Editor’s note: This past December, the Disruptive Women in Health Care blog launched a series on The Value of Health: Creating Economic Security in the Developing World. In addition to Disruptive Women’s own pool of experts, a number of guests were invited to post on this critically important topic. We invite you to download the ebook or read the original posts.

By Lois Privor-Dumm. It’s really simple.  8.8 million children die every year.  Not here in the US, but in developing countries where they don’t have access to the same care that we do here.  How much of our global health budget goes to address these basic needs?  Less than $1 of every $10.

Children are the future of every country.  Providing them with basic care to ensure they survive until their fifth birthday doesn’t seem to be that much to ask.  And, it’s a good investment.  Simple antibiotics or oral rehydration solutions along with the basic vaccines that children receive in the US every year are available at a cost that is around many people’s co-pay for a single prescription.

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As we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Sources: US Global Health and Child Survival Budget, 2009 and UNICEF, State of the World’s Children, 2008

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

The following post by Lois Privor-Dumm, IMBA, Director of Alliances and Information for the PneumoADIP at Johns Hopkins Bloomberg School of Public Health, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Lois heads up several vaccine projects related to advocacy and communications as well as access and implementation. She is currently working as Director, Large Country Introduction for the Accelerated Vaccine Introduction Technical Assistance Consortium (AVI TAC), a GAVI-funded project with an aim to accelerate introduction of pneumococcal and rotavirus vaccines in low-income countries. Lois has been at Johns Hopkins since 2005 helping guide strategies and accelerated uptake on both the Hib Initiative and PneumoADIP and has been leading projects in developing and donor countries to support strengthening of policies and awareness for childhood pneumonia as part of a global World Pneumonia Day Coalition effort.

Hib, pneumococcal and rotavirus vaccines that have long been available in the US, offer significant promise to the children in developing countries. Not only could these vaccines, save millions of lives over the course of the next couple of decades, but they also have the potential to add to the wealth of nations. Yet, despite enormous promise, there are still delays 1-2 decades before children in developing countries have access.

Vaccines have long been considered one of the most affordable and cost-effective public health interventions available today. Historically, they have been pennies per dose. According to the World Bank’s Disease Control Priorities Report, at $7 per DALY averted in Sub-Saharan Africa for the Expanded Program on Immunization (EPI), a package of six WHO recommended vaccines including diphtheria, tetanus, pertussis, polio, measles and represents excellent value for money. By comparison, statin with aspirin, beta blocker and ACE inhibitors for ischemic heart disease costs $2,028/DALY averted.

However, with newer vaccines costing not pennies, but dollars per dose, do we need to reestablish our paradigm for affordability?

A recent review of the economic case for expanding vaccination coverage of children done by researchers at Harvard and Johns Hopkins suggests that new vaccines are a good investment. Cost-benefit analyses of Hib vaccination, for example, indicate that the cost of vaccination is less than the savings accrued by preventing mortality, lowering future health care costs, and reducing productivity losses among parents (who no longer have to stay home with a sick child). However, even these analyses may underestimate the true economic benefits of childhood vaccination.
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Why is it that you can buy a Coke or mobile phone refill cards in a remote African village but in these same villages, you cannot consistently get basic lifesaving medicines? Why are pneumonia and diarrhea still the biggest infectious disease threats for children when effective and affordable solutions to prevent and treat a large portion of deaths already exist?  What is the contribution of vaccines in creating a more productive society and wealth of nations?  These are just a few of the questions asked at the new International Vaccine Access Center (IVAC), launching on Monday December 7th at the Johns Hopkins Bloomberg School of Public Health. IVAC seeks to translate evidence into policy, and policy into access to life-saving vaccines for all children.

Indeed, access is a hot topic. When I told several people about IVAC, the most common reaction is great – we really need this! There are many groups working in research or policy or in program implementation, but the bridge to ensuring access remains a challenge. On the surface, solutions can seem simple – show the need, build awareness and provide the solution at a low enough price and it will reach those that need it most.  Some try to help by providing vaccines, medicines or supplies, but that often creates more challenges than benefit because of concerns about sustainability.    Even with country level policies and commitments from donors to fund new interventions, implementation can see many stumbling blocks with uptake not reaching forecasted levels.  Sometimes it is because the health system is not strong enough.  Should that be a reason for delay of a life-saving intervention if the delivery platform is imperfect?  If the implementers are not entirely convinced, it is a strong barrier and one with the potential to impact manufacturers’ willingness to supply or donors’ willingness to fund if countries can’t show that they are appropriately using resources.  This must be played against the potential to save lives, however.

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This is one of my favorite photographs from a recent trip to Nigeria. I love how happy this little girl is to be with her big brother, as he looks at her with that I-know-so-much-more-than-you attitude of all older siblings. It’s an interaction that could have taken in Philadelphia, Baltimore or Cleveland, but I took it when I was at the University College Hospital of Ibadan.

I was in West Africa to make a documentary on the impact of new vaccines and pneumonia prevention efforts in developing countries.  After years working at a pharmaceutical company where I was fortunate enough to launch these new vaccines, I realized that something was missing.  I was surprised to learn that the percentage of deaths due to pneumonia was so high (almost 1/5 of all post neonatal deaths).  Ninety-five percent of these deaths occur outside of the US, Europe and other industrialized countries, yet it was in the developed world where we did most of our business.  We often forget about children in the developing world.  We see pictures of desperate, hungry children and rationalize well, if I don’t do this one thing, something else will kill them anyway.  But all you need to do is travel to one of these countries to realize that children are the same all over the world.  You forget that they are still grappling with some of the diseases that have long been out of our minds for children in our country.

Pneumonia? Who would have thought that this is such a large problem for young children?  In fact, it is the illness that leads to the most deaths worldwide – over 2 million young lives lost every year, a child every 15 seconds.   We have access to pneumonia vaccines and antibiotics to treat – child deaths due to pneumonia are relatively rare in US and Europe.  These deaths unfortunately occur all too often in the developing world.

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