Ciro de Quadros

Sabin Vaccine Institute, Washington, Washington, D.C., United States

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Publications (77)549.42 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs.
    Health Policy and Planning 02/2014; DOI:10.1093/heapol/czu002 · 2.65 Impact Factor
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    ABSTRACT: Deployment of oral cholera vaccine (OCV) on the Island of Hispaniola has been considered since the emergence of the disease in October of 2010. At that time, emergency response focused on the time-tested measures of treatment to prevent deaths and sanitation to diminish transmission. Use of the limited amount of vaccine available in the global market was recommended for demonstration activities, which were carried out in 2012. As transmission continues, vaccination was recommended in Haiti as one component of a comprehensive initiative supported by an international coalition to eliminate cholera on the Island of Hispaniola. Leveraging its delivery to strengthen other cholera prevention measures and immunization services, a phased OCV introduction is pursued in accordance with global vaccine supply. Not mutually exclusive or sequential deployment options include routine immunization for children over the age of 1 year and campaigns in vulnerable metropolitan areas or rural areas with limited access to health services.
    The American journal of tropical medicine and hygiene 10/2013; 89(4):682-687. DOI:10.4269/ajtmh.13-0200 · 2.53 Impact Factor
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    ABSTRACT: Despite a WHO recommendation in 2009, reaffirmed in 2013, that all countries should consider introducing rotavirus vaccines into their National Immunization Programs, as of June 2013 only 45 have done so. One major consideration appears to have been the costs of the vaccine to countries. Of concern, is that Asian countries have been slow to introduce rotavirus vaccines despite having robust data that could inform the decision-making process. Although decisions on new vaccine introduction are very complex and vary by country and region, economic evaluations are often pivotal once vaccine efficacy and safety has been established, and disease burden documented and communicated. Unfortunately, with private sector list prices of vaccines often used in economic evaluations, rather than a potential public health sector pricing structure, policy-makers may defer decisions on rotavirus vaccine introduction based on the belief that "the vaccine price is too high," even though this might be based on erroneous data. The Pan American Health Organization's Revolving Fund provides one example of how vaccine price can be made more competitive and transparent through a regional tendering process. Other mechanisms, such as tiered pricing and UNICEF procurement, also exist that could help Asian and other countries move forward more quickly with rotavirus vaccine introduction.
    08/2013; 9(11). DOI:10.4161/hv.26107
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    Ciro de Quadros
    Vaccine 07/2013; 31:C4–C5. DOI:10.1016/j.vaccine.2013.05.058 · 3.49 Impact Factor
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    ABSTRACT: Tenth International Rotavirus Symposium Bangkok, Thailand, 19-21 September 2012 Over 350 scientific, public and private sector experts from 47 countries convened at the Tenth International Rotavirus Symposium in Bangkok, Thailand on 19-21 September 2012 to discuss progress in the prevention and control of rotavirus, the leading cause of diarrhea hospitalizations and deaths among young children worldwide. Participants discussed data on the burden and epidemiology of rotavirus disease, results of trials of rotavirus vaccines, postmarketing data on vaccine impact and safety from countries that have implemented rotavirus vaccination programs, new insights in rotavirus pathogenesis, immunity and strain diversity, and key issues related to vaccine policy and introduction.
    Expert Review of Vaccines 02/2013; 12(2):113-7. DOI:10.1586/erv.12.148 · 4.22 Impact Factor
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    ABSTRACT: Governments have the authority and responsibility to ensure vaccination for all citizens. The development of vaccination legislation in Latin America and the Caribbean (LAC) parallels the emergence of sustainable, relatively autonomous, and effective national immunization programs. We reviewed vaccination legislation and related legal documents from LAC countries (excluding Canada, Puerto Rico, the United States, and the US Virgin Islands), and described and assessed vaccination legislation provisions. Twenty-seven of the 44 countries and territories in the Region have proposed or enacted vaccination legislation. Provisions vary substantially, but legal frameworks generally protect the sustainability of the immunization program, the individual's right to immunization, and the state's responsibility to provide it as a public good. Of the legislation from countries and territories included in the analysis, 44 per cent protects a budget line for vaccines, 96 per cent mandates immunization, 63 per cent declares immunization a public good, and 78 per cent explicitly defines the national vaccine schedule. We looked for associations between vaccination legislation in LAC and national immunization program performance and financing, and conclude with lessons for governments seeking to craft or enhance vaccination legislation.
    Journal of Public Health Policy 01/2013; 34(1):82-99. DOI:10.1057/jphp.2012.66 · 1.48 Impact Factor
  • The Lancet 09/2012; 380(9848):1145-6. DOI:10.1016/S0140-6736(12)61663-8 · 39.21 Impact Factor
  • Ciro A de Quadros
    Vaccine 05/2012; 30(22):3249-50. DOI:10.1016/j.vaccine.2012.04.001 · 3.49 Impact Factor
  • Joel G Breman, Ciro A de Quadros, Paulo Gadelha
    Vaccine 12/2011; 29 Suppl 4:D3-5. DOI:10.1016/j.vaccine.2011.11.037 · 3.49 Impact Factor
  • Ciro A de Quadros
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    ABSTRACT: The smallpox eradication campaign operated in Ethiopia from 1970 until 1977. During this time Ethiopia had only 84 hospitals, 64 health centres and fewer than 400 physicians in a country of 25 million people. In 1970 smallpox vaccination was relatively unknown in the country, and the government actually contested the fact that smallpox was present in the country. Most of the resources of the Ministry of Health were used for malaria eradication. Initial pessimism from the Ministry of Health and others was eventually overcome as the smallpox eradication campaign continued to pick up steam but many remained unenthusiastic. Ethiopia was the first country in the world to start its smallpox eradication campaign from day one with the strategy of "Surveillance and Containment". Establishing a surveillance system in a country with a limited health infrastructure was a daunting challenge. At the end of the first year of the programme in 1971, 26,000 cases of smallpox had been registered through the growing surveillance system. Throughout revolution of 1974 the smallpox campaign was the only UN program to operate in the country; in fact it expanded with the hire of many locals leading to a "nationalized" program. This development ushered in the most successful final phase of the program. As the program progressed cases were diminishing in most regions, however transmission continued in the Ogaden desert. Over the course of the campaign approximately 14.3 million US dollars was spent. Working conditions were extremely challenging and a variety of chiefs, guerrillas, landowners and governments had to be appeased. The programme was successful due to the dedicated national and international staff on the ground and by having the full support of the WHO HQ in Geneva.
    Vaccine 12/2011; 29 Suppl 4:D30-5. DOI:10.1016/j.vaccine.2011.10.001 · 3.49 Impact Factor
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    ABSTRACT: The Expanded Programme on Immunization (EPI), launched in 1974, has developed and implemented a range of strategies and practices over the last three decades to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. Many of these strategies have been implemented, resulting in immunization coverage exceeding 80% among children one year of age in many countries. Yet millions of infants remain under-immunized or unimmunized, particularly in poorer countries. In November 2009, a panel of external experts met at the United States Centers for Disease Control and Prevention (CDC) to review and identify areas of research required to strengthen routine service delivery in developing countries. Research opportunities were identified utilizing presentations emphasizing existing research, gaps in knowledge and key questions. Panel members prioritized the topics, as did other meeting participants. Several hundred research topics covering a wide range were identified by the panel members and participants. However there were relatively few topics for which there was a consensus that immediate investment in research is warranted. The panel identified 28 topics as priorities. 18 topics were identified as priorities by at least 50% of non-panel participants; of these, five were also identified as priorities by the panel. Research needs included identifying the best ways to increase coverage with existing vaccines and introduce new vaccines, integrate other services with immunizations, and finance immunization programmes. There is an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies.
    Vaccine 08/2011; 29(47):8477-82. DOI:10.1016/j.vaccine.2011.08.048 · 3.49 Impact Factor
  • Christopher B Nelson, Ciro de Quadros
    Vaccine 06/2011; 29(38):6443. DOI:10.1016/j.vaccine.2011.06.006 · 3.49 Impact Factor
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    ABSTRACT: Vaccines have already saved many lives and they have the potential to save many more as increasingly elaborate technologies deliver new and effective vaccines against both infectious diseases--for which there are currently no effective licensed vaccines--such as malaria, tuberculosis, and HIV and non-infectious diseases such as hypertension and diabetes. However, these new vaccines are likely to be more complex and expensive than those that have been used so effectively in the past, and they could have a multifaceted effect on the disease that they are designed to prevent, as has already been seen with pneumococcal conjugate vaccines. Deciding which new vaccines a country should invest in requires not only sound advice from international organisations such as WHO but also a well informed national immunisation advisory committee with access to appropriate data for local disease burden. Introduction of vaccines might need modification of immunisation schedules and delivery procedures. Novel methods are needed to finance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to afford them. Here, we discuss some options.
    The Lancet 06/2011; 378(9789):439-48. DOI:10.1016/S0140-6736(11)60406-6 · 39.21 Impact Factor
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    ABSTRACT: Immunization programs are important tools for reducing child mortality, and they need to be in place for each new generation. However, most national immunization programs in developing countries are financially and organizationally weak, in part because they depend heavily on funding from foreign sources. Through its Sustainable Immunization Financing Program, launched in 2007, the Sabin Vaccine Institute is working with fifteen African and Asian countries to establish stable internal funding for their immunization programs. The Sabin program advocates strengthening immunization programs through budget reforms, decentralization, and legislation. Six of the fifteen countries have increased their national immunization budgets, and nine are preparing legislation to finance immunization sustainably. Lessons from this work with immunization programs may be applicable in other countries as well as to other health programs.
    Health Affairs 06/2011; 30(6):1134-40. DOI:10.1377/hlthaff.2011.0265 · 4.64 Impact Factor
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    ABSTRACT: By examining the role research has played in eradication or regional elimination initiatives for three viral diseases--smallpox, poliomyelitis, and measles--we derive nine cross-cutting lessons applicable to malaria eradication. In these initiatives, some types of research commenced as the programs began and proceeded in parallel. Basic laboratory, clinical, and field research all contributed notably to progress made in the viral programs. For each program, vaccine was the lynchpin intervention, but as the programs progressed, research was required to improve vaccine formulations, delivery methods, and immunization schedules. Surveillance was fundamental to all three programs, whilst polio eradication also required improved diagnostic methods to identify asymptomatic infections. Molecular characterization of pathogen isolates strengthened surveillance and allowed insights into the geographic source of infections and their spread. Anthropologic, sociologic, and behavioural research were needed to address cultural and religious beliefs to expand community acceptance. The last phases of elimination and eradication became increasingly difficult, as a nil incidence was approached. Any eradication initiative for malaria must incorporate flexible research agendas that can adapt to changing epidemiologic contingencies and allow planning for posteradication scenarios.
    PLoS Medicine 01/2011; 8(1):e1000405. DOI:10.1371/journal.pmed.1000405 · 14.00 Impact Factor
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    ABSTRACT: Infectious diseases such as smallpox, pneumonia, rotavirus, malaria and measles have inflicted untold pain, suffering and death on the human population. The fingerprints of these deadly diseases can be found across the pages of history. The harrowing effects of pneumonia on the human body were described by Hippocrates as early as 460 B.C.;1 smallpox scarring can be found on Egyptian mummies dating back more than 3,000 years ago;2 and the Persian philosopher and physician Rhazes detailed the devastation of measles in the 10 century A.D.3 Without the benefits of modern medical interventions, our ancestors had little to no defense against infectious disease, and mortality rates were staggering. In 1531, for example, measles was responsible for the death of half the population of Honduras.4 Furthermore, some historical estimates indicate case fatality rates as high as 90 percent during smallpox epidemics among Native American populations in the early part of the 15th century.5 Yet as science advanced, humanity developed defenses against infectious disease in the form of lifesaving interventions, including vaccines, medical products (e.g., bed nets), therapeutics, and behavioral interventions.6 Across the developed world, these interventions quickly turned the tide against infectious disease. In the United States, infectious disease mortality declined 95 percent during the first 8 decades of the 20th century, from 797 deaths per 100,000 in 1900 to 36 deaths per 100,000 in 1980.7 The success of vaccination programs in the United States and Europe ushered in the 20th-century the concept of "disease eradication"-the idea that a specific disease could be eliminated from the planet. In 1977, after a decade-long campaign involving 33 nations, smallpox was eradicated worldwide-approximately ten years after it had been eradicated from the United States and the rest of the Western Hemisphere.8 But for millions living in the world's poor and developing countries, it is as if these live-saving interventions were never developed. The World Bank defines developing countries as those making less than US $11,905 gross national income per capita per year. People living in developing countries make up more than 80 percent of the world's population.9 A child born in a developing country faces many of the same risks her ancestors did 1,000 years ago. She is 237 times more likely to die of Hib disease than a child born to parents living in a high-income country.10 She's also 118 times more likely to die from rotavirus diarrhea,11 89 times more likely to die from pneumococcal disease,10 57 times more likely to die from HIV/AIDS,12 and 29 times more likely to die from tuberculosis.12 For such children, life-saving medical interventions are few and far between. That is why child mortality rates in the developing world remain as high as 60 times those in developed countries,13 and life expectancies are shorter by almost a quarter century.14.
    Human vaccines 11/2010; 6(11):922-5. DOI:10.4161/hv.6.11.13599 · 3.14 Impact Factor
  • The Pediatric Infectious Disease Journal 11/2010; 30(1):1-2. DOI:10.1097/INF.0b013e3182005389 · 3.14 Impact Factor
  • Ciro A de Quadros, Orin S Levine
    The International Journal of Tuberculosis and Lung Disease 11/2009; 13(11):1318. · 2.76 Impact Factor
  • M Teresa Valenzuela, Ciro de Quadros
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    ABSTRACT: The burden of pneumococcal disease in Latin America is most pronounced in children aged <6 years. The increasing rate of resistance of Streptococcus pneumoniae to penicillin and other antibiotics has generated concern among health authorities, since infection by antibiotic-resistant serotypes may be associated with increased mortality. Increased resistance is due to a number of factors including high antibiotic usage in this region. Vaccination with pneumococcal conjugate vaccines offers an effective approach to counter resistant disease due to covered serotypes. Existing surveillance systems must be continued to recognise changes in patterns of resistance and the serotypes that cause pneumococcal disease.
    Vaccine 06/2009; 27 Suppl 3:C25-8. DOI:10.1016/j.vaccine.2009.06.005 · 3.49 Impact Factor
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    ABSTRACT: To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region. We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted. Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated. A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.
    Revista Panamericana de Salud Pública 04/2009; 25(3):270-9. DOI:10.1590/S1020-49892009000300011 · 0.85 Impact Factor

Publication Stats

2k Citations
549.42 Total Impact Points


  • 2004–2013
    • Sabin Vaccine Institute
      Washington, Washington, D.C., United States
  • 2009
    • University of the Andes (Chile)
      CiudadSantiago, Santiago, Chile
  • 2008
    • Rutgers New Jersey Medical School
      Newark, New Jersey, United States
  • 1991–2006
    • Pan American Health Organization (PAHO)
      • Family and Community Health (FCH)
      Washington, Washington, D.C., United States
  • 2003
    • Fundação Oswaldo Cruz
      Rio de Janeiro, Rio de Janeiro, Brazil
  • 1999–2003
    • Organización Panamericana de la Salud
      Buenos Aires, Buenos Aires F.D., Argentina
  • 1998–2001
    • Pedro Kourí Tropical Medicine Institute
      La Habana, Ciudad de La Habana, Cuba
  • 1997
    • Case Western Reserve University
      • School of Medicine
      Cleveland, Ohio, United States
  • 1995
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States