Marine Martirosyan
Vahe Sarukhanyan 

On October 30 of last year the Armenian government adopted a law to accept a donation from The Center for Vaccine Equity (CVE), a division of the U.S. based Task Force for Global Health.

The donation was in the form of 60,000 seasonal influenza vaccines. A memo of understanding on how the vaccines were to be provided was signed by the CVE and Armenia’s Ministry of Health. The memo regarding the free medicine contains a number of interesting clauses that casts suspicion on this charitable donation.

First, we should note that the ministry’s website surprisingly contains no new information on the memo. Last fall, the press in Armenia only covered the issue in passing and used news supplied by the ministry’s website as their main source. So let’s now try and understand why the government decided to accept the donation of medicine and what those drugs actually are.

It was Sergey Khachatryan, the Deputy Minister of Health, who proposed the initiative to the executive branch. It was the health ministry that drafted the documents, including the memorandum and arguments supporting it. The ministry noted that a campaign against seasonal flu hadn’t been included in the government’s National Vaccination Agenda.

“Due to an increase in influenza illness in the past few years, an epidemic risk situation has been registered in the country and the health of vulnerable groups is at risk,” read the ministry’s argument in favor of the initiative. Vulnerable groups, as cited by the ministry, include the military, health workers, children in orphanages and their staffs, and old age homes.

Of interest is that the health ministry did not specify the years when cases of influenza had increased in the country. According to the annual logs of the ministry, influenza cases from 2009-2013 significantly dropped in comparison to the 1990s or the early 2000s.

In the bar chart below we show the figures for influenza both in absolute and relative numbers (per 100,000 individuals). There were no registered cases in 2012.

In the health ministry’s argument in favor of the initiative we read:

“Throughout the entire world, as in Armenia, numerous influenza cases are registered yearly, due to the various type sand sub-types of influenza, which show up in at risk and age groups with different levels of intensity, which increases the burden placed on the health sector. Statistics from epidemiological analyses prove that two peak periods of illness are registered in the country – from September to October and the following February, which continues till the end of April.

The most effective preventative measure against seasonal influenza, taking into account its airborne transmission mechanism, is vaccination. In accordance with proposals of the World Health Organization, it is necessary to give preventative vaccinations to vulnerable groups on the advent of each season given that such groups often display complications from flu, including death.”

Pneumonia Mortality Rates at Hospitals (Individuals aged 0-14 and over 14)

The health ministry’s argument in favor of the initiative continues:

“In recent years, no primary preventative measures against influenza have been taken in Armenia. As a result, the at-risk season is regarded as a period for increased flu and related respiratory illnesses. This negatively impacts on attendance by students and staff alike at the country’s schools and on wide segments of society, oftentimes resulting in serious cases. This was the case in the military during last year’s flu season.

Frontline preventative measures against the flu haven’t been comprehensively implemented in Armenia, mainly due to a lack of funds. In some years only a tiny number of vaccinations have been carried out, and not all vulnerable groups were included.

The non-profit Task Force for Health’s Center for Vaccine Equity is proposing a donation of flu vaccines, something which is of urgent necessity for the country. Given the vagaries of the international vaccine market, coupled with the intensification of seasonal influenza, there is a great disparity between the supply and demand for vaccines.”

Armenia’s Ministry of Health says the value of the vaccines is US$ 600,000. Thus, the cost of one is $10.

The memo was signed by Minister of Health Armen Muradyan and Thomas Rosenberg, Executive Vice President of the Task Force.

What vaccines did Armenia receive?

Armenia received flu vaccines designed for the southern hemisphere. As we all know, the peak flu season lasts from fall to spring. Since this period is different in the two hemispheres of the globe (In the northern hemisphere from September–May; in the southern hemisphere from March to November), the World Health Organization has come up with two formulas for manufacturing flu vaccines and two application stages. And despite the fact that Armenia is located in the northern hemisphere and the flu cases, according to the ministry of health, peak during September to May, Armenia was given vaccines designed for the southern hemisphere.

In any event, the vaccines for both hemispheres don’t differ all that much. They both cover H1N1  - a subtype of the virus of influenza A  - most commonly known as ‘swine flu’,  influenza A virus subtype H3N2, and Type B viruses. We should note that Flu types A and B can turn into epidemics and pandemics, which isn’t the case with Type C influenza. In other words, the vaccines prepared with these elements are logically designed to prevent epidemics and pandemics.

Who is donating the vaccines to Armenia?

As we noted at the start of the article, the Center for Vaccine Equity (CVE) has allocated the vaccines to the ministry of health.

The CVE is part of the The Task Force for Global Health (TFGH) a nonprofit, public health organization, based in Atlanta, Georgia.

It was founded as the Task Force for Child Survival in 1984. The Task Force was initially tapped to serve as a Secretariat for a consortium of global health organizations: UNICEF, WHO, The Rockefeller Foundation, The United Nations Development Programme, and the World Bank.

 It later changed its direction as neutral convener and collaborator, and began to get involved in global health projects. The TFGH implements a variety of health-related programs and immunization and vaccines is just one of them. This is the purview of the Center for Vaccine Equality established in 2011. According to Forbes magazine, TFGH was the third largest non-profit in terms of private donor projects.

TFGH was co-founded by global health pioneer and former Center for Disease Control (CDC) Director, Dr. William Foege and two of his former CDC colleagues, Carol Walters and Bill Watson. It’s no accident that the CDC and Emory College are partners of the TFGH. Emory is where the Food Fortification Initiative (FFI) is located, an international group that advocates the enrichment of wheat, maize flour and rice. Such an enrichment plan is being debated for Armenia.

TFGH obtained the vaccines from Green Cross Corporation via the non-profit Global Health Solutions (GHS).

Hetq sent a list of questions to the health ministry on March 25 on this issue. To date, we haven’t heard back from them. In the future we will take a detailed look at the memorandum and its interesting facets.

(To be continued)