A matter of life or death

When we speak of immunisation, we speak of life. A quote from a village chief from a remote Senegalese village powerfully illustrates this. “We used to have epidemics here. We used to bury two or three children every week because of measles. This does not happen anymore because our children are immunised.”

Immunisation is a proven, cost-effective way of reducing disability and mortality. It contributes to a healthier population and to reducing poverty levels and represents a sound economic investment. Immunisation can be the key to achieving three of the millennium development goals (MDG): MDG 4, to reduce child mortality by two thirds by 2015; MDG 5, to improve maternal health and reduce maternal mortality; and MDG 6, to combat HIV/Aids, malaria and other diseases.

The developed world has taken some important strides to tackle the essential health needs of the developing world. The World Health Organization (WHO) established the compulsory licensing system in 2003, through which developing countries can produce and acquire cheap generic medicines for public health needs without breaking international trade laws. The global alliance for vaccines and immunisation (GAVI) was launched in 2000 to save children’s lives and protect people’s health through the widespread use of safe vaccines, with a particular focus on the needs of developing countries. It innovatively pulls together private and public sector resources through the financial markets to raise funds for immunisation. It is helping to fund programmes in 70 of the world’s poorest countries and it’s anticipated that over 10 years it will help immunise 500 million people.

According to the World Bank, mortality rates for children under five in developing countries have been reduced by 16 per cent between 1990 and 2006, yet 30,000 children die daily from preventable diseases, and half of these deaths occur in sub-Saharan Africa. In January 2007, the global polio eradication initiative announced that more than 400 million children under the age of five were vaccinated against polio in 2007 in 27 countries. The advisory committee on poliomyelitis eradication (ACPE) – the independent, technical body providing strategic guidance on polio eradication – hailed global progress in curbing type 1 wild poliovirus transmission. Measles deaths in Africa fell by 91 per cent between 2000 and 2006, from an estimated 396,000 to 36,000, reaching the UN 2010 goal to cut measles deaths by 90 per cent four years early.

While this is very welcome news, there are still a number of obstacles. An example of one is the availability and provision of vaccines for pneumococcal disease, which causes pneumonia, meningitis and septicaemia, as well as rotavirus, which causes diarrhoea. Each year two-and-a-half million children die from pneumococcal disease and rotavirus. All of these children could be saved. In industrialised countries experimental rotavirus vaccines have shown a protective efficiency of 80 per cent. In the western world the prevention of pneumococcal disease is considered so serious that since the year 2000, vaccinations have been recommended for all children aged from two to 23 months. It is necessary that these immunisations become as common in African countries as they are in Europe and America.
Immunisation is worthless if delivery structures are non-existent, which is unfortunately a major problem in many developing countries. At present, developing countries have an unprecedented range of new vaccines and technologies available, but current health system deficits effectively means that they will not be delivered to those who need them. The tackling of structural deficits in healthcare systems in many developing countries requires sustained investment and funding. A recent EU-African Caribbean Pacific Assembly report, ‘Access to healthcare’, found that half of all medical equipment in developing countries is not in use due to insufficient healthcare systems. Another issue regarding the provision of essential healthcare is the availability of healthcare professionals. The lack of sufficiently trained healthcare professionals in the developing world is an issue of grave concern. Many EU countries welcome skilled health workers from the developing world to their shores; every skilled healthcare professional that leaves a developing country is a big loss. Europe is benefiting at the developing world’s expense.

Finding a vaccine for HIV/Aids is one of the most important objectives. Two-and-a-half decades after the outbreak of HIV/Aids, the disease continues to outpace the global response. According to data released by the joint UN programme on HIV/Aids (UNAIDS), an estimated 33 million people are now living with HIV worldwide, and the rates of infection among women have been rising in almost every region of the world. In 2006, women represented 45 per cent of HIV-infected adults worldwide and 59 per cent in sub-Saharan Africa. The difference in rates of infection is even more striking among young people aged between 15 to 24 in sub-Saharan Africa, where young women are four times more likely to be HIV-infected than young men.

With the number of new HIV infections climbing each year, a vaccine remains the best hope of reversing the pandemic. More than 30 vaccine candidates are undergoing early trials on four continents and according to a recent Eurobarometer report, nine out of 10 Europeans want the EU to fund additional research into an Aids vaccine. I hope the European immunisation week from 21-27 April will promote the benefits of immunisation and refocus our efforts to make immunisation available to those most in need.

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