More Money Urged to Improve Child Immunization Rates

Three million lives are saved each year through childhood vaccines and immunizations, but that success rate could double with more funding and support, according to a new report on the state of vaccines worldwide.

Major progress has been achieved controlling measles, tetanus, tuberculosis and whooping cough, and steps are being made to tackle influenza and strains of hepatitis, according to the 116-page report produced jointly by the World Health Organization, UNICEF and the World Bank.

Polio is nearly eradicated, the report says. Pockets of the scourge remain only in the most destitute areas of 10 nations in Africa and Southeast Asia, the report said, and the disease was wiped out in Congo in 2001, despite fierce fighting there. However, only $725 million of the estimated $1 billion needed between now and 2005 to fight the disease has been secured, casting doubt on a final push to end polio worldwide.

“In many regions of the world, it is more the rule than the exception for children to die of common childhood conditions such as measles, which alone causes 700,000 deaths a year,” said Dr. Gro Harlem Brundtland, director-general of WHO, in a statement announcing the report’s release this week. “We need to act fast and effectively to ensure that children and adults everywhere have access to life-saving vaccines.”

With an additional investment of $250 million a year, at least 10 million more children would have access to basic vaccines, WHO said. Also, newer vaccines, such as hepatitis B and Haemophilus influenza type B, or Hib, would cost only $100 million more a year. Together the two diseases kill 970,000 children in developing nations each year.

During the last decade, worldwide immunization coverage was maintained at 70%, the report found. However, the number without context hides the disparities among developing nations, those in stagnation and those with a public health system capable of fully treating its citizens.

Fissures grew in countries such as India, where 40% of the world’s polio cases occur in only four districts in the northern state of Uttar Pradesh. Nations in Africa, where civil wars and revolutions defer state funding from the public health infrastructure, have seen vaccination rates slip since their peak of 55% in 1990, while South American nations have seen their rates approach 87% for all vaccines.

Dr. Edward Hoekstra has seen the benefits of immunization firsthand. In a measles inoculation effort in late June, Hoekstra and a crew of 10,000 health workers from WHO, UNICEF and the local Red Cross managed a 94% coverage rate in Kenya, which also hosts 200,000 refugees from war-torn Somalia and Sudan.

“We averted 10,000 deaths immediately,” said Hoekstra, senior health advisor for UNICEF’s Global Measles Programme. “We’re going to Ghana next week, and soon Cameroon.”

Hoekstra began his global health work with the Centers for Disease Control and Prevention, where he helped establish public health clinics in South America. Revisiting them decades later, Hoekstra realized how important his efforts have been.

“I was visiting a clinic in Venezuela I had helped create. It was good to see the clinic was still there, but it was a shock to see the same doctors were still there,” Hoekstra said.

The key to the early success was that the programs were not overly ambitious, Hoekstra said. He helped provide basic public health that a developing state could sustain. Working with WHO and UNICEF, their goal was to create and fund specific and viable programs that would produce a desired outcome of better public health. Success was measured by how many programs were created and how long they lasted, Hoekstra said.

But billionaire businessman Bill Gates changed that in January 2000 with a $750-million donation over five years to the Global Alliance for Vaccines and Immunization, which now coordinates vaccination efforts worldwide.

The major donation by the Bill and Melinda Gates Foundation thrust GAVI into a managerial role. The alliance formed by governments, international groups such as UNICEF, international banks, the vaccine industry and private donors such as the Gates Foundation administers the Vaccine Fund, which the Gateses first filled. The Vaccine Fund now totals $1.56 billion, thanks to help from developing nations and other private foundations.

The Gates Foundation, however, shuns the idea that the Microsoft founder runs the show. “We’re not in the front seat,” said Anne Marie Hou, a foundation spokeswoman.

GAVI approaches world public health by getting a developing country to invest in its own public health infrastructure. Countries receiving support from the Vaccine Fund have been asked to analyze their infrastructure and find ways to make vaccinations and immunizations a sustainable project.

“We work with countries to develop a plan,” said Hou of the foundation’s role. “We don’t build infrastructure, but we get the vaccines there.”