The introduction of the hepatitis B vaccine has been very successful, with global coverage rates rising steadily. By April 2005, 158 countries had introduced the vaccine into their routine immunization programmes (12). This major turnaround came about because disease burden data are now well-established and because of a sharp drop in cost.
Low-income countries received assistance for the purchase and delivery of hepatitis B vaccine from the Global Alliance for Vaccines and Immunization (GAVI), a public-private partnership, and its financing arm, The Vaccine Fund. GAVI's target is for all countries to introduce the vaccine by 2007.
Use of the conjugate vaccine against Haemophilus influenzae type b (Hib) is gradually increasing but still falls far short of what is needed, particularly in the poorest countries. By April 2005, 96 countries immunized children against Hib as part of their routine immunization programme (13).
Vaccines against pneumococcal and meningococcal diseases and rotavirus are being improved. These vaccines have the potential to save millions of children from death and disability and may be more widely available in developing countries by 2008-2009.
New vaccines are far more expensive than the traditional vaccines, and most developing countries still lack the necessary financial and technical resources to introduce and sustain their use in routine immunization programmes. Expanding cold chain and delivery capacity, determining disease burdens and accurate forecasting present additional challenges.
In that regard, GAVI has had a large measure of success in mobilizing resources for countries seeking to introduce new and underused vaccines as part of its immunization programmes. Since it was launched in 2000, it has committed five-year grants totalling about $1.4 billion to 72 eligible countries for all supports (14). A further challenge will be to ensure countries' continued financial sustainability in immunization with new vaccines once GAVI support ends.