John Wecker

John Wecker helped countries introduce a lifesaving vaccine against Japanese encephalitis.

What’s it take to get a vaccine to a child?

“Introducing a vaccine is a long-term commitment,” says John Wecker, former director of PATH’s Vaccine Access and Delivery program. Before countries commit to adding a vaccine to their public health programs, they need the best information possible about the need for vaccine and its possible effects. Yet this critical information can be strikingly hard to come by.

Take, for instance, the curious case of vaccine against Japanese encephalitis (JE). Sometimes called “brain fever,” Japanese encephalitis primarily strikes poor children in Southeast Asia and the Western Pacific. Infected children who manage to survive have a high chance of being left with neurological problems ranging from paralysis to the inability to speak.

There is no cure for JE. The only solution is prevention through vaccination. But until PATH launched our Japanese Encephalitis Project in 2003, tens of thousands of children died or were disabled each year for lack of an accessible, affordable, and reliable vaccine.

The curious part of the story is that the necessary vaccine already existed.

Documenting a devastating disease

John continues the story:

Despite its devastating consequences, JE was virtually unheard of in the industrialized world. Because of poor diagnostic and surveillance systems, the impact of the disease wasn’t even fully understood in the countries where it existed. In China, 200 million children already had been vaccinated against JE, but no one outside of the country had used the Chinese vaccine. People needed to be convinced that this vaccine was necessary and that it worked.

Photo from 'Vaccine guards millions of children in India from a killer' slideshow.

In 2006, India launched a landmark campaign to vaccinate 100 million children against Japanese encephalitis. View the slideshow.

There are many different factors that decision-makers in developing countries take into consideration before introducing a new vaccine. They need to know the impact of the disease on their country, whether the vaccine will work in their population, and whether it should get priority given competing health needs and scarce resources. PATH’s Japanese Encephalitis Project collaborated with international partners and ministries of health in Asia to accelerate the introduction of the JE vaccine. Working in partnerships, we established better systems for diagnosing JE and tracking its incidence so people could see that JE was, in fact, causing a tremendous number of deaths and disabilities. We also modeled the cost-effectiveness of introducing the vaccine. This hard evidence was critical for decision-making.

At the same time, we supported clinical trials to demonstrate the role that the Chinese vaccine could have in preventing the disease, and we worked with the manufacturer to improve its facilities to meet international standards. Finally, we negotiated an affordable price that would make ongoing immunization programs sustainable for poor countries.

Reaching India and beyond

John describes how the JE vaccine has made a difference to millions of children in the Asia-Pacific region:

In 2006, India became the first country outside of China to use the JE vaccine. Within five years, close to 100 million children were vaccinated. The vaccine has since been introduced in Cambodia, Nepal, Sri Lanka, and the Democratic People’s Republic of Korea, which is also called North Korea. We look forward to the day when all children at risk in the Asia-Pacific region are protected from the disease.

Vaccinating the children of North Korea was particularly gratifying. It required extensive negotiations with the government, the manufacturer, and the US State Department to reach an agreement. As a member of the observation team, I witnessed a highly organized and well-conducted campaign to vaccinate half a million children in just one week. We visited many clinics where mothers and their children, dressed in their finest traditional Korean clothing, waited patiently in long lines to receive the vaccine. Living in fear of an outbreak of JE, these parents were highly motivated to get their children vaccinated. At times like that, it’s clear to me what a difference we’re making.

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Photos, from top: Ryan Youngblood, PATH.