Health experts assess global immunization efforts

With less than 1,000 days left to meet the United Nations’ goal to cut child mortality 67 percent by 2015, there is cause to be optimistic, said global health experts Tuesday during a panel discussion hosted by the Kaiser Family Foundation. But, in the race to vaccinate the world’s children, widely regarded as one of the most cost-effective pursuits in the battle against child mortality, there are still hurdles to clear.

The panel discussion, called "Getting to Zero: Saving Children's Lives with Vaccines," brought together leaders from USAID, the Global Alliance for Vaccines and Immunisation (GAVI), Save the Children and the Center for Global Development. Panelists lauded efforts to supply low-income countries with vaccines, but expressed concern that a shortage of trained health workers might be keeping children from benefitting. Also, without outside help, middle-income countries aren’t progressing, they said.

Since 2000, when the UN established the Millennium Development Goals, pledging — among other things — to reduce child mortality to a fraction of the 1990 rate, the percentage of children in developing countries who have received at least one dose of measles-containing vaccine has increased from 70 to 84 percent, according to the UN’s 2012 Millennium Development Goals Report. Sub-Saharan Africa, where the percentage of vaccinated children has climbed from 55 to 75 percent, has seen the most impressive improvement.

“We do see the possibility within our generation to bring down the mortality levels in the world to those we enjoy in rich countries,” said Ariel Pablos-Mendez, USAID’s assistant administrator for global health. “One-fourth of child deaths today could be prevented with vaccines that already exist.”

GAVI, a nonprofit organization that negotiates with drug companies to get reduced rates on vaccines for poor countries, has immunized more than 371 million children over the last 12 years. And the work is accelerating. Between 2011 and 2012, the organization more than doubled the number of children it reached annually, according to GAVI's most recent progress report. This year, GAVI CEO Seth Berkley said the organization, which is backed by the governments of 18 countries, has funding to distribute more than 600 million vaccine doses.

“The critical issue is making sure we don’t slow down in the days we have left,” he said.

On the ground, there aren’t enough trained, supported health workers to perform the immunizations, said Carolyn Miles, president and CEO of Save the Children. Because of the shortage, some countries have to make difficult decisions, like pulling health workers away from administering routine immunizations to work on the UN’s goal of eradicating polio.

“Vaccines don’t deliver themselves,” she said.

Most of the gains have been made by high-income and — thanks in large part to organizations like GAVI and UNICEF — low-income countries, said Amanda Glassman, director of global health policy for the Center for Global Development. To qualify for help from GAVI, countries must have a Gross National Income per capita of $1500 or less.

“When you look at some middle income countries, they are not much richer than some of the GAVI eligible countries,” Glassman said. But, while a country with a GNI of $1500 might pay $3 per vaccine dose with GAVI's help, a country with a slightly higher GNI may be expected to pay $16. For those countries, she said, “It’s not an affordable intervention in the short term.”

Even when a country initially qualifies for GAVI, if it crosses the $1500 threshold it must take over full costs.

“Inequity is the major issue for the post-2015 framework,” Miles said. “While the Millennium Development Goals have been terrific in terms of getting us focused, they have driven these inequalities in some ways. The kids who are easy to reach have been reached … We have to think forcefully about those who are going to be the hardest to reach.”

Berkley said GAVI is discussing strategies to include more countries and to keep graduating countries from leaping into the open market unprepared.

A key part of the solution is changing attitudes about immunization within developing countries, he said. Without proper education, as countries approach eradication of diseases like polio, getting vaccinated might seem like a waste of time to many families. They see the sacrifices their neighbors are making to get the medication, he said, but they don’t see the disease.

In some countries, people routinely reject the vaccine, Pablos-Mendez said.

“Society is used to accepting that a kid will die,” he said. The challenge is “changing their minds.”