1. Heidi Larson, UNICEF Vaccination in Tomorow's Society - Fondation Merieux NEW COMMUNICATION ISSUES AROUND IMMUNISATION Heidi Larson, Ph.D. Senior Communication Advisor UNICEF New York

2. GLOBAL ENVIRONMENT New vaccines, new issues, new “costs” of vaccination Global vaccine divide between developed and developing countries

3. GLOBAL ENVIRONMENT 2 Less visible disease threats - immunization success - has lead to increased questioning around do we (still) need vaccines? Additional questions around immunization technology - injection safety, waste management, immunization schedules, mass campaigns

4. GLOBAL ENVIRONMENT 3 At the same time, new threats - bioterrorism - and the return of an old vaccine against disease that was once declared as eradicated

5. GLOBAL ENVIRONMENT 4 Stronger rights-based, “right to know” environment - growing civil society demands on access to information The public increasingly challenging “quality” and “safety” of commodities Previously locally isolated adverse events now national/international media events

6. GLOBAL ENVIRONMENT 5 Increased and more rapid communication channels Less-government controlled information and more global and commercially driven media Internet, e-mail, global and satellite TV More frequent global travel, more exposure/understanding of different languages - “francophone issues”

7. GLOBAL ENVIRONMENT 6 Proliferation of research giving sometimes incomplete or controversial information How to address the “incomplete” scientific evidence?

8. Why does it matter to UNICEF? In 2001 UNICEF delivered over 2.8 billion doses of vaccine to ~ 100 countries UNICEF supplies vaccines for over 40% of the world’s children

9. but,... this equals only 5% of the world’s expenditures on vaccines nearly 60% of vaccine is procured from developing countries manufacturers

10. Value of the vaccine market has doubled but value of basic vaccines has dropped by 40% Mercer Management

11. 1992 1997 USA/EU manufacturers leaving the developing country market 1992 to 2001 2001 3 33 7

12. The high social value of vaccines in contrast with their relatively low economic value, compared to pharmaceuticals (US$ 5 bn : US$ 300 bn) Pharmaceuticals Vaccines Economic Value Social Value Rappuoli, Miller and Falkow, The Intangible Value of Vaccination, Science, vol. 297, 9 August 2002

13. Introduction of newer vaccines increases vaccination costs for infants, with vaccine costs increasing from 5% to 30% of the total

14. LESS PUBLIC TRUST Publicly available information on vaccines is confusing WHO, the USA and EU and vaccine industry sometimes give different guidance and standards Confusing information creates more public questioning

15. LESS PUBLIC TRUST 2 Politically, economically, ethnically and socially marginalised groups have less trust in government provided commodities/services - increasing rumours due to lack of trust in the provider (eg. OPV sterilizes, causes cancer and HIV/AIDS)

16. COUNTRIES IN TRANSITION Immunization was previously imposed by government as a “public good” for the health of the public There is new need for citizen demand driven-services.

17. COUNTRIES IN TRANSITION 2 In many countries, immunization is a state-provided service - meaning it is also vulnerable to state budget cuts/constraints Government health staff dedicated to immunization become de-motivated due to strained resources and lack of political support to immunization

18. COUNTRIES IN TRANSITION 3 Preventive services are less attractive than specialized, treatment-oriented professions that earn more money and status Previously government-provided services such as public registries and calls for immunization are less available

19. COUNTRIES IN TRANSITION 4 The health reform process is not followed by adequate structural and behavior changes - people not taking adequate individual responsibility including responsibility for their own health or the health of their own children. Former state-provided services are changed to privatized health care - mandatory and “coercive” versus demand driven services

20. EUROPE OR DEVELOPING ECONOMY? One of the issues facing the region is increasing questions as to whether countries should be procuring “European” or “African” vaccines This vaccine divide has lead to increasing questions on quality - when everyone got the same vaccines there was a different level of trust

21. EUROPE OR DEVELOPING ECONOMY? At the same time other products locally procured/produced are sometimes less questioned for quality and safety because they are local and therefore more trusted Korean Samsung/Hyundai seen as a high-tech products and vaccines are not?

23. (RE-)branding immunization for “tomorrow’s society” Re-establishing the value of immunization - a child right and a public good Benefits (OVER risks) of immunization Immunization as an investment rather than an expenditure Status of immunizer (as “local hero”) vs. immunologist

24. (RE-)branding immunization for Immunization service - public service - civic responsibility? Democratization of demand through community based organizations and the media Positioning Immunization in broader development context - ie. vaccines and national/global security Vaccines - weapons of mass protection!

25. FIGHTING GLOBAL COMMUNICATION CHALLENGES ADD TO INCREASE OF COSTS OF VACCINATION PER CHILD