Vaccines have saved the lives of millions of children and could save millions more as newer vaccines are developed and introduced.
Vaccines have resulted in the global eradication of smallpox. We are on the brink of attaining global eradication of polio and measles deaths have decreased by 78% since 2000.
New vaccines will prevent thousands of child deaths each year from rotavirus diarrhoea and pneumococcal pneumonia when countries can gain access to these vaccines.
Immunisation is one of the most cost-effective investments in child health, yet in 2009, in low-income countries, two out of five deaths in children under five years old were caused by pneumonia or diarrhoea.
New vaccines can prevent a large number of these deaths but the global community has not committed the necessary resources to bring the full range of vaccines to all children.
Polio eradication is not yet assured and we are at great risk of losing the dramatic progress made against measles as donor funding has dropped precipitously despite rapid movement toward elimination.
The reduction in measles deaths alone accounts for nearly 25% of the overall reduction in child deaths since 1990. Achieving the fourth Millennium Development Goal — to reduce under-five child mortality by two-thirds by 2015 — will not be possible without additional support for immunisation. It would be a crime if this goal is missed simply for lack of financial support. Society has long recognised the value of vaccines.
Since 1974, the World Health Organisation(WHO) has coordinated a global expanded programme on immunisation. Major support came from bilateral development agencies and the United Nations Children’s Fund negotiated a significantly reduced price for vaccines in developing countries. But vaccines cannot administer themselves. It takes organised structures and trained personnel to deliver vaccines safely to those who need them.
In 2008 more than 22-million infants were missed by routine immunisation services and remain unprotected. Recognising that developing countries need assistance to enjoy the full benefits of immunisation, important global partnerships were developed.
The Measles Initiative has provided more than $700-million in support of campaigns and disease surveillance that strengthen the components of routine immunisation systems, delivering nearly 700-million doses of measles vaccine since 2000 and preventing an additional 4.3-million childhood deaths.
The result is measurable success in improving routine vaccination coverage and in reducing child deaths at an incredibly low cost. But, funding for measles control has dropped by 75% since 2007, resulting in delayed campaigns, outbreaks and deaths. For the Polio Eradication Initiative, Rotary International has played an exemplary role by raising more than $1-billion over the past 25 years, working closely with other partners.
The Gavi Alliance [formally the Global Alliance for Vaccination and Immunisation] was formed to ensure that children in the poorest countries of the world have access to the life-saving potential of new vaccines. The alliance currently provides more than $1-billion a year.
The Measles Initiative and the Polio Eradication Initiative maximise the impact of vaccines. Countrywide immunisation campaigns ensure that all children are vaccinated, even in hard-to-reach areas where many children cannot access immunisation services.
Campaigns are complex undertakings that also deliver other preventive interventions such as deworming medicine, insecticide-treated bed nets for malaria control and vitamin A to prevent the blindness often associated with measles. Yet, even with all of this cooperation, innovation and collaboration, we are at risk of losing many of the gains that have been made.
Since June 2009 more than 30 African countries have experienced measles outbreaks, resulting in more than 89 000 cases and 1 400 deaths. The WHO estimates that the combined effect of decreased financial and political commitment may result in a return to more than half-a-million measles deaths a year by 2013, erasing progress achieved over the past 18 years.
Why is this? First, prevention is invisible. When immunisation is successful, nothing happens. In contrast, disease or injury is highly visible and demands attention. Those who are sick with malaria, tuberculosis or HIV are in immediate need of treatment and can be passionate advocates.
Unfortunately, there are not the same kinds of passionate advocates for prevention as there are for treatment. Furthermore, children do not vote and cannot influence social priorities. So, immunisation often receives lower priority.
Second, the global economy and many developing country economies are in deep distress. This lessens the likelihood that they will invest in low-visibility activities despite very high returns.
Third, there is both donor and recipient fatigue. Donors are tired of being asked to give more even though gains are measurable by decreases in child deaths. Recipients often get tired of having to ask for more, especially when they are having difficulty sustaining the cost of new vaccines.
What needs to be done to save more children? We need a balanced immunisation investment strategy that reinforces routine immunisation, achieves existing initiatives to eradicate polio and reduce measles deaths by 95% and enables the introduction of new vaccines.
At the global level developed countries and philanthropies need to recognise that developing-country needs are increasing as new life-saving public health measures become available, and adjust their support accordingly.
National governments must review budgetary priorities and increase their support for their own programmes. For example, many countries are not providing the 50% of operational costs for follow-up measles campaigns requested by the Measles Initiative.
At the local level people must demand that vaccines and immunisation services be made available without barriers. Only by concerted action at local, national and global levels can we fully realise the massive benefits of vaccines.
Kofi Annan was the seventh secretary general of the United Nations from 1997 to 2006. Jimmy Carter served as 39th president of the United States from 1977 to 1981. Both are members of The Elders (www.theelders.org)