Port Louis — The medical specialist of the Centre for Disease Control was here for the 4th African Rotavirus Symposium. He elaborates on this little-known pathogen that claims half a million lives yearly and the advances in fighting preventable diseases.
What is a rotavirus and why is it such a source of preoccupation ?
A rotavirus is one of the pathogens that cause diarrhea in children under five years old. It's the most important cause of severe diarrhea and vomiting in that age group. What we're concerned about is that, although this infection affects the whole world, children in poor countries who develop this germ tend to die. According to our estimates, globally more than half a million children die of rotavirus every year. What's particularly concerning is that there are now vaccines that can prevent this, vaccines that have been introduced in several countries in the Americas that are highly efficacious and safe. If introduced in the poor countries that have high mortalities due to the rotavirus, these vaccines will prevent a large proportion of these half a million deaths.
It's good to know that these vaccines exist. But isn't getting them to the people who need them the hardest part ?
Actually, in the last few years, there's been an initiative that's been funded by the Bill and Melinda Gates Foundation through the Global Alliance for Vaccines and Immunizations (GAVI). We have been working, along with our collaborators, an American NGO called PATH and the World Health Organization, on the Accelerated Development and Immunization Plan (ADIP). The idea of ADIP is to take the vaccines that are being introduced in rich countries and accelerate the timeline to have them introduced in poorer countries. Traditionally, with older vaccines, it sometimes took 15 years between availability and any sort of introduction in poor countries.
ADIP aims to accelerate that process by generating data from the countries where these deaths are occurring, talking to industry and, to a large extent, subsidizing vaccines for the first five years in the very poorest, or GAVI-eligible, countries. There are around 70 GAVI-eligible countries around the world, many of which are in sub-Saharan Africa.
Aid organizations and philanthropists like Bill Gates increasingly want to know that the money they donate is well spent. Is this accountability an important factor ?
The Bill and Melinda Gates Foundation is an organization that administers money donated by the Gates but also by other philanthropists, such as Warren Buffet who has pledged to give $40 billion over a number of years. It administers these funds in a way that has been notable in its businesslike attitude and I don't mean businesslike in the sense of making profits but in the sense that it expects outcomes and results, not waste. That has been one of the successes of the Gates initiative. The money has made an impact because of accountability instead of just being thrown around.
What impact will this have on the future of Africa?
There are several bodies of work among economists that have shown that increasing the health of the population increases its wealth. It's something that economic laypeople have always thought was rather obvious but for economists it's the first time that this link has been shown. There's a strong hope that when these preventable diseases are in fact prevented, it'll help in getting Africa on its feet economically.
If and when these preventable diseases are brought under control, what health challenges will Africa have to face in the future ?
As infectious diseases are brought under control, African healthcare issues will be the same as the ones in developed countries, such as obesity and heart diseases.
Do you find that the big pharmaceutical companies are amenable to developing vaccines for diseases that affect poorer countries or are they more concerned about coming up with the new Viagra ?
Pharmaceutical companies are out there to make money and it's absolutely true that they have their eyes on the richer markets. But they also realize increasingly that financial opportunities and markets exist in having a global interest in vaccinations. For example, if you vaccinate China, India and Africa, even though the cost of the vaccine will be considerably less than in richer countries, the economies of scale will allow them to make money.
I don't want to sound too naïve but there's also perhaps a general increased consciousness that these vaccines should be more globally available and I think industry shares this vision.
The CDC enjoys a considerable amount of prestige around the world. Given the emergence of certain killer diseases, such as bird flu and Ebola, what are the centre's priorities for the future ?
The CDC is a public health agency dedicated to infectious disease research but also, importantly, chronic diseases and anything that affects the health of people. Most of its mandate is domestic [within the US], but it's always been recognized as one of the leading public health bodies that plays an important role in international work.
Its priorities are wide-ranging. There are the high-profile diseases, such as SARS and Ebola, which hit the news. But there are also the other diseases, like the rotavirus, which are not nearly as newsworthy but kill far more people. That's not to say that the latter are more important, it's clearly important to address these high-profile diseases as well, but the CDC tries to deal with the more global public health problems.