by Keith Martin, GAVI Alliance - February 15, 2011
As a physician, the death of a child from a preventable or treatable disease is one of life’s most heart wrenching experiences. Visiting a West African clinic I was confronted by a row of six lethargic babies splayed out on a long wooden table with IVs in their arms as they fought for their lives. Each was suffering from a type of pneumonia or gastroenteritis that could easily have been prevented by inexpensive, easily available vaccines.
Although they have never been a favourite of any large, international advocacy campaign, pneumonia and diarrhea kill more children under the age of five than any other illness. They account for three times more deaths than malaria and HIV combined. A staggering 1.6 million children under the age of five die of pneumonia and 1.3 million children succumb to diarrheal diseases every year.
Both can kill if the causative bacteria or virus gets into the blood stream. When this happens devastating effects can ensue; dehydration, drops in blood pressure, seizures, cardiovascular collapse, multi-organ failure and death. This enormous, catastrophic loss of life is made all the more senseless because most of the deaths attributable to pneumonia and severe diarrhea in young children are preventable. The solution is within our reach with two new vaccines.
Vaccines are some of the most cost effective public health initiatives in the world and their impact has been dramatic. The Global Alliance for Vaccines and Immunization (GAVI) has been providing vaccines for children living in the world’s poorest countries since 2000. In the last ten years alone GAVI’s programs have saved more than five million lives and could avert another four million deaths but for this to happen more needs to be done.
Recently, GAVI launched a new global initiative to vaccinate children against pneumonia and diarrhea in more than 40 developing countries. This year, for the first time, infants in Guyana, Sierra Leone, Yemen, Kenya, Mali, Democratic Republic of the Congo and Honduras will be immunized against pneumonia. It is hoped that the pneumococcal vaccine will be introduced together with the vaccine against rotavirus to reduce deaths from diarrhea. Where this has occurred the results have been dramatic. In the United States, prior to vaccination programs there were 57 000 hospitalizations and 107 000 visits to the emergency room for rotavirus induced diarrhea. Now, with more than 80 per cent of children in the United States immunized, these numbers have fallen by more than 90 per cent.
Vaccination brings even larger benefits when part of a larger effort to support primary health care in developing countries such as improving people’s access to medications, micronutrients, skilled health care workers, reliable diagnostics, basic surgical procedures, proper sanitation, clean water and electricity. When a mother takes her child to a health clinic for his or her vaccination, it is also an opportunity for her to be in contact with a health worker as well as with a wide range of health services. Remarkably, powerful international development organizations have aligned and can make this happen.
Last year, through the G8’s Muskoka Initiative, UN bodies and others came together to champion maternal and child health. Vaccination programs should be integrated into this worthy effort. Also, GAVI and research based pharmaceutical companies have done an outstanding job to bring the cost of vaccines down in developing countries. This has been achieved through an innovative financing scheme called the Advance Market Commitment (AMC). This mechanism accelerates the development and manufacture of vaccines for developing countries at affordable prices. By creating a market for vaccines, the AMC has enabled drug companies to reduce the total cost of a vaccine to a fraction of what it is in the developed world.
GAVI’s program to vaccinate under fives in the world’s poorest countries against numerous diseases – including pneumonia and diarrhea – will cost $6.8 billion to meet country demand until 2015. So far only $3.1 billion has been raised for GAVI, only enough to introduce the pneumococcal vaccines in 19 of 44 countries. With another $3.7 billion the program could be rolled out in the remaining 25 countries. This investment could save another four million children’s lives in the next five years alone.
Will the international community take up GAVI’s challenge and fully fund this program? Or will we miss one of the greatest opportunities to improve the lives of the world’s most vulnerable children?
Dr. Keith Martin is a physician and Member of Parliament. He is also the founder of the Canadian Physicians Overseas Program and the Centres for International Health and Development initiative. For more information please visit www.canadaaid.ca.