Originally the advertising slogan for Virginia Slims cigarettes, the message “we’ve come a long way baby” targeted the ‘modern woman’, tapping into the women’s liberation movement of the 1960s and 70s to sell their product. Ironically, the campaign now serves as a reminder of how far the anti-smoking movement has come and what a concerted public health effort can make possible.
Meanwhile, the fight against pneumonia is a public health success story – in progress.
By the late 90s, around half of all developed countries were using the Hib vaccine to immunise children against what was then one of the main causes of pneumonia – haemopilus influenzae type b. But in low-income developing countries, high costs meant children had no access to the vaccine. It was not until 11 years after Hib was introduced in developed countries that the first developing country was able to include the vaccine in its national immunisation program. Even then introduction was only made possible by manufacturer donations.
“It took a dedicated campaign” says Gavi, the Global Vaccines Alliance, “to bring about positive and dramatic change.” The 2005 Hib Initiative funded alliance members to combine their knowledge and expertise to promote uptake and create demand through advocacy and evidence-sharing. The campaign called for the inclusion of Hib vaccine in every national immunisation programme and in just four years, almost all low-income countries had introduced Hib vaccines, preventing as many as 430,000 deaths. The vaccine has since led to eradication of Hib meningitis in some of the poorest countries in the world.
But another ten years on, pneumonia is the biggest infectious killer of children under five.
Why is a vaccine-preventable disease killing two children every minute?
Vaccinating children against Hib was just the beginning of the story. The most significant cause of pneumonia is the pneumococcus bacteria. There are more than 90 types of pneumococcus and the most effective vaccines against these bacteria are pneumococcal conjugate vaccines (PCVs) which immunise against multiple strains.
Building on lessons learned from the delay between introduction of the Hib vaccine in developed countries and rollout in developing countries, Gavi recognised the need for another targeted campaign. They came up with the Advanced Market Commitment, an innovative financing mechanism to accelerate the development and introduction of new vaccines in low-income countries through guaranteed purchase of vaccines, ahead of production at a set price. PCVs were chosen for the pilot program. As a result, PCVs are now being delivered in 57 low-income countries and have helped vaccinate 109 million children against pneumonia.
Universal access to Hib and PCVs could prevent half of the nearly 1 million child deaths that pneumonia causes each year (2015). But 170 million children have not received these vaccines and 99% of children who die from pneumonia were born in developing countries. PCV coverage remains lower than many other vaccines at just 37% and is rising more slowly.
The Advanced Market Commitment has been a huge step in the right direction, but its work is just the beginning. As with the Hib Initiative, leadership and commitment, including from governments, manufacturers, the health sector and the public are needed to step-up the fight against pneumonia. In our report Fighting for Breath Save the Children explains how the international community can come together to save 5.3 million lives. We’ve come a long way baby, but there’s a long way still to go.