Official Bank Sites Related Links April 6, 2006—Immunization is one of the most successful public health programs worldwide, reaching 75 percent of 130 million babies born each year. But 30 million infants, most of them in the developing world, are not being immunized, says World Bank Senior Health Specialist Amie Batson. Measles, virtually eliminated in the West, alone killed more than 348,000 people in Sub-Saharan Africa and 239,000 in South Asia in 2001, according to the just-released second edition of Disease Control Priorities in Developing Countries. The book is a joint project of the World Bank, World Health Organization, and the Fogarty International Center of the U.S. National Institutes of Health, supported by a grant from the Bill & Melinda Gates Foundation. Sub-Saharan Africa accounts for 58 percent of the world’s pertussis deaths, 41 percent of tetanus deaths, 59 percent of measles deaths, and 80 percent of yellow fever deaths, says the book. The lingering presence of vaccine-preventable diseases in the world’s poorest countries is among a broad array of health concerns addressed by this publication and two companion volumes—Global Burden of Disease and Risk Factors and Priorities in Health (available in seven languages). All three books were released this month in Beijing, China. World Bank health specialists say there are many challenges in trying to broaden the reach of immunization in developing countries. Many countries are heavily dependent on grants to fund their immunization programs. They have small health budgets and hard-to-reach areas. In addition, new vaccines that can prevent over a million deaths from acute respiratory and diarrheal diseases would take an even bigger bite out of developing countries’ budgets. Vaccine Not Reaching All The statistics underscore another problem: vaccines aren’t reaching all children in developing nations. While immunization reaches an average of 75 percent worldwide, it may only reach 10 to 20 percent of the population in some districts or regions, says Batson, who leads the Bank’s immunization team. And in some places, earlier gains have been reversed. In Kenya, for instance, the number of immunized children has been falling. Government of Kenya statistics show just over 59.percent of babies were fully immunized in 2003—down from a high of 79 percent in 1993. The number immunized against measles fell to to 51 percent in 1998 before climbing back up to 68 percent in 2005, says Dr. Tatu Kamau, Manager of the Kenyan Government’s Expanded Program on Immunization. Kamau says part of the reason for decline in coverage was the country’s immunization program was heavily dependent on donors, with little back up support from the government. The country ran out of vaccine in 2000 when major donor support was suddenly withdrawn, he says. Even when vaccine was available, the program lacked staff and equipment to effectively distribute it, limiting people’s access to immunization. In addition, many health facilities and parents could not afford the needles and syringes required for vaccination. “Documentation was also poor, so that even the reduced amount of vaccination happening was not being fully captured,” Kamau says. An influx of funding in 2001 turned the situation around. Kamau says the immunization program can now fund four out of five vaccines, as well as equipment needed to administer the vaccines. Measles coverage rates climbed back up to 68 percent in 2005. The funding came from the Global Alliance for Vaccines and Immunization (GAVI), whose partners include developing and industrial country governments, the World Bank, UNICEF, the Bill & Melinda Gates Foundation, non-governmental organizations and the vaccine industry. GAVI committed US$1.4 billion to immunization programs in developing countries between 2000 and 2005. A total of $US79 million went to Kenya alone. Weak Health Systems Batson says one of the biggest problems in many developing countries are weak financial and delivery systems in the health sector. “For an immunization program to be effective, there needs to be a functioning health system with trained and motivated workers,” Batson says. “If the systems aren’t working, large parts of the population won’t receive vaccines or other critical health interventions.” Developing countries’ health budgets are limited, Batson says. On average, low-income African countries spend less than $10 per capita on health, with some governments, such as the Government of Ethiopia, spending as little as $3. Limited health budgets must cover a range of critical services and goods, from public health priorities like immunization and malaria control to acute hospital care. Partnerships like GAVI are looking to the World Bank for help on how to better support the larger health system, working within national budgeting and planning processes, Batson says. “The challenge is every single year there is a new cohort of babies that has to be vaccinated. Every single year you have to be at least as good as you were last year. Unless the system is working, they are at risk,” she says. A Health Bargain It costs an average of US$17 to fully vaccinate a child—making the traditional vaccination package one of the true best buys today, says Logan Brenzel, World Bank Senior Health Specialist and lead author of the Vaccine-Preventable Diseases chapter in the Disease Control Priorities in Developing Countries, second edition. Newer and more complex vaccines may be harder to afford. Vaccines that protect against rotavirus (acute diarrhea) and pneumococcal (acute respiratory) diseases, avian flu, or HIV/AIDS (at least 10 years away, says Batson), will be more expensive than the traditional vaccines (e.g. measles, polio, tetanus), Brenzel says. “Cost is always an issue,” she says. The global community would likely provide funds to support priority new vaccines for the first five to 10 years they are used. But once funding is depleted, country budgets will have to accommodate these additional costs, says Brenzel. “Countries already have a difficult job, finding sufficient resources to fund all the health priorities,” she says. “How do you allocate between priorities like malaria, HIV/AIDS, measles, and pneumonia control, not to mention hospital care?” A fast-spreading virus like avian flu, however, may trump cost concerns, she says. “From a global perspective—for the global public good—it makes sense for the world collectively to find the resources to deal with a major problem like avian flu. If we are fortunate enough to have an effective vaccine, donor support for immunization will be a big part of it.” |
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