New vaccines can save two million children each year
Pneumococcal diseases, primarily pneumonia and meningitis, are the most important vaccine-preventable causes of death in children under five. The disease kills more than 1.6 million people each year, over half of whom are children. Ninety-nine percent of these deaths occur in the world's poorest countries.
Rotaviruses are the leading cause of severe diarrheal disease and dehydration in infants and children. Worldwide, Rotavirus has been estimated to account for almost 40 percent of all cases of severe infant diarrhea, which translates into over half a million deaths each year, mostly in children under the age of two.
In addition, over two million are hospitalized with pronounced dehydration. Infants and young children with rotavirus infection suffer vomiting, fever, and diarrhea. For children with severe disease, this combination of symptoms can progress to dehydration and death.
The introduction already underway
In 2009, the first of the GAVI eligible countries, Rwanda and the Gambia, are expected to introduce the 7-valent pneumococcal conjugate vaccines, meaning that the vaccine protects seven strains of the bacteria. These introductions are soon to be followed by 10- and 13-valent vaccines that protect against more strains common in Africa, which are expected to be available in the next couple of years. Eleven countries have been approved for GAVI funding to use the pneumococcal conjugate vaccine so far. More than 30 countries have expressed interest in introducing the pneumococcal vaccine as soon as the new conjugate version is available.
From 2009 onwards, extended protection vaccines including 10 and 13 serotypes are expected to become available in increasing quantities. Significant health impact is expected and key findings from cost-effectiveness analysis showed that it meets the WHO criteria for "very cost effective", an estimated $22 per DALY saved or $691 per death averted.
As for the introduction of the rotavirus vaccines, 14 of the 72 countries eligible for GAVI support currently qualify. To be eligible a country's immunization coverage for the third dose for diphtheria, pertussis and tetanus (DTP3) has reached 50 percent and the government is not already funding the vaccine. Support became available to countries for the first time in 2007 and as of January 2009, four of the 14 countries - Bolivia, Guyana, Honduras and Nicaragua - were approved for this new type of support from GAVI.
Vaccines as platform for scaling up more comprehensive packages
During the Global Immunization Meeting in February this year it was made clear that immunization is reaching more children and the poor than any other core intervention part of the "continuum of care". This is because of the mix of delivery strategies that is being used, such as campaigns, outreach and child health days in addition to the facility based delivery. There was also a general agreement that although we need to remain focused on results we also need to build sustainable immunization and health systems as we achieve these results. In many countries immunization coverage rates have stagnated because of health systems barriers, such as the lack of qualified or motivated staff, poor management, supervision and monitoring, and a poor supply and logistic systems.
Using immunization as a platform, more integrated packages including insecticide-treated nets, vitamin A supplements and deworming tablets, have also increasingly been delivered through integrated campaigns, child health days or during the routine visit. With this in mind UNICEF's Saad Houry made the following important remarks during the fourth Global Immunization Meetings in New York:
"Looking forward, the large scale introduction of pneumococcal and rotavirus vaccines in developing countries will provide us with an historic opportunity to address two of the most important causes of mortality in children under 5 - pneumonia and diarrhea - in a comprehensive way. [...] By introducing these new vaccines as part of a comprehensive package of services and strengthening community-based systems, we will maximize their impact on MDG 4, and do so in a sustainable way."