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 Opinion

World losing the war on virulent, preventable childhood diseases

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Monday, 26 July, 2010

In this article for the Daily Nation, Jimmy Carter and Kofi Annan argue that scaling up immunisation across the world is crucial to achieving Millennium Development Goal 4 - the reduction of child mortality.

Vaccines have saved the lives of millions of children around the world, and have the potential to save millions more in the future as newer vaccines are developed and introduced.

Vaccines have resulted in global eradication of smallpox, we are on the brink of attaining global eradication of polio, and measles deaths have decreased by 78 per cent since 2000.

Newly developed vaccines will prevent hundreds of thousands of child deaths each year from rotavirus diarrhoea and pneumococcal pneumonia when countries can gain access to these vaccines.

Immunisation is one of the most cost-effective investments in child health. Yet in 2009 in low-income countries, two out of five deaths in children under five were due to pneumonia or diarrhoea.

Polio eradication is not yet assured, and we are at great risk of losing the dramatic progress made against measles as donor funding has dropped precipitously despite rapid movement toward elimination.

The reduction in measles deaths alone accounts for nearly 25 per cent of the overall reduction in child deaths since 1990.

Achieving Millennium Development Goal 4 — to reduce under-five child mortality by two-thirds by 2015 — will not be possible without additional support for immunisation. It would be a crime if this goal were missed simply for lack of adequate financial support.

Society has long recognised the value of vaccines. Since 1974, the World Health Organisation has co-ordinated a global Expanded Programme on Immunisation.

However, vaccines don’t give themselves. It takes organised structures and trained personnel to deliver vaccines safely to those who need them. In 2008, more than 22 million infants were missed by routine immunisation services and remain unprotected.

The Measles Initiative has provided more than $700 million in support of campaigns and disease surveillance that strengthen the components of routine immunisation systems, delivering nearly 700 million doses of measles vaccine since 2000 and preventing an additional 4.3 million childhood deaths.

The result is measurable success in improving vaccination coverage and in reducing child deaths at an incredibly low cost. However, funding for measles control has dropped 75 per cent since 2007, resulting in delayed campaigns, outbreaks and deaths.

For the Polio Eradication Initiative, Rotary International has played an exemplary role in raising more than $1 billion over the past 25 years, working closely with partners.

The Measles Initiative and the Polio Eradication Initiative maximise the impact of vaccines. Country-wide immunisation campaigns ensure all children are vaccinated, even in hard-to-reach areas where many children cannot access routine immunisation services.

During campaigns, thousands of healthcare workers move out to immunise millions of children under five-years old over a few days.

Campaigns are complex undertakings that also deliver other preventative interventions such as deworming medicine, insecticide-treated bed-nets for malaria control, and vitamin A to prevent blindness often associated with measles.

Since June 2009, more than 30 African countries have experienced measles outbreaks resulting in more than 89,000 cases and 1400 deaths.

WHO estimates that the combined effect of decreased financial and political commitment may result in a return to over 500,000 measles deaths a year by 2013, erasing progress achieved over the past 18 years. Why is this?

First, prevention is invisible. When immunisation is successful, nothing happens. In contrast, disease is highly visible and demands attention.

Second, the global economy and many individual developing country economies are in deep distress. This lessens the likelihood they will invest in low visibility activities despite very high returns.

Third, there is both donor and recipient fatigue. Donors are tired of being asked to give more even though gains are measurable, while recipients often get tired of having to ask for more.

What needs to be done to save more children? We need a balanced immunisation investment strategy that reinforces routine immunisation, achieves existing initiatives to eradicate polio and reduce measles deaths by 95 per cent.

Mr Jimmy Carter is a former US president, while Mr Kofi Annan is a former UN secretary-general.

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