Africa’s vac­ci­na­tion test

Financial Mirror (Cyprus) - - FRONT PAGE -

In Fe­bru­ary in Ad­dis Ababa, African health min­is­ters signed a widely cel­e­brated dec­la­ra­tion of their com­mit­ment to keep­ing immunisation at the fore­front of ef­forts to save the con­ti­nent’s chil­dren from death and dis­ease. Ful­fill­ing that com­mit­ment will be no easy feat. Immunisation is not just a health is­sue; it is also an eco­nomic chal­lenge.

The case for vac­ci­na­tion is strong. Glob­ally, an es­ti­mated 2-3 mil­lion child deaths and 600,000 adult deaths are pre­vented an­nu­ally through immunisation. More­over, immunisation is con­sid­ered one of the most cost-ef­fec­tive pub­lic-health in­ter­ven­tions for re­duc­ing child mor­bid­ity, mor­tal­ity, and dis­abil­ity. A re­cent study es­ti­mates that ev­ery dol­lar spent on vac­ci­na­tion will save $16 in costs of ill­nesses averted. Ac­count­ing for the value in­di­vid­u­als place on longer and health­ier lives, net re­turns on in­vest­ments in immunisation soar to some 44 times the cost. And net re­turns ex­ceed costs for all vac­cines.

Sig­nif­i­cant progress has been made. In 2014, 86% of chil­dren were im­mu­nised against diph­the­ria, tetanus, and per­tus­sis, com­pared to less than 5% in 1974. And there have been ex­tra­or­di­nary ad­vances in the num­ber and kinds of vac­cines that are avail­able.

Yet, world­wide, an es­ti­mated 18.7 mil­lion in­fants are not be­ing reached by rou­tine i mmu­ni­sa­tion ser­vices. The prob­lem, of course, is ac­cess.

De­tailed anal­y­sis of immunisation re­veals sig­nif­i­cant dis­par­i­ties within and across coun­tries. More than 60% of the non-im­mu­nised in­fants live in just ten coun­tries: the Demo­cratic Repub­lic of the Congo (DRC), Ethiopia, In­dia, In­done­sia, Iraq, Nige­ria, Pak­istan, Philip­pines, Uganda, and South Africa.

Rou­tine immunisation cov­er­age re­mains par­tic­u­larly low in Africa; in­deed, it has stag­nated over the last three years, against a back­drop of weak and un­der-re­sourced health sys­tems. As a re­sult, one in five African chil­dren still do not re­ceive life­sav­ing vac­ci­na­tion. In 2014, an es­ti­mated 42% of all global deaths from measles were in Africa.

Most of Africa’s un­der-im­mu­nised chil­dren live in Nige­ria, Ethiopia, the DRC, South Su­dan, and Guinea. Poor peo­ple, those liv­ing in ru­ral ar­eas, and fam­i­lies with lower ed­u­ca­tion lev­els com­prise the ma­jor­ity of those who are not reached.

Clearly, money is a lead­ing fac­tor shap­ing immunisation out­comes. Be­yond in­ad­e­quately fi­nanced health sys­tems, which re­main weak and in­ef­fi­cient, es­pe­cially in ru­ral ar­eas, African coun­tries face chal­lenges in af­ford­ing new, more ex­pen­sive vac­cines.

New vac­cines should be en­abling us to save more lives. Yet Médecins Sans Fron­tières es­ti­mates that the in­tro­duc­tion of new vac­cines made it 68 times more ex­pen­sive to vac­ci­nate a child in 2014 than in 2001 in most African coun­tries. An­other study showed that in 2001, the to­tal cost of the orig­i­nal set of six World Health Or­gan­i­sa­tion­rec­om­mended vac­cines was less than one dol­lar. In 2014, the num­ber of WHO-rec­om­mended vac­cines had risen to 11 – and the cost had reached about $21 for boys and $35 for girls. The added costs of de­liv­ery, cur­rently es­ti­mated at about $25 per child, bring the to­tal cost of fully im­mu­nis­ing a child to­day to $50-60.

That same study found that, in many low- and mid­dlein­come coun­tries, i mmu­ni­sa­tion bud­gets are cur­rently in­suf­fi­cient to sus­tain vac­ci­na­tion pro­grammes, much less in­cor­po­rate the new costlier vac­cines. As sev­eral health min­is­ters pointed out in Ad­dis Ababa, high vac­cine prices force poor coun­tries’ gov­ern­ments to make tough choices about which deadly dis­eases they can af­ford to pre­vent.

For some coun­tries, the sit­u­a­tion is about to get worse, as Gavi, the in­ter­na­tional group which has helped to fi­nance the dra­matic global ex­pan­sion of new vac­cines, phases out sup­port for coun­tries deemed to have “grad­u­ated” from as­sis­tance. With­out el­i­gi­bil­ity for the lower prices ob­tained by Gavi, many of these coun­tries may not be able to af­ford newer vac­cines.

In or­der to cope with this chal­lenge, African po­lit­i­cal lead­ers have com­mit­ted to in­vest in the con­ti­nent’s ca­pac­ity to de­velop and pro­duce its own vac­cines. But this is a longterm strat­egy that will re­quire co­or­di­nated re­gional in­vest­ment plan­ning, mar­ket devel­op­ment, and stronger reg­u­la­tory ca­pa­bil­i­ties. In the short to medium term, African coun­tries would do well to look into the power of col­lec­tive bar­gain­ing to strike bet­ter deals for needed vac­cines.

While Africa can and should do more to i mprove vac­ci­na­tion, the global com­mu­nity also has a re­spon­si­bil­ity to make a con­certed ef­fort to bring down vac­cine costs. The re­cently an­nounced re­duc­tion in the price of pneu­mo­coc­cal vac­cine is a step in the right di­rec­tion, but it is not enough. With­out col­lec­tive ac­tion, eq­ui­table and sus­tained ac­cess to immunisation in Africa will re­main a ma­jor prob­lem – and chil­dren’s lives will con­tinue to be lost.

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