongst those who are most vulnerable, at a global level.

But there is a solution.

In December 2010, the World Health Organisation endorsed a new tool to diagnose TB: Xpert MTB/RIF (Xpert). Instead of using a microscope, this revolutionary tool uses DNA technology to rapidly identify TB bacteria in less than two hours.

By diagnosing patients correctly and in hours rather than in weeks, Xpert allows patients to immediately know their status (and form of TB contracted), helping them to receive treatment earlier, stop the spread of disease in their communities and lead healthier, more productive lives.

Xpert could be a game changer for TB control in China and globally. With the technology now available, it would be unethical to deny people access to an accurate diagnosis of their illness; a luxury that we in Australia take so much for granted.

Check out this photo blog which shows how Xpert has dramatically improved MDR-TB control in India.

One year on: GAVI Alliance on track to save 4 million lives

ONE year ago today, international donors pledged to invest $4.3 billion to immunise 250 million children and save an estimated 3.9 million lives.


At the Global Alliance on Vaccines and Immunisation (GAVI) pledging conference last year, the total pledged surpassed even GAVI's own target of $3.7 billion.

With strong advocacy from RESULTS volunteers, the Australian Government more than tripled its contribution to $200 million over the period 2011-13.


And GAVI is delivering on its side of the bargain. A first-year ‘report card’ shows the Alliance is delivering on its promise to immunise 250 million children by 2015 -- and in the process save four million lives.


Some of the key milestones include:
- Routine immunisation rates across all GAVI-supported countries averaging over 80 per cent;
pentavalent vaccine introduced in 65 countries;
- Developing countries rolling out new vaccines against the major causes of the two biggest childhood killers in the world: pneumonia and severe diarrhoea.
- The first-ever GAVI funding windows for vaccines against human papillomavirus and rubella;
- Reductions in price of rotavirus and HPV vaccines for GAVI-supported programmes.
Vaccines provide a proven, cost effective intervention for saving the lives of children everywhere, particularly the world's poorest children. In a time of financial austerity and with international aid spending coming under increased scrutiny, the GAVI Alliance is a clear example of good aid in action.


RESULTS urges the GAVI Alliance to put equity front and centre of immunisation strategies in the next decade. By expanding coverage without addressing inequalities, gaps between rich and poor will widen.


One year on RESULTS congratulates the amazing achievements of the GAVI Alliance, and continues to champion the potential for immunisation to reduce poverty - urging greater efforts to reach the final 20 per cent of children around the world still left without access to vaccines.

Funds raised for RESULTS!

THREE Sydney schoolgirls raised $320 for RESULTS from a cake stall in their local community during the school holidays. 

 A huge THANK-YOU goes out to Ella, Edita and Sienna for their awesome work! 

The Global Fund: Back in Business

The Global Fund to Fight AIDS, TB and Malaria will be ready to begin funding new grants in September 2012. 

This good news is a far cry from where the Global Fund found itself just over six months ago, when due to lower than expected donor contributions, it announced that no new grants would be approved until 2014.

The decision was taken by the Global Fund Board at its meeting in Geneva on May 10-11, 2012.

The Board said that its decision was made possible by a "new and encouraging financial forecast," which estimated that approximately $1 billion would be available to fund new grants in the period 2012-2014.

This $1 billion is on top of the $615 million that was made available in March 2012, to carry essential programs through the period of uncertainty that was facing the Global Fund.

The positive forecast is a result of strategic Board decisions and transformations currently underway which have significantly improved the Funds financial supervision and overall efficiency.

The better than expected financial position has been made possible by money from new donors like Namibia, a hike in contributions from existing donors such as Japan and Saudi Arabia, and the cutting of support for programs in some emerging economies such as China and Brazil.

Whilst the Board is pleased that work can begin so much sooner than what was originally thought, it is concerned that current pledges remain insufficient to sustain current efforts and continue making the great gains in global health for which the Global Fund has become well known.

RESULTS, along with other Australian aid advocacy groups such as MSF, World Vision, the Global Poverty Project and Oxfam, will be calling on the Government to make an additional $100 million commitment to the Global Fund this year, as a vote of confidence in its life-saving work.

UN Secretary General Ban Ki-moon has offered to host a dinner during the UN General Assembly session in September 2012 in support of health-related development goals, with a special focus on the Global Fund. 

The dinner should provide an opportunity for heads of state and government, and also for business leaders, to recommit themselves to the Global Fund as a key instrument for the achievement of the Millennium Development Goals, and, for some, to also announce new financial commitments.

The case for vaccines

Mary Moran is the Director of Policy Cures’.

Policy Cures’ mission is to provide innovative ideas and accurate analysis to accelerate development and uptake of new drugs, vaccines, diagnostics and other products for diseases of the developing world.

The widespread introduction of vaccines against common childhood diseases was one of the defining health interventions of the last century.

A decade-long immunisation campaign by the World Health Organisation resulted in the eradication of smallpox. When the programme began, the disease still threatened 60 per cent of the world's population and killed one in four people it infected. Similarly, polio at its peak paralysed or killed half a million people per year. Since the widespread introduction of a safe and effective polio vaccine, the number of reported cases has dropped by over 99 per cent. 

It’s not for nothing that WHO Director-General Margaret Chan declared vaccines to be ‘one of the best life-saving buys on offer’ – currently available vaccines are estimated to prevent over 2.5 million child deaths every year.

A new generation of vaccines for developing countries – such as those against pneumonia, meningitis and diarrhoea – is now showing the potential to extend this impact. A vaccine against meningitis A (costing less than 50 cents a dose) was introduced in three African countries in 2010. Historically, meningitis epidemics have killed as a many as 25,000 people and sickened 250,000 in a single year. Of the nearly 20 million people who received the vaccine in the 2010-11 epidemic season, not a single one came down with meningitis A. Vaccines against diarrhoea.

Australia has been a leader in developing many of these vaccines: it was an Australian who first discovered rotavirus – which alone kills nearly half a million children every year – and an Australian who developed the world’s first ever highly-protective vaccine against a parasite.

Recently, the Australian government has also stepped up: in 2011 it more than tripled its funding to the Global Alliance for Vaccines and Immunisation (GAVI Alliance), bringing its total investment to $200 million over 3 years.

This funding is a recognition of not only the importance of the problem, but also Australia’s capacity to make a difference; as Joel Negin from the University of Sydney points out, this contribution to GAVI amounts to less than a cup of coffee per Australian per year. It also highlights the way multilateral organisations like GAVI can effectively translate our aid dollars into lives and money saved.

But, as welcome as these advances are, more remains to be done. It is not enough to buy existing vaccines – we also need to make the ‘missing’ vaccines that patients in the developing world need.  Malaria still kills more than 600,000 people per year, the lack of a HIV vaccine means HIV treatment costs are soaring while overstrained health systems struggle to cope with the demands of scaling-up treatment, and our vaccine against tuberculosis is nearly a hundred years old and ineffective in the tropical regions where it is most needed.

We know that investing in R&D of new vaccines saves millions of lives, as the polio and smallpox vaccines have shown. We also know that failing to invest in R&D is a grave mistake that can cost millions of lives. In the 1990s, the global community didn’t invest in R&D to create pneumonia and rotavirus vaccines for the developing world even though the technology and expertise were available: as a result millions of lives have been needlessly lost from these two diseases while we waited for catch-up funding to create these vaccines in the 2010s. We cannot allow this to happen again.

Ongoing financial woes in Europe and slow recovery in the United States are putting pressure on the traditional funders of R&D for neglected diseases. Despite this, David Cameron’s government in the UK has ring-fenced the aid budget from huge public spending cuts – saying that it is a mark of a country that ‘we never turn our backs on the world’s poorest’. 

The US, meanwhile, continues to provide twice as much public funding for neglected R&D than the rest of the world’s governments combined. In comparison, Australia provides only around 1% of global public funding for neglected disease R&D, despite having the enviable status of being one of the only advanced economies to avoid a recession in the global financial crisis.

It would be almost negligent – not to mention short-sighted – for Australia not to strengthen its investment in vaccines and immunisation when it has the chance. Deferring the aid budget increase because of an arbitrary timeline for returning the budget to surplus would be placing political expediency before human lives.

Over two million children die every year from vaccine-preventable illnesses. Many more die from diseases against which there either no vaccine, or only a Western vaccine that is unsuited to developing country use.

Australia needs to continue to invest in delivering vaccines to those who need them, but also to increase its investment in R&D for the next generation of vaccines: we need both.

Evaluation of ways to increase vaccine uptake in Timor-Leste

Professor Peter McMinn is the Bosch Chair of Infectious Diseases at the University of Sydney. He has developed extensive research and teaching collaborations in Southeast Asia and has spent long periods in Malaysia, Indonesia, Timor-Leste and Vietnam training local microbiologists in communicable disease diagnosis and research and in epidemic and vaccine-preventable disease surveillance.  

Timor-Leste is a newly independent nation, which is currently ranked 162 of 182 countries in the UN Human Development Index. In 2010, the under-five mortality rate was 64 per 1000 live births and the neonatal mortality rate was 44 per 1000 live births. Acute respiratory and diarrhoeal infections, many of which are vaccine preventable, are the major causes of morbidity and mortality of under-five year old children. In 2010, only 46% of Timorese children were fully immunised and 23% had received no immunisations at all. Consequently, there is an urgent need to increase he uptake of vaccination in Timor-Leste.

The reasons for poor vaccine uptake in Timor-Leste are many, including the remoteness of many communitiesfrom existing health facilities and low levels of literacy and health knowledge, especially in remote rural communities. The poor state of the roads in Timor-Leste compounds the problem of getting vaccines tothe children who live in remote communities.

We are currently engaged in a project with the Timor-Leste Ministry of Health to identify possible ways to increase childhood immunisation uptake from the current 46% completion level to 90% or greater.

One means of achieving this will be through the introduction and road-testing of an electronic immunisation registry, in which newborn infants will be uniquely identified by fingerprint scanning. Infants presenting to mobile and fixed primary healthcare clinics or in their homes (see below) will be identified by the fingerprint scanner and immunizations due for that child will be displayed. We will evaluate the feasibility, suitability and acceptability of the registry under local conditions as well as to examine how well it improves the uptake of immunsation. A pilot study of the electronic immunisation registry will be undertaken in the Dili District.

Given the current state of road and health facility infrastructure in Timor-Leste, it is currently necessary to take a more proactive approach to bringing vaccines to children living in remote communities. This necessitates a door-to-door approach to finding children and providing them with immunisations. Vaccines will be transported to remote communities rather than expecting mothers to walk their children over long distances in mountainous terrain to reach the nearest health post. We propose to train health workers to deliver vaccines to children in their homes. The health workers will bring the vaccines to the remote villages by motorcycle or, if necessary, by carrying the vaccines on the backs of Timor ponies.

We hope that the introduction of an electronic immunisation registry plus the initiation of door-to-door delivery ofvaccines will increase the uptake of vaccines toward 90% of Timorese children, thus preventing the circulationof many vaccine-preventable diseases and leading to a major improvement in children’s health.