Serious pneumococcal infections are a major global health problem and are vaccine-preventable.
Print this pageVaccines for South Asia and the world
Vaccination rates among children have risen dramatically but it is important to continue the efforts.
South Asia provides the world with great technological advances. Its industry makes steel for the world. Its engineers create satellites and invent new software. Its drug companies make treatments available for many. These advances improve lives and strengthen economies all over the globe.
But medical breakthroughs don’t work for people who don’t get them. For the children of South Asia, vaccinations are an example of an effective, safe, and practical technology that holds enormous promise but requires a renewed collaborative rush forward for action. Fortunately, collective action by developing and developed nations, U.N. agencies, private industry and others, is helping these life-saving technologies reach the children who need them most.
The past two decades have seen major progress in the survival of adults and children in South Asia and the world. As UNICEF reported last week, child mortality has decreased to a record level globally. Childhood malnutrition is receding, and simple treatments for diarrhoea and pneumonia are more widely available than ever before. These steps are progress, but more remains to be done. Consider that with more than three million child deaths each year, South Asia remains home to more than 30 per cent of all the world’s child mortality. The rate of death among newborns is unacceptably high, and pneumonia and diarrhoea continue to be the leading infectious causes of death in spite of affordable, simple treatments such as oral rehydration therapy and through breastfeeding, improved nutrition, and vaccination.
Vaccines prevent enormous amounts of disability and death each day. Through the efforts of UNICEF, national governments, and other agencies, rates of vaccination against six of the most lethal childhood diseases rose from a grim 5 per cent in the 1970s in developing countries to a worldwide high of about 80 per cent by the early 1990s.
These global achievements are testimony to what is possible, and highlight the need to continue our efforts and not be satisfied with current levels. Important pockets of under-vaccination remain. In some rural parts of India, for example, 70 per cent of children under age five are not fully immunised against childhood diseases and 40 per cent haven’t received a single shot. In urban centres such as Kolkata, where epidemics spread most easily, almost half of all children in some areas are not fully immunised while 20 per cent have had none.
Bringing down child mortality means including new vaccines as a key part of a child survival package and strengthening the systems to deliver these life-saving interventions. Vaccines to provide protection against the two leading causes of pneumonia deaths — Hib and pneumococcus — are widely available to the wealthy through the private sector but not yet routinely used in India and other major countries in the region. These two bacteria account for about 50 per cent of all the child pneumonia deaths, and the vaccines are recommended by the World Health Organisation (WHO) and easily administered through existing programmes.
Generous donors
Supply and financing obstacles are also rapidly disappearing thanks to generous support by the GAVI Alliance and international donors. Indian manufacturers have just announced the launch of locally manufactured Hib vaccines. Several Asian countries have already made a decision to adopt Hib vaccines. For pneumococcal vaccines, a group of international donors including the governments of Italy, the U.K., Canada, Norway, Russia, and the Bill & Melinda Gates Foundation pledged $1.5 billion over a period of seven to 10 years for an innovative approach to stimulating vaccine development and ensuring affordable prices under an initiative called the Advance Market Commitment (AMC).
The AMC initiative will stimulate suppliers, including Indian manufacturers, to develop and supply these life-saving vaccines to developing countries at affordable prices. For each of these vaccines, the GAVI Alliance provides support to help procure the vaccine for the health systems to deliver them to the children who need them most. As a result of these efforts, 30 of the world’s poorest countries, including Sri Lanka and Pakistan, have already signalled interest in introducing pneumococcal vaccines between 2008 and 2010.
Signs of progress are visible everywhere in South Asia — booming economies and satellites in space. On child survival, however, many recent advances have yet to reach the region’s most vulnerable citizens. In Kolkata, leaders from the region’s UNICEF offices and national governments gathered to use immunisation to improve child survival. Let’s urge them, like their counterparts in other South Asian sectors, to aim for the heavens and reach for the stars. The consequences of inaction — millions of child lives lost unnecessarily — are too great.
(Mathuram Santosham is Professor of International Health and Paediatrics, and Orin Levine is Associate Professor of International Health and Executive Director of GAVI’s PneumoADIP. Both are affiliated with the Johns Hopkins Bloomberg School of Public Health in Baltimore, U.S.)
at Johns Hopkins Bloomberg School of Public Health and is funded by GAVI Alliance.