No child born to die

Save the Children’s call to mobilise global vaccinations provides hope to millions of children, but obstacles remain.

Save the Children - Nurse preparing vaccine
Almost nine million children die each year before their fifth birthday [Credit: Anna Kari/Save the Children]

Tayitu’s eyes well up with tears each time she gazes helplessly at her son Siham as he struggles to draw breath.

She is still grieving over the loss of Siham’s twin-brother Redwan, who died only a few months ago due to pneumonia.

Tayitu now fears the fatal disease may have returned, this time to claim Siham – who has just turned one. She is losing hope fast.

The nearest district hospital from her village in the Amhara region of northern Ethiopia is a four hour drive away, and the last time she took Redwan there, she had to wait for more than a day to see a doctor. Redwan received intensive treatment for 12 days but died soon after he returned home.

“Now Siham has also started with breathing problems. It’s as if his breathing is obstructed. I’ve taken him to the health centre but I’m afraid that even if I take him to the hospital, like I did with Redwan, it will not make a difference,” says Tayitu.

Child killers

Tayitu with Siham at home in Amhara Region, Ethiopia [Credit: Caroline Trutmann/Save the Children]

Her fears for the life of her son are not misplaced. Pneumonia accounts for nearly one in three child deaths in Ethiopia, other major killers being diarrhoea and malaria.

Globally, the picture is not much different in most of the poorest countries.

Pneumonia and diarrhoea kill more children under the age of five than any other illnesses, accounting for three times more deaths than malaria and HIV combined. Annually, 1.6 million children under five die of pneumonia and 1.3 million succumb to diarrhoeal diseases. Almost all of these deaths occur in developing countries.

“For every child who dies from pneumonia – the most common form of serious pneumococcal disease – in rich countries, 2,000 die from pneumonia in developing countries. This is not acceptable,” says Helen Evans, the interim CEO of GAVI Alliance (formerly known as Global Alliance for Vaccines and Immunisation) – a public-private global health partnership created in 2000 to save children’s lives and protect people’s health by increasing access to immunisation in the world’s poorest countries.

But there is a new glimmer of hope. Experts believe the scandalous scale of child mortality can be drastically reduced through adequate health care interventions, including immunisations.

In what could be described as the biggest global fight against pneumonia and diarrhoea to date, GAVI has started providing the most advanced vaccines ever to the world’s poorest countries which could potentially save millions of children’s lives.

Initially the pneumonia vaccines are being rolled out and GAVI intends to follow the release with rotaviral diarrhoea vaccines in the near future.

For pneumonia, this is the first time that variants of a vaccine are being made available that specifically target the strains of the disease prevalent in a region.

The rotavirus vaccine, on the other hand, is targeted at saving children from rotaviral diarrhoea which is highly communicable; just clean water, sanitation and hygiene will not prevent babies from contracting it, and virtually every child on the planet will have at least one infection by their third birthday.

In the most severe cases infants will quickly become dehydrated, putting their lives in danger.

In wealthy countries, few children die from rotaviral diarrhoea because of ready access to health care services and over-the-counter treatment, and because well-nourished children are less susceptible in the first place.

In developing countries, however, rotavirus can be lethal – especially if children have a weakened immune system because they are malnourished. The problem is further compounded if they have limited or no access to health care.

The new immunisation drive – which will see infants in Kenya, Sierra Leone, Yemen and Guyana immunised against pneumonia through their public health service for the first time this year – means the poorest countries can access the benefits of the vaccine within months of it being rolled out in the West.

This is a significant departure from what has happened in the past, where developing countries had to wait for years before the same vaccines were released in their markets at a price affordable to them. 

In an innovative co-financing scheme, the developing countries will share the cost of these vaccines starting at only a few cents, depending on their per capita income. The rest of the cost will be borne by the funds pooled by GAVI, donated by rich nations and other donors.

An important part of the arrangement involves pharmaceutical companies supplying the latest vaccines for distribution at a significantly reduced cost to what they charge in developed markets. In return, they get a committed investment from donors for long-term supply.

It is like ordering a large stock of supplies from a wholesaler and getting a massive discount in return for making advance payments. This enables governments to budget and plan for their long term immunisation programmes.

As more pharmaceuticals join in the advance payment scheme, the discounts they offer are likely to get more competitive reducing the price of vaccines even further.

Insufficient funding

Nurse Mohammed Abbas gives Hashim an antibiotic to treat pneumonia [Credit: Colin Crowley/Save the Children]

GAVI’s immunisation scheme is highly ambitious. It plans to immunise 240 million additional children in the next five years, saving four million lives. However, a funding crisis is looming.

Out of $6.8bn earmarked for the global programme, only $3.1bn has been committed so far and this goal can only be achieved if GAVI is able to secure another $3.7bn.

As the world’s leading immunisation coordinating agency struggles to cope with a big cash deficit, the effects are beginning to appear. Out of over 45 countries which have been identified for the roll-out of pneumonia and diarrhoea vaccines, only 19 have had funding secured.

“Just when we are on the brink of a breakthrough against these two major child killers, the cash is running out. Without it children will continue to die on a scale, and from causes, that would be unimaginable in the developed world,” warns Justin Forsyth, the chief executive of Save the Children.

The aid agency has launched a global “No Child Born To Die” campaign to save millions of children’s lives around the world and is calling for G8 countries and other rich nations to pledge more cash for vaccines at a special conference to be hosted by the UK government in June.

Forsyth adds: “Without the specially subsidised rates, many developing world governments won’t be able to afford to pay for the pneumonia and diarrhoea vaccines. That’s why GAVI needs to be properly resourced over the next five years if the UN target for reducing child mortality is to be reached.”

Forsyth’s argument is based on harsh realities faced by poorer countries struggling to keep their health care systems on track.

Even at a discounted price, the vaccines are expensive to roll out for many countries. Imagine the scenario for countries like Burundi where the total per capita government health expenditure is just one US dollar, or in Sierra Leone where it stands at four US dollars.

This makes the cost of pneumonia vaccine look phenomenal in context – even at its lowest subsidised price of 10 cents – and a costly purchase to countries already grappling with deep-rooted poverty.

Preventing prevention

In addition to the funding issue, countries are already restricted by their ability to distribute the vaccines; there is no point having new vaccines without the sufficient trained health workers to administer them, or the facilities to store them.

For this reason, in order to qualify for GAVI-supported pneumonia and diarrhoea vaccine introductions, countries must have above 50 per cent coverage of Diphtheria-Tetanus-Whooping cough vaccine as per WHO/UNICEF estimates.

Having this level of existing vaccine coverage suggests a country may be able to cope with the distribution and correct administration of the new vaccines. Therefore the countries with some of the poorest health distribution infrastructures – and who arguably need the vaccines most – still have a long way to go before they can become eligible to roll-out highly subsidised vaccines.

According to WHO estimates there is a critical shortage of 3.5 million health workers in the poorest countries, without whom millions of children will face illness and early death.

Doctors, midwives, nurses and community health workers form the vital backbone of the health services and without them, life-saving measures cannot be put in place. Without them, essential vaccines cannot be delivered.

Even more critically, the children that are served worst by this lack of health provision are – as Save the Children points out – the poorest and most marginalised children; in other words, the children who need help most.  

Despite the obvious challenges, the global immunisation campaign against pneumonia and diarrhoea offers great hope for the millions of people who die from these diseases around the world.

The vaccine roll-out scheme this year heralds a defining moment in global collaboration to reduce child mortality. It also puts to test the commitment of the rich nations to fund the ambitious project which promises to potentially save millions of children’s lives and costs a fraction of what was spent on bailing out the world’s financial system.

Ask Tayitu what a pneumonia vaccine would mean to her child. 

Davinder Kumar is a London-based development journalist and a Chevening Human Rights Scholar. He is currently supporting Save the Children’s media operations. To learn more about the ‘No Child Born To Die’ campaign, you can visit their website.

Source: Al Jazeera