Taking steps to save the world's children

It's time for the world to get serious about pneumococcal disease

David Murdoch and Orin Levine

The Press Christchurch

Jul 30, 2008

The New Zealand government showed leadership in June when it introduced the pneumococcal vaccine into the National Immunisation Schedule, making it available free to all infants as well as to at-risk children up to age five. In doing so, they have demonstrated a commitment to protecting our children and they have set an example for countries around the world to follow.

Pneumococcal disease is one of the world's leading infectious killers, yet most people have never heard of the disease. Most are surprised to learn that it kills 1.6 million people world-wide every year – more than half of whom are children under age five years – putting it on par with well-recognized killers like tuberculosis, malaria and HIV/AIDS.

Pneumococcal disease refers to all the infections caused by a bacterium called Streptococcus pneumoniae– or simply "the pneumococcus." The most important infections caused by pneumococcus are pneumonia, meningitis and ear infections.

Pneumococcus is the most common cause of pneumonia in people of all ages. It is also one of the major causes of meningitis - alongside (and not to be confused with) meningococcus which was the target of the recent $200 million vaccination campaign in New Zealand.

Pneumococcal disease is still a major health care problem in New Zealand. Well over 500 cases of pneumococcal disease occur annually, with about 150 of them in children under age five. The true number of cases is much higher, as many are difficult to diagnose with laboratory tests. Maori and Pacific people have high rates of pneumococcal disease, with a recent study from Hamilton and Christchurch showing the incidence of pneumonia was three times higher in Maori than in non-Maori. One in 10 children who develop pneumococcal meningitis die, and as many as 50% of survivors suffer from permanent brain damage. This has been a tragic situation, given that a safe and effective vaccine exists that can prevent most pneumococcal infections.

The introduction of the pneumococcal vaccine into the childhood National Immunisation Schedule is also likely to benefit adults. Since the introduction of the vaccine in the USA and Canada, there has been a significant reduction in the incidence of pneumococcal disease amongst individuals who were not vaccinated, particularly those greater than 65 years old. This indirect effect has presumably occurred through reduction in the transmission of the pneumococcus from vaccinated children to adults.

Global action is now needed on pneumococcal disease. We have a safe and effective vaccine to protect children from pneumococcal infections, and even better vaccines are coming in the next two years. At an international level, innovative financing is making sure that pneumococcal vaccines are affordable and available to all children who need them – not just those living in wealthier countries.

This is essential because of the high rates of pneumococcal disease in the developing world. Groups such as the Pneumococcal Awareness Council of Experts (PACE) have been created to educate policy makers about the benefits of, and opportunities for, prevention.

PACE has created a Global Call to Action that calls upon governments, international institutions, philanthropists and other leaders in health to work together to make sure that safe, effective vaccines are made widely available at affordable prices.

New Zealand is doing its part at home. It is now time for leaders in other countries to do the same, and for New Zealand to join international efforts such as the GAVI Alliance.

Working together, we can prevent the deaths of 5-8 million children by 2030. We have the vaccines, the technology, the financing and the demand to prevent this disease. It is time for governments internationally to take advantage of this progress in health care and ensure it is available to the people who need it most. The price of action will be measured in dollars. The price of inaction will be measured by the number of children who lose their lives to a preventable disease.

Professor David Murdoch
Department of Pathology,
University of Otago, Christchurch

Dr. Orin Levine
Co-chair, Pneumococcal Awareness Council of Experts (PACE)
Executive Director, GAVI's PneumoADIP at Johns Hopkins