For years, pneumonia has gone about its business of inflicting suffering on families and children. Today, pneumonia will claim the lives of nearly 2,800 children in sub-Saharan Africa. But pneumonia's hold on African children could soon be history. In Brazzaville this week, the World Health Organization is bringing together more than 100 of Africa's decision-makers and leaders in immunization and child health to chart a course for the prevention of childhood pneumonia by vaccination.
The WHO's meeting comes at an important time because pneumonia in Africa is a problem on the verge of getting worse, not better. The HIV epidemic is fueling large increases in the incidence of pneumonia, and antibiotic resistance makes treatment more complicated and less effective. And sickle cell disease, which is common in West Africa, increases by many times the risk of the leading bacterial causes of childhood pneumonia.
Vaccines are the reason that we may be able to defeat pneumonia. Unlike some other major killers of children in Africa, vaccines are available to prevent the major causes of child pneumonia deaths: bacteria known as pneumococcus and Hib. These vaccines are safe and effective. In fact, their effectiveness was proven in clinical trials conducted in West Africa. One recent clinical trial from The Gambia showed that pneumococcal vaccination reduced the risk of death in children by 16 percent. Another showed that Hib vaccination prevented 20 percent of serious pneumonias. And additional vaccines that are in development promise to be even more effective, saving many more lives.
For years, vaccines against pneumonia were routinely used in rich countries, but did not reach most African countries. The most commonly cited obstacle to their use was the lack of financing to purchase the vaccine. With the creation of the GAVI Alliance, and the associated GAVI Fund, that obstacle is largely removed for nearly all African countries. With more than $4 billion in funding between now and 2015, countries can obtain Hib vaccines, and beginning next year pneumococcal vaccines, for a small co-payment (between US$0.15 and US$0.43 per dose for most African countries).
Even with GAVI's financing, there are valid challenges to vaccine introduction. Staff must be re-trained. Cold stores for maintaining the vaccine must be enlarged. Surveillance should be established to measure the vaccine's impact. However, these challenges must also be viewed in relation to the challenges of treatment and the costs of inaction, namely, the missed opportunity to prevent pneumonia in children.
Together the use of these two vaccines is expected to prevent up to 40 percent of serious pneumonia in African children. The vaccines exist. The financing is available. The programmatic obstacles are surmountable. The missing link is the political will to make the introduction of these vaccines a national priority. We hope that this is just what the WHO's meeting participants will do today. If they do, it means a bleak future for pneumonia and a bright one for African children.
Orin Levine is Executive Director of GAVI's PneumoADIP. Rana Hajjeh is Director of GAVI's HibInitiative. Both are located at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. Dr. Levine's email address is olevine@jhsph.edu Dr. Hajjeh's email address is rhajjeh@jhsph.edu
