Child poverty: what role for vaccination?

With less than 1,000 days to go before the 2015 target date for reaching the Millennium Development Goals, health officials, NGOs and activists are attempting to inject momentum into a final push to defeat child poverty.

The MDGs are eight goals set out by the United Nations at the Millennium Summit in the year 2000. They include reduce child mortality rates, eradicating extreme poverty, improving maternal health, achieving universal primary education and combatting disease such as HIV/AIDS and Malaria.

Of course, these are not eight separate targets to be met; the MDGs overlap and improving outcomes in one area often has positive knock-on effects in another.

As Dr Seth Berkeley of the GAVI Alliance explained recently, keeping children healthy helps to keep them in education and also saves families from having to spend money on health care. Thus, improving children’s wellbeing can protect families from slipping into poverty.

The MDGs have brought the role of vaccines in development policy into focus, with voices from the World Bank to the Gates Foundation highlighting the value of immunisation especially in developing countries.

Digital rally

An online debate – dubbed the ‘#MDGMomentum Rally’ – took place last week (April 5), connecting thousands of individuals and organisations with an interest in development policy.

The consensus was that great progress has been made over the past two decades – with child mortality falling by 40% – but that a final push would be needed if the 2015 targets are to be met.

Geoff Adlide, Director of Advocacy and Public Policy at the GAVI Alliance, said the biggest killers of children are pneumonia and diarrhoea. Millions of cases of death and disability are vaccine-preventable, he added, noting that pneumococcal, rotavirus and pentavalent vaccines (against diphtheria, tetanus, pertussis, hepatitis B and haemophilus type b) are the health interventions which make the most cost-effective contribution to reducing childhood mortality.

Rolling out immunisation programmes in some of the world’s poorest communities has already had an impact by saving literally millions of lives, according to the GAVI Alliance, and more benefits will follow from recent investments like those in Ghana, Rwanda and Tanzania.

The number of vaccine manufacturers supplying GAVI has doubled in a decade, helping to dramatically improve access to immunisation. This translates, for example, into 180 million doses of pentavlent vaccine being shipped as part of the GAVI programme last year, compared to just 8 million doses ten years ago.

Sustaining progress

The debate has already begun to move beyond the 2015 deadline, with experts asking how the momentum built in pursuit of the MDGs – and the structures developed since the targets were set – can be preserved and expanded post-2015.

A powerful article published in The Lancet medical journal last month celebrates the 40% reduction in the number of children dying before their fifth birthday (compared to 1990) and emphasises the importance of a healthy population as a prerequisite for development.

The joint letter, signed by top officials from the WHO, UNICEF, the World Bank, the GAVI Alliance, and the Global Fund to fight AIDS, TB and Malaria, says that every extra year’s increase in average life expectancy can increase GDP (a measure of economic output) by 4%.

“Some of the best buys in improving global welfare are through investments in health, such as expanding access to immunisation. Healthy individuals are more productive, earn more, save more, invest more, and work longer. Unhealthy people carry a high cost for themselves and for their countries,” the authors wrote.

The letter stresses the links between the 8 MDGs, highlighting the virtuous cycle that can follow when the right combination of interventions are made. A child who is poorly nourished with tip into malnutrition if he or she contracts an infectious disease such as measles.

Given that malnourished children are already more susceptible to infections, this is a pattern seen too often in the developing world. Protecting children from diarrhoea – through breastfeeding, hand-washing, better sanitation and vaccination – even helps them to absorb the nutrients in the food they receive.

The UN established a High-Level Panel to look at the post-2015 Development Agenda. It met in Bali, Indonesia, on March 25-27 and is expected to make a series of proposals at the UN General Assembly in September.

Experts in global health and development are rallying to put health at the centre of the debate that will follow.