/ 27 August 2008

Access to vaccines expanded

Thousands of South Africa’s poorer children will be saved from death by dehydration or suffocation when vaccines against two of the biggest childhood diseases become available in the public sector next month.

The Eastern Cape is due to start providing children with pneumococcal conjugate (PCV-7) and the RotaTeq vaccines from September.

From April next year the vaccines will be added to the government’s childhood vaccination schedule, according to Biovac, the public-private partnership set up to facilitate use of vaccines in South Africa.

PCV-7 protects children against pneumococcal disease caused by the pneumococcus bacterium, globally the major vaccine-preventable cause of death among young children.

The RotaTeq vaccine tackles the rotavirus, which causes a diarrhoeal disease thought to affect almost every child on the globe before the age of three. Respiratory and diarrhoeal disease are the two biggest killers of children worldwide.

Morena Makohana, deputy chief executive of Biovac, said South Africa will be the first African country to purchase these two vaccines for national distribution. ”It’s exciting; more vaccines means more lives are going to be saved.”

Both vaccines have been available to South Africans who could afford them for some time, but their prohibitive cost has kept them out of the public sector. RotaTeq was registered for use in the United States in 2000 and the PCV-7 in 2006.

Key to the government’s decision to provide the vaccines will be a lower price, but Wyeth, which owns the pneumococcal vaccine, and Merck, which has the RotaTeq vaccine, are coy about the price.

It is estimated that about 600 000 children die worldwide every year from dehydration as a result of vomiting and diarrhoea caused by rotavirus, and close to two million are hospitalised. A further two million children die each year as a result of pneumonia, which directly accounts for about 20% of paediatric deaths. Children living with HIV are vulnerable to the disease and other infections caused by pneumococcus.

The PCV-7 vaccine works in HIV-infected children, although it is less effective. One difficulty is diagnosing the cause of pneumonia in children and the best way to treat it.

Using a vaccine against the pneumococcus will remove one of the potential causes, making detection of the underlying pathogen easier and cheaper.

It will also curb the spread of the disease and cut transmission of drug-resistant pathogens caused by inadequate treatment.

The impact of the vaccines will also be felt by adults. ”You vaccinate the small ones, but the ripple effect goes through to the older people,” said Makohana. Vaccinating enough children leads to ”herd immunity”, where even those who are not vaccinated will not contract the disease.

Harvard professor David Bloom, who gave lectures in South Africa on the economic benefits of vaccination this month, said that preventable diseases are a drag on the economy.

Bloom said vaccination should be seen ”not just as a cost but as an economic generating investment”. Rather than just using moral, legal or social reasons to mobilise governments into extending vaccination programmes, policymakers should also use economic arguments.

The wider benefits also include the avoided costs of illness and death, as well as improved productivity for parents who do not have to care for sick children.

Developmental benefits should also be counted because neurological, cognitive and physical impairment caused by childhood diseases cut children’s potential productivity by reducing their ability to learn.

A problem for policymakers, who may have a relatively short political life-expectancy, is that vaccine costs are upfront, while the benefits happen down the line.

”Policymakers find the additional costs of new vaccines quite daunting. Vaccine programmes are difficult to cost, but the alternative is likely to be even more costly,” said Bloom.