The unfinished business of immunization

Published: 14 September 2010

New vaccines against the pneumococcal bacteria and rotavirus could save more than 1 million children’s lives each year, but a 4 billion US dollars gap (4 billion Swiss francs or 3.1 billion euro) in funding threatens these and other immunization programmes, said a report published jointly today by the International Federation of Red Cross and Red Crescent Societies (IFRC) and the GAVI Alliance.

Immunization has shown excellent results against diseases such as polio and measles, but continued success requires sustained political and financial commitment. Too many children are still dying of vaccine preventable diseases, the report called “Immunization: unfinished business” said.

Just two diseases – pneumonia and diarrhoea – account for 36 per cent of all under-five deaths worldwide. Most of these lives could be saved with cost-effective and relatively cheap immunization measures.

The GAVI Alliance accelerates and finances vaccines in the world’s poorest countries. In a forecast detailed in the report, it says that by 2015, more than 40 nations plan to introduce pneumococcal vaccine against the bacteria associated with pneumonia and meningitis. More than 110 million children could be immunized and approximately 840,000 lives saved.

With GAVI support, just over 40 countries are also planning to introduce the vaccine against rotavirus – the most common cause of severe diarrhoea in young children. Nearly 60 million children could be immunized and some 200,000 lives saved.

“GAVI’s immunization support is critical to achieving the Millennium Development Goals and the G8 Muskoka Initiative on maternal and child health,” said Nina Schwalbe, GAVI’s managing director of policy and performance. “We must remain focused on immunization as a proven and cost-effective cornerstone to improving global health for children in the world’s poorest countries.”

Together with an expansion in routine vaccines such as diphtheria, pertussis, tetanus, and other vaccines, GAVI estimates more than 4 million lives could be saved in total. But to make all the progress that’s technically possible, it will have to fill a funding gap of approximately 4 billion US dollars.

“Immunization to date has been a triumph,” says Bekele Geleta, secretary general of the IFRC – the world body of the International Federation of Red Cross and Red Crescent Societies, whose work includes the promotion of humanitarian values, disaster management and community health action. “But broadly speaking, the world has done the ‘easy’ 80 per cent; the ‘difficult’ 20 per cent remains.

“That 20 per cent includes the most inaccessible communities, the poorest of the poor, the marginalized, and those already suffering from complex or neglected disasters, like the long-term drought in the Horn of Africa.”

A broad decline in funding for the inter-agency Measles Initiative, founded in 2001, and an erosion of political will have enabled the disease to make a comeback. There is growing concern that the gains of the past decade could be reversed, leading to more than 500,000 measles deaths annually by 2012. Recent outbreaks in Africa, where measles deaths had been reduced by 92 per cent (between 2000 and 2008), provide a sobering reminder that the gains are fragile.

Since the start of the Global Polio Eradication Initiative (GPEI) in 1988, meanwhile, the incidence of polio has been reduced by 99 per cent worldwide and only in four countries is it still endemic: Afghanistan, India, Nigeria and Pakistan.

Never has the world been closer to eradicating polio, but the surviving one per cent is lethal, as the recent outbreak in Tajikistan confirms. GPEI says the historic achievement is also now threatened by a 1.3 billion US dollars (1.3 billion Swiss francs or 1 billion euro) funding shortfall for implementing activities in 2010–2012, and disease surveillance and immunization campaigns are already being curtailed.

The joint IFRC and GAVI Alliance report also argues that a key point about immunization – a public-health “best buy”, especially for low-income countries without the health-care infrastructure to treat large numbers of sick people – is its cost-effectiveness.

Communicable disease is the enemy of development, it adds. Research has shown that every US dollar invested in a vaccine dose saves an average of 14.50 US dollars in health-care costs. Vaccines enable people to be productive, including those, often women, who care for the sick. Vaccination is easy to do, it reinforces primary health-care, and its impact can be amplified through the “herd-immunity” effect.


Immunization: unfinished business is published jointly by the IFRC and the GAVI Alliance.

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