Posted by: blog4globalhealth | 10/22/2009

Childhood Immunizations: Successes Evident; Equity Gaps Clear

WASHINGTON – More than 100 million infants worldwide are now receiving the key immunizations they need to survive before their first birthday every year.

There is great cause for celebration for the lives saved by this remarkable achievement, which was reported to a standing-room only crowd at the National Press Club Wednesday by the World Health Organization, UNICEF and the World Bank in the third edition of the State of the World’s Vaccines and Immunization report. As Global Health Council President and CEO Jeffrey L Sturchio said yesterday in a news release, “Child mortality has declined by more than 50 percent since 1970, thanks in large part to the tremendous strides made toward the goal of universal vaccination coverage.”

However, 24 million infants in 2007 (or about 20 percent of total infants born that year) did not receive the recommended complement of vaccines in their first year of life. Why, you ask? The panel of experts convened at the Press Club answered that the reason is not primarily because of supply. And although the average cost of fully immunizing a child is expected to rise from $6 per child in 2000 to $18 per child in 2010, Rakesh Nangia of the World Bank said that developing countries now manufacture 86 percent of the global demand for traditional vaccines. Saad Houry of UNICEF added that the overall cost of all recommended vaccinations has ticked up in large part because of the development of new vaccines while prices of many vaccines have actually fallen.

The primary reason 24 million infants are not being fully immunized, according to the panel, is inadequate delivery systems and communication. As Sturchio put it, “Governments, the private sector and civil society must continue to collaborate to reach children in the most remote and poorest places on the globe to make sure they benefit from vital vaccines and immunization.”

The challenge most discussed by the room full of vaccination experts Wednesday to reaching those 24 million infants was that of focus and equity. It comes as no surprise that remote and poorer regions in countries often have lower vaccination rates than wealthier regions with easier access to vaccines. Nangia pointed out that 10 million of the 24 million infants not reached are in India, and 6 million of that 10 million infants are in 4 Indian states. Dr. Stephen Blount of the Centers for Disease Control (CDC) said that the global health community knows how to reach the children who are not receiving their vaccinations but that there simply needs to be more drive and focus.

Another challenge is funding. WHO, UNICEF and the World Bank estimate that there is at least minimum $1 billion annual funding shortfall from what is required to meet targets agreed to by the global community. Nangia said that this issue is even more vital because of the food, fuel and financial crises gripping the world. The World Bank estimates that even with some indications of economic recovery, 90 million people worldwide will be pushed back into poverty this year, according to Nangia. Properly financing early childhood vaccinations is critical to ensuring the momentum in reducing childhood deaths is not reversed.

Perhaps another challenge is communicating the huge return on investment of childhood vaccinations to people in donor nations such as the United States. A Kaiser Family Foundation survey conducted from January through March this year found that 61 percent of adults in the U.S. said “increasing the number of children who get immunized for diseases like polio” should be a top priority for U.S. spending on health in developing countries. Furthermore, a survey conducted among registered voters by Hart Research Associates and Via Novo for the Bill & Melinda Gates Foundation from May 15-17 found that only 14 percent identified immunization of children as one of their top three priorities in helping people in developing countries. 

Despite these challenges, the chord struck by the panel Wednesday was one of optimism and enthusiasm for reaching the goal of universal childhood vaccination. The mandate of WHO and UNICEF’s Global Immunization Vision and Strategy for 2006 to 2015 is clear: if all countries provide vaccines for 90 percent of children against 14 diseases – diphtheria, pertussis, tetanus, measles, polio, tuberculosis, hepatitis B, Hib, rubella, meningococcal disease, pneumococcal disease, rotavirus, and (where needed) Japanese encephalitis and yellow fever – two million children’s lives will be saved year after year.

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