Why is the world’s most successful child health intervention going begging?

Vaccines have saved the lives of millions of children around the world, and have the potential to save millions more in the future. They have resulted in the global eradication of smallpox; we are on the brink of attaining global eradication of polio, and measles deaths have decreased by 78 per cent since 2000. Newly developed vaccines will prevent hundreds of thousands of child deaths each year from rotavirus diarrhea and pneumococcal pneumonia when countries can gain access to these vaccines.

Immunisation is one of the most cost-effective investments in child health. Yet in 2009, two out of five deaths among children under five-years-old in low-income countries were due to pneumonia or diarrhea. New vaccines can prevent a large proportion of these deaths, but the global community has not committed the resources to bring the full range of vaccines to all children.

Polio eradication is not yet assured, and we are at great risk of losing the dramatic progress made against measles as donor funding has dropped precipitously despite rapid movement towards elimination. The reduction in measles deaths alone accounts for nearly 25 per cent of the overall reduction in child deaths since 1990. Achieving Millennium Development Goal four – to reduce by two-thirds mortality among children under the age of five by 2015 – will not be possible without additional support for immunisation. It would be a crime if this goal were missed simply for lack of financial support.

Society has long recognised the value of vaccines. Since 1974, the World Health Organization (WHO) has co-ordinated a global immunisation programme. Major support came from bilateral development agencies, and Unicef negotiated a significantly reduced price for vaccines in developing countries. However, vaccines don’t give themselves. It takes organised structures and trained personnel to deliver vaccines safely to those who need them. In 2008, more than 22 million infants were missed by routine immunisation services and remain unprotected.

Global partnerships were developed to assist countries with vaccinations. The Measles Initiative has provided more than $700 million in support of campaigns and disease surveillance that strengthen routine immunisation systems, delivering nearly 700 million doses of measles vaccine since 2000 and preventing an additional 4.3 million childhood deaths. The result is measurable success in improving routine vaccination coverage and in reducing child deaths at an incredibly low cost. However, funding for measles control has dropped 75 per cent since 2007, resulting in delayed campaigns, outbreaks and deaths.

For the Polio Eradication Initiative, Rotary International has raised more than $1 billion over the past 25 years, working closely with partners. The Global Alliance for Vaccines and Immunisation (Gavi) was formed to ensure that children in the poorest countries of the world have access to the life-saving potential of new vaccines.

The Measles Initiative and the Polio Eradication Initiative maximise the impact of vaccines. Country-wide immunisation campaigns ensure all children are vaccinated, even in hard-to-reach areas. During campaigns, thousands of health care workers move out to immunise millions of children under five-years-old. Campaigns are complex undertakings that also deliver other preventive interventions such as deworming medicine, insecticide-treated bed nets for malaria control, and vitamin A to prevent the blindness often associated with measles.

Yet, with all of this co-operation, innovation and collaboration, we are at risk of losing many of the gains that have been made and foregoing the additional benefits that are within reach.

Since June 2009, more than 30 African countries have experienced measles outbreaks resulting in more than 89,000 cases and 1,400 deaths. The WHO estimates that the combined effect of decreased financial and political commitment may result in over 500,000 measles deaths a year by 2013, erasing the progress achieved over the past 18 years. Why is this?

First, prevention is invisible. In contrast, disease or injury is highly visible and demands attention. Those who are sick with malaria, tuberculosis, or HIV are in immediate need of treatment and can be passionate advocates. In contrast, there are not the same kinds of passionate advocates for prevention. Furthermore, children do not vote and cannot influence social priorities. So, immunisation often receives a lower priority.

Second, the global economy and many developing economies are in deep distress. The are less likely to invest in low visibility activities despite the very high returns.

Third, there is both donor and recipient fatigue. Donors are tired of being asked to give more even though the money saves the lives of children. Recipients often get tired of having to ask for more, especially when they are having difficulty sustaining the costs of new vaccines.

What needs to be done to save more children? We need a balanced immunisation investment strategy that reinforces routine immunisation, achieves existing initiatives to eradicate polio and reduce measles deaths by 95 per cent, and enables the introduction of new vaccines.

At the global level, developed countries and philanthropies need to recognise that developing country needs are increasing as new life-saving public health measures become available. They must adjust their support accordingly.

Governments must review budget priorities and increase their support of their own programs – for example, many countries are not currently providing the 50 per cent of operational costs for follow-up measles campaigns.

At the local level, people must demand that vaccines and immunisation services be made available without barriers. Only by concerted actions at local, national, and global levels can we fully realise the massive potential of vaccines.

Kofi Annan is a former Secretary-General of the United Nations. Jimmy Carter is a former president of the United States of America