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Border control

Maintaining the integrity of the vaccine also depends on factors that are beyond the manufacturers’ control. Recent incidents involving falsified vaccination cards have highlighted the effect of weak border controls on the risk of outbreaks. In countries like Nigeria, Uganda, and Sudan, falsified cards can easily be purchased illegally, allowing travelers to bypass international requirements. The false cards are seen as less costly than actual vaccination. A lack of awareness about the risks of contracting yellow fever also leads some travelers to forgo vaccination. Insufficient controls at points of departure and entry further limit surveillance efforts.


The 2016 outbreak in Angola involved Eritrean migrants who were traveling with false cards. From there, the outbreak spread to the neighboring Congo, leading to 137 deaths among confirmed cases and 498 deaths among suspected cases. The response cost Gavi alone $13.7 million, while the economic disruption is thought to have cost the government and local organizations more. Implementation of robust routine vaccination would have led to better coverage rates and could have averted not only loss of life, but the significant impact on the country’s economy.


Another threat comes from the growth of air travel. For example, yellow fever cases were discovered in China despite the fact that Asia was previously considered nonendemic for yellow fever. An Asian outbreak would be catastrophic; current global vaccine production is not equipped to cope with large-scale epidemics in these new areas.


While the global health community has a limited ability to address border control, it can play a role in making sure that travelers and the local population are vaccinated, Nguyen said, adding that Gavi recently launched a new program helping countries increase their capacity to diagnose yellow fever and identify outbreaks.


“Without having a targeted response at the falsification question itself, which by and large is very much within the remit of the authority, we're really making sure that our support for health systems is positioned in a way that meets their needs, and that we're looking at the growing threat of increasing population movements and change of disease patterns in a broader sense,” Nguyen said.


Maintaining a sustained and concerted effort toward implementing the EYE strategy will be key to ensure the long-term success of the vaccine, she said. “It's not a program where we can rest on our laurels. Having the right diversity of supply, increasing volumes, and making sure that we stay in line with the scientific policy will help.”

Maintaining the integrity of the vaccine also depends on factors that are beyond the manufacturers’ control. Recent incidents involving falsified vaccination cards have highlighted the effect of weak border controls on the risk of outbreaks. In countries like Nigeria, Uganda, and Sudan, falsified cards can easily be purchased illegally, allowing travelers to bypass international requirements. The false cards are seen as less costly than actual vaccination. A lack of awareness about the risks of contracting yellow fever also leads some travelers to forgo vaccination. Insufficient controls at points of departure and entry further limit surveillance efforts.


The 2016 outbreak in Angola involved Eritrean migrants who were traveling with false cards. From there, the outbreak spread to the neighboring Congo, leading to 137 deaths among confirmed cases and 498 deaths among suspected cases. The response cost Gavi alone $13.7 million, while the economic disruption is thought to have cost the government and local organizations more. Implementation of robust routine vaccination would have led to better coverage rates and could have averted not only loss of life, but the significant impact on the country’s economy.


Another threat comes from the growth of air travel. For example, yellow fever cases were discovered in China despite the fact that Asia was previously considered nonendemic for yellow fever. An Asian outbreak would be catastrophic; current global vaccine production is not equipped to cope with large-scale epidemics in these new areas.


While the global health community has a limited ability to address border control, it can play a role in making sure that travelers and the local population are vaccinated, Nguyen said, adding that Gavi recently launched a new program helping countries increase their capacity to diagnose yellow fever and identify outbreaks.


“Without having a targeted response at the falsification question itself, which by and large is very much within the remit of the authority, we're really making sure that our support for health systems is positioned in a way that meets their needs, and that we're looking at the growing threat of increasing population movements and change of disease patterns in a broader sense,” Nguyen said.


Maintaining a sustained and concerted effort toward implementing the EYE strategy will be key to ensure the long-term success of the vaccine, she said. “It's not a program where we can rest on our laurels. Having the right diversity of supply, increasing volumes, and making sure that we stay in line with the scientific policy will help.”