BD and the Partnership for Maternal and Child Health

BD (Becton Dickinson), a leading US medical supply company, and the United Nations Children's Fund (UNICEF) entered into a partnership to eliminate maternal and neonatal tetanus, one the most devastating vaccine-preventable diseases, worldwide by 2005. While only two years old now, the Partnership for Maternal and Child Health has already become an important case study for an effective public-private partnership that uses collaborative multisector efforts to solve a serious global childhood disease.

The Problem: Maternal and Neonatal Tetanus

In the industrial world, neonatal tetanus is a long-forgotten childhood threat because of the tetanus toxoid (TT) booster. But in the developing world, tetanus is dubbed "the silent killer," because it is the cause of death for nearly 250,000 infants and 30,000 to 50,000 women every year. It is caused by a common type of bacteria and usually results from the use of unsterile instruments or unhygienic obstetrical and birthing practices. Tetanus is a painful and debilitating disease and kills 70%-80% of the newborn children it infects.

The good news is that maternal and neonatal tetanus has already been eliminated in 111 of the world's countries. However, there are 49 countries that have not yet succeeded in eliminating the disease and 27 of those account for more than 90% of all cases. In 1990, at the World Summit for Children, government leaders and global health professionals made the elimination of tetanus one its top priorities.

The Solution

To support the World Summit for Children goal, BD teamed up with UNICEF to launch the Partnership for Maternal and Child Health, an ambitious partnership initiative to eliminate maternal and neonatal tetanus worldwide by 2005. The program is also designed to support and extend globally the UNICEF/World Health Organization (WHO) guidelines for safe immunization practices.

The program targets areas of the world that are most at risk for tetanusthose where the reported or estimated incidence of the disease exceeds one case per one-thousand live births, or where fewer than 80% of all women of child-bearing age have received the minimum three doses of the TT vaccine. The program also emphasizes the development of national action plans by the ministries of health and the integration of immunization and education initiatives into a country's other primary healthcare efforts. The governments will outline specific requirements for carrying out the three rounds of tetanus immunization and promoting safe injection practices.

One of the challenges to implementing the program will be raising the necessary financial resources. A fund-raising total of approximately $100 million has been set as the goal by 2005. These funds will be used to help in the administration of the three TT vaccine dosesat a cost of .40 cents eachto the 100 million women at risk in 57 developing countries, and to promote clean birthing practices. Additional financial resources from the participating governments will also be needed to support the program's activities.

The program's comprehensive global plan seeks to achieve the following primary goals:

• Identification of all of the districts within the 57 countries at risk for maternal and neonatal tetanus;
• Immunization of over 100 million women of child-bearing age with three doses of tetanus toxoid (TT) vaccine;
• Promotion of improved birthing practices through education and the provision of disposable delivery kits;
• Promotion of improved immunization services, community surveillance efforts, and school immunization programs;
• Documentation of all incidents and achievements.

Program Partners

In addition to BD and UNICEF, the Partnership brings together the resources and expertise of a number of other important institutions and organizations:

• Bill and Melinda Gates Foundation
• Program for Appropriate Technology in Health (PATH)
• US Agency for International Development (USAID)
• US Fund for UNICEF
• United Nations Population Fund (UNFPA)
• World Health Organization (WHO)
• And a coalition of other bilateral, multilateral and non-governmental organizations.

Each of the organizations involved in the partnership has a stake in the program's success and will provide a combination of financial resources, logistical support, and technical assistance.

Results

• BD initially committed a $1 million cash donation, $3 million in donated BD equipment, and corporate technical assistance to the Partnership for Maternal and Child Health. These funds enabled the development of a comprehensive five-year global plan for the elimination of maternal and neonatal tetanus.
• BD has expanded its program donation to also include 135 million of its Uniject" and Soloshot" syringesat least half of the syringes needed to support the worldwide campaign. Both devices are pre-filled with the vaccine and incorporate the company's newest auto-disable technology, which includes a special one-way valve that prevents the syringe's reuse.
• Biofarma, the national vaccine manufacturer of Indonesia, has agreed to be the primary vaccine supplier for the Partnership program. In addition to filling all of the auto-disable syringes with the TT vaccine, the company will also donate at least 9 million vaccine doses to the tetanus elimination program.
• BD has provided a generous Global Health Fund grant, which supports the staffing of an associate medical professional at Columbia University through a fellowship in international public health. This associate will be seconded to UNICEF to work directly on the Partnership's activities and will serve as an intermediary between the various partners in the program.
• Since January 2000, seven countries have already benefited from the Partnership for Mother and Child Health: Bangladesh, Brazil, China, Ethiopia, India, Indonesia, and Vietnam. All of these countries have begun conducting studies to target high-risk areas and three of the countries (Ethiopia, India, and Vietnam) have already begun immunization initiatives using auto-disable syringes.

For more information about the Partnership for Maternal and Child Health, contact:
Bette Scott
BD, Community Partnerships