Over the coming days in Sierra Leone, motorbikes and vans will be loaded up with coolboxes before going into the countryside, carrying a new pneumococcal vaccine that has the potential to change the life chances of millions of children. Malaria, HIV and Aids dominate the headlines, but pneumonia kills 1.6 million children a year, making it the second biggest child killer, after neonatal complications and infections.
In a world where budget constraints at home have made aid donors wary of new commitments, here is a development good news story. Last year, Sierra Leone lifted official charges for healthcare for mothers and children. Now, it is introducing its first vaccination programme for pneumonia, provided free through the public health system. Kenya, Guyana and Yemen are doing the same.
The Global Alliance for Vaccines and Immunisation (GAVI), the partnership between aid donors and the private sector which is financing this initiative, estimates that globally between 250,000 and 550,000 children’s lives could be saved annually through the pneumococcal vaccine. Even at the lower end of this scale, the vaccine could represent a major step forward towards the millennium development goal of a two-thirds reduction in child mortality by 2015.
GAVI’s track record in reducing the lag between life-saving vaccines being developed and reaching children in developing countries has been impressive. But GAVI also faces a funding shortfall of $3.7bn (£2.3bn) between now and 2015. A pledging meeting in London in June will require some hard decisions to be taken if universal coverage of life-saving vaccines in the poorest countries is to become a reality.
As Save the Children argues in a new report released today, No Child Born to Die: closing the gaps, there’s a compelling case for investing in vaccines as part of a wider strategy to cut the mortality of under-fives. Vaccines work: the success of immunisation against measles has been spectacular, with a fall in deaths from 750,000 a year at the start of this decade to 160,000 in 2008. The smallpox and polio eradication programmes are – justly – regarded as totemic development successes. At the right price, vaccines can make a hugely cost-effective contribution to tackling some of the major causes of death and disability in children, saving on costly healthcare further down the line.
There are two challenges ahead. One involves expanding access to the new pneumococcal and rotavirus vaccines. Yet this cannot happen unless a major unfinished agenda is implemented at the same time. Despite the push to expand vaccine coverage in the past decade, one in five children – 23 million a year – go without the DPT vaccine for diphtheria, tetanus and whooping cough, and almost one third of children in Africa are not immunised against measles. Overwhelmingly, these are children from the poorest families, who are most at risk of the diseases vaccines help to prevent. They are usually not being immunised because they are not being reached effectively by wider healthcare. So governments in developing countries need not just to boost overall vaccine coverage, but to focus on the poorest children and as part of a wider set of interventions, without which the impact of vaccines will be blunted.
Bridging the growing funding gap that is opening up for GAVI between now and 2015 will require substantial increases in donor funding, whether from bilateral aid or from innovative finance. At the moment, some major countries, including Germany, Australia, Spain and Italy, contribute very little.
Donors should increase their funding, but also use it judiciously to ensure vaccine coverage is expanded for the poorest children, and to leverage further movement on price by pharmaceutical companies. At the moment, the prices for pneumococcal and rotavirus remain many times those for more established vaccines, and explain a large part of the GAVI $3.7bn funding shortfall. Closing the gap cannot be achieved simply by donors giving more: the private sector needs to help place immunisation on a sustainable financial footing by bringing down costs. A new architecture for pricing needs to be agreed in London, which puts life-saving vaccines within the reach of every child.
Implementing this threefold strategy in 2011 – focusing on the poorest children as part of a drive to expand health care; increasing donor funding; and bringing down prices – could make decisive progress towards the international goal of a two-thirds reduction in child mortality.