Immunization Key to Saving World's Poorest Children

Yoweri Museveni and Jens Stoltenberg Yale Center for the Study of Globalization

As national leaders -- one in Scandinavia, the other in East Africa -- we awaken each day to dramatically different realities. Consider, for example that a newborn in Uganda cannot hope to live much beyond the age of 46, compared to a life expectancy in Norway of 79 years.

In Africa, the struggle to survive starts early. For every 1,000 children born, more than 170 die before they turn fiveoften for want of vaccines that could easily have saved their lives. In contrast, in 2002, Norway lost four children under the age of five per 1,000 born.

There are significant and seemingly intractable economic and environmental reasons for this gap, but there is also great promise. With the proper investments and political will on the part of national and international leaders, immunization can save the lives of millions of children in the poorest regions of the world. Among the most important and cost-effective public health tools ever invented, vaccines should be seen as a cornerstone of international development.

Yet in 2003, more than 27 million children -- most of them among the world's poorest-- missed out on key vaccines during their first year of life It is unacceptable that, also in 2003, almost 1.5 million children died from diseases for which vaccines are available and routinely administered to children in wealthier countries.

Governments of both rich countries and poor have boosted the amount of money they give for vaccines. The United Kingdom, for example, has just last week promised as much as US$1.8 billion over the next 15 years, if its innovative financing plan is approved and other nations agree to participate. Such generosity must become the norm, as much more support will be required to cover the long-term commitment that vaccine programs need.

UNICEF and WHO reported recently that the world is far from meeting the internationally-agreed Millennium Development Goal of reducing childhood mortality by two-thirds by 2015. Given current trends, the UN agencies say, the immunization coverage rates needed to achieve this goal will not be met until 2037.

A major infusion of resources is required to reverse decades of under-investment in health service delivery systems and to support countries in crisis. WHO estimates that an additional US$8 -12 billion is needed over the next decade to provide vaccines against yellow fever, hepatitis B and Haemophilus influenzae type b (Hib), and strengthen routine immunization coverage in the poorest countries.

We have a proven solution for how such resources can be used efficiently and effectively, as demonstrated by a ground-breaking new global immunization initiative, the Global Alliance for Vaccines and Immunization (GAVI),

The GAVI Alliance and its financing arm, The Vaccine Fund, bring together under one umbrella a unique group -- national governments from industrialized and developing countries, UNICEF, WHO, The World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, public health institutions and NGOs. Their common goals are to increase access to essential vaccines among children in poor countries, to improve injection safety, and to accelerate the development and introduction of new vaccines for diseases such as rotavirus and pneumococcal pneumonia, which together accounted for more than 2 million deaths in 2002.

By the end of 2003, GAVI support for immunization in low- income countries, had averted an estimated 670,000 premature deaths (both childhood and adult deaths) among children born in 2001-2003, an impressive achievement within only three years of its launch. Hepatitis B vaccine is now being funded in 50 of the more than 70 countries that GAVI supports (with gross national income less than US$1,000 per capita).

Uganda and Norway have played an integral part in GAVI's initial success: Norway, which has already provided more than US$100 million to GAVI, has announced that it will give almost US$ 300 million more through 2010 and Uganda has committed its resources to dramatically increasing the immunization rate among Uganda's children.

The achievements of GAVI and its partners have been recognized most recently with last week's announcement of a second US$750- million grant over 10 years from the Bill & Melinda Gates Foundation. Nine countries and the European Union have also contributed significant resources to this alliance. However, increased resources and political will are still needed if efforts to immunize children in the poorest countries are going to be significantly scaled up.

What will it take to create a world in which a child's chances of living past the age of five will not depend so strongly on which country he or she calls home? The answer is more money, a commitment on the part of rich countries and poor alike to place vaccines high on their public health agendas, and a proven system, like that of GAVI, for channeling new funds to the people who are most in need.

Yoweri Museveni is president of Uganda and Jens Stoltenberg leads the Norwegian Labor Party and is former prime minister of Norway. He is also a board member of The Vaccine Fund.