versión impresa ISSN 0042-9686
Bull World Health Organ vol.78 no.1 Genebra ene. 2000
Immunization "is a key step toward overcoming poverty"
The Global Alliance for Vaccines and Immunization (GAVI) was formally launched in late January at the World Economic Forum in Davos, Switzerland. A new partnership of public and private sector bodies, GAVI aims to increase childrens access to vaccines in developing countries. The choice of the Economic Forum, a high-level summit for business and political leaders, was deliberate: GAVI insists that immunization is not only a human right, but also a key step towards economic development.
Tore Godal, Executive Secretary of GAVI, expanded on this theme some weeks before the launch, in a lecture at the London School of Hygiene and Tropical Medicine. Godal chose an audacious title: Immunization against Poverty. He presented some of the mounting evidence that improved health has contributed significantly to economic development, both at population level and within households, during the twentieth century. "Diseases and their underlying causes can affect families in a number of ways," he said. They included reduction in productivity, impediment of education or retained high dependencies on family members. This could lead to adverse effects on the economies of families. "The emerging conclusion is that the right investment in health is at least as important as education."
Many of the conditions that kill children in developing countries are avoidable with simple and cost-effective interventions. In quantitative terms, vaccines represent the intervention with the largest potential impact. The vaccines that make up the traditional "cluster" given by the WHO Expanded Programme on Immunization can be delivered for just US$ 25 per year of healthy life gained. Any intervention that buys a year of life for less than the average per-capita gross domestic product of the country is regarded by the World Bank as cost-effective. Therefore, there is a compelling case for countries with limited resources to focus on immunization, said Godal.
Now, given the availability of newer vaccines and a shift in resources towards primary health care, a rare opportunity exists to bring immunization to more children, said Godal. Despite the success of child immunization programmes through the 1980s and 1990s, coverage rates in many countries are stagnating and in some countries, notably in sub-Saharan Africa, they are falling. Researchers calculate that more than 2 million lives could be saved each year if existing vaccines, such as those against hepatitis B and Haemophilus influenzae b (Hib) were available to all children. Recent analyses show that these vaccines, although more expensive than the traditional cluster, are still highly cost-effective. Further vaccines that are expected to be licensed soon, such as a vaccine against pneumococcal pneumonia, could save many additional lives.
Before Christmas, the Bill and Melinda Gates Foundation announced a donation of US$ 750 million over five years to the Global Fund for Childrens Vaccines, a new initiative linked closely with GAVI. However, significant further funds will be necessary to ensure a long-term programme.
The World Health Organization is one of several partners in GAVI. Other partners include the World Bank, the United Nations Childrens Fund (UNICEF), the Bill and Melinda Gates Childrens Vaccine Program, the Rockefeller Foundation, the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) and some national governments.