Childhood immunization: remarkable gains endangered by funding issues
Dr Margaret Chan
Director-General of the World Health Organization
Immunization was on the agenda at the May World Health Assembly, which is attended by delegations from all 193 WHO member states.
The immunization session covered current progress internationally and within countries, expectations for the Decade of Vaccines, and plans for WHO to develop a global vaccine action plan to guide work during the decade.
Well over 50 delegations and representatives of civil society took the floor on this item. For those of you unfamiliar with the workings of Health Assemblies, this number represents an extraordinary level of interest and engagement.
I think a brief summary of these interventions is a good way to give you an overview of what countries themselves see as progress and sources of pride. It also tells you some of their deep-seated concerns, right now and for the future.
Many developing countries are proud of their ownership of national immunization programmes, and many have dedicated budget lines as a formal expression of this commitment.
As we enter this Decade of Vaccines, we heard about great progress and high praise for support from WHO and UNICEF, but especially for the GAVI Alliance.
GAVI operates according to a fundamental principle that resonates extremely well with public health thinking in general and the principles that guide the work of WHO: every child, regardless of where it is born or the wealth of its parents, deserves protection with the best that science can offer.
This is an expression of fairness, and this is a principle that guides much of my own personal work.
With GAVI support, vaccines that prevent pneumonia and diarrhoea, the two biggest childhood killers, are now being rolled out in a number of countries. But these new vaccines are expensive and sustainability is definitely a problem, as stressed by many speakers from the developing world.
As reported, many countries have added yellow fever and hepatitis B vaccines to routine immunization programmes.
We heard first-hand accounts of what the new meningitis vaccine, developed in a project coordinated by WHO and PATH, with support from the Gates Foundation, means for Africa and its people.
Launch of the vaccine, which costs less than 50 cents a dose, a price demanded by African ministers of health, began last December in the three hyper-endemic countries in Africa’s notorious meningitis belt, namely Burkina Faso, Mali, and Niger. By the end of that month, 19.5 million people had been vaccinated in the three countries.
WHO and its partners are currently assessing the impact of these initial mass immunization campaigns, including their safety and efficacy. This is a thorough, systematic assessment, but early results look extremely promising.
Epidemic meningitis is not the biggest killer in Africa, but it is one of the most greatly feared of all diseases. My staff in the field tell me that long lines for vaccination form at the first hint of an epidemic that will leave around 25% of affected children, I mean the ones that survive, permanently impaired with brain damage or profound hearing loss.
For once, Africa is the first to receive the very best technology that the world, working together, can offer.
Ladies and gentlemen,
Delegates gave us two extremely clear messages.
First, the achievement of ambitious, yet fully agreed goals, such as expanded immunization coverage, the introduction of new vaccines, polio eradication, and measles elimination, is directly tied to funds.
We heard compelling pleas to fully replenish GAVI funds so that recent spectacular progress, supported by strong country ownership, does not lose its momentum.
Second, expanded vaccination coverage alone will not help countries reach the MDG for reducing young child mortality. According to the latest UNICEF estimates, some 8.1 million young children died in 2009 from largely preventable causes.
This figure is the lowest recorded in more than six decades. It is a measure of welcome progress, but the figure is still way too high. Immunization is thought to prevent 2 to 3 million childhood deaths each year. Vaccines are magic bullets, yes, but they don’t hit all the enemies that extinguish so many young lives.
Countries reminded us of the critical role of basic primary health care measures, such as oral rehydration therapy, home-based antibiotic treatment for pneumonia, and things so straightforward, yet so difficult for the poor, as adequate nutrition and good hygiene.
The issue of sustainable funding came up over and over again. As I have heard on many occasions, a vaccine that is too expensive for the developing world is worse than no vaccine at all.
Many asked the international community to seek ways to reduce the costs of vaccines, especially the newer ones.
Delegates from the developing world referred to the need for technology transfer and skills training to enable local manufacturing of vaccines, especially in Africa. Some described WHO’s key role in achieving exactly this objective for the local manufacturing of pandemic influenza vaccines.
And what has happened since the May Assembly?
On 6 June, leading drug companies announced dramatic slashes in vaccine prices for the developing world, including a 95% price cut on the new rotavirus vaccine that can prevent diarrhoeal deaths.
On 13 June, donors pledged more than $4 billion to support the work of GAVI, an amount that exceeded anyone’s wildest dreams. This money will certainly hasten the introduction of new vaccines and expand vaccination campaigns in Africa’s meningitis belt, which has 25 countries.
There are critics, of course. Many cite the lack of basic infrastructure for delivering vaccines and the crumbling of public health services, after years of neglect, throughout most of the developing world.
But let me reassure the critics. The strengthening of health systems has moved near the top of the international health agenda. The May Health Assembly adopted no fewer than 5 resolutions setting out ways to build stronger health systems that extend affordable services to the poor.
This is, after all, how health operates in the context of the MDGs, with their overarching goal of poverty reduction. By improving health, you reduce poverty. But to do so, you must reach the poor.
Ladies and gentlemen,
This decade of vaccines has a vision, and vision always feeds that perennial optimism of public health that keeps us going despite the many obstacles and setbacks thrown our way by policies and events beyond our control.
This decade will help realize the full power of immunization to prevent morbidity and mortality. And the young lives saved from death or life-long disability will be numbered in the millions.