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 as newer vaccines are developed and introduced. Vaccines have resulted in global eradication of smallpox, we are on the brink of attaining global eradication of polio, and measles deaths have decreased by 78 percent 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. Immunization is one of the most cost-effective investments in child health. Yet in 2009 in low-income countries, two out of five deaths in children under five-years old 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 necessary 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 toward elimination. The reduction in measles deaths alone accounts for nearly 25 percent of the overall reduction in child deaths since 1990. Achieving Millennium Development Goal 4 -- to reduce under-five child mortality by two-thirds by 2015 -- will not be possible without additional support for immunization. It would be a crime if this goal were missed simply for lack of adequate financial support.

Society has long recognized the value of vaccines. Since 1974, the World Health Organization (WHO) has coordinated a global Expanded Program on Immunization (EPI). 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 organized structures and trained personnel to deliver vaccines safely to those who need them. In 2008, more than twenty-two million infants were missed by routine immunization services and remain unprotected.

Recognizing that developing countries need assistance to enjoy the full benefits of immunization, important global partnerships were developed. The Measles Initiative has provided more than $700 million in support of campaigns and disease surveillance that strengthen the components of routine immunization 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 percent since 2007, resulting in delayed campaigns, outbreaks and deaths.

For the Polio Eradication Initiative, Rotary International has played an exemplary role in raising more than $1 billion over the past 25 years, working closely with partners. The GAVI Alliance was formed to ensure that children in the poorest countries of the world have access to the life-saving potential of new vaccines. The GAVI Alliance currently provides more than $1 billion per year.

The Measles Initiative and the Polio Eradication Initiative maximize the impact of vaccines. Country-wide immunization campaigns ensure all children are vaccinated, even in hard to reach areas where many children cannot access routine immunization services. During campaigns, thousands of health care workers move out across a country to immunize millions of children under five-years old over a few days. 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 blindness often associated with measles disease.

Yet, with all of this cooperation, innovation and collaboration, we are at risk of losing many of the gains that have been made and forgoing 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 1400 deaths. The World Health Organization estimates that the combined effect of decreased financial and political commitment may result in a return to over 500,000 measles deaths a year by 2013, erasing progress achieved over the past 18 years. Why is this?

First, prevention is invisible. When immunization is successful, nothing happens. In contrast, disease or injury is highly visible and demands attention. Those who are sick with malaria, TB, 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 as there are for treatment. Furthermore, children do not vote and cannot influence social priorities. So, immunization often receives lower priority.

Second, the global economy and many individual developing country economies are in deep distress. This lessens the likelihood they will invest in low visibility activities despite very high returns.

Third, there is both donor and recipient fatigue. Donors are tired of being asked to give more even though gains are measurable by decreases in child deaths. 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 immunization investment strategy that reinforces routine immunization, achieves existing initiatives to eradicate polio and reduce measles deaths by 95 percent, and enables introduction of new vaccines. At the global level, developed countries and philanthropies need to recognize that developing country needs are increasing as new life-saving public health measures become available, and adjust their support accordingly. National governments must review budgetary priorities and increase their support of their own programs -- for example, many countries are not currently providing the 50 percent of operational costs for follow-up measles campaigns requested by the Measles Initiative. At the local level, people must demand that vaccines and immunization services be made available without barriers. Only by concerted actions at local, national, and global levels can we fully realize the massive potential benefits of vaccines.


Kofi Annan served as 7th Secretary-General of the United Nations from 1997 to 2006. Jimmy Carter served as 39th President of the United States from 1977 to 1981.