The Progress of Nations 2000

COMMENTARY: NEW AGENDA FOR VACCINES

help in timies of (lisaster. Imagine the horror of the world if a
major earthquake were to occur
and people stoo d by and watched
without assisting the survivors!
Yet every d(lay, the equivalent of a
major earthquake killing over
30,000 younllg (childlren ccurs to
a (listurl)bingly muted1 response.
They d(lie qulietly in i some of the
pi)oorest villages on earth, far relmo)ved from the scrutiny and the
conscience of the worl(d. Being
meek an(d weak in life makes these
dying multitudles even more invisible in d(leath.
All chil(lren everywhere must
le able to enjoy the lbenefits of
science and experience developed
around( vaccines. All chilIdren
everywhere, without (liscrimination, have andi must be able to

enjoy equal rights. The Convention on the Rights of the Child,
ratified by all but two countries,
binds the world in a compact to
realize these rights. Distance and
remoteness must therefore neither blind our vision, blunt our
feelings, nor stall our response
to this numbing, recurrent tragedly. It is our collective responsihility to see that these deaths are
prevented.
And they are preventable. We
can and,must now go the distance and finish what so desperately remains to be d(one by
unleashing the full power of
immunization against the six
traditional child-killer diseases.
Measles is still a severe threat,
especially in South Asia and subSaharan Africa, and efforts are

needed to stop the (ldownward
slide in measles coverage that
occurred in Africa (during the
1990s.
Half of the infants born in
developing countries are unprotected against l tetanus and
200,000 die from the disease
each year because their mothers
have not been iminrlized with
tetanus toxoid. And as infants
die, so too do women: In parts of
Africa, fewer than 40 per cent of
women are immunized against
tetanus. In rural pockets of
China and India, 10 per cent or
less may he protecte(l.
Whooping cough (pertussis)
still afflicts 20 million to 40 million people every yearu primarily
in developing countries, although
a pertussis vaccine has been
available for more than 70 years.
Efforts to reach the iunreached
must go hand in hand(l with the
improvement of iniiunization
safety. Reuse of unllsterilize(1
needles, )poor hygiene at the time
of vaccination andi inadlequate
waste disposal are the main culprits. Failures in the cold chain
to maintain vaccines at the proper
temperature are also a problem.
Personnel must le I rained and(
systems introducedl to prevent
these dangerous practices.
The Safe Injection Global Network - which links international
organizations, NGOs and private
sector entities- is promoting
the use of syringes that function
only for a single (lose. It is also
investigating the po)ssibility of
introducing vaccine(s that (don't
require needles for (lelivery,
but can le givenl through other
methods, including oral doses,
jet ejectors, nasal sp)rays, skin
creams and even genetically
modified foods.
A clear priority now is to renew
commitment at all levels to attain
the immunization gals. The net
must he cast wider to reach all
those who have not heen reacthe(1
thus far the poor, the displaced,

people living in far-flung villages,

childlren living on the streets,
refugees and people living in areas
of conflict. Extensive educational
and outreach campaigns must he
mounted iii countries with high
incidlences of disease. Governments must renew their commitment and resolve problems caused
bly corruption, inadequate services and mismanagement.
A revolution only
for some
Vaccines have chainged the course
of history and hurman development, and they continue to (do so.
A veritable pul)lic health revolution is occurring, with relatively
recent vaccines and vaccinedelivery technologies joining atndl
strengthening the august ranks
of older tried-and-true vaccines.
The promise these develop)ments
hold is enormous; the ulnacceptablde reality is that many in the
(leveloping world will continue to
le exclud(le(l from their benefits.
A vaccine now offers protection
from hepatitis B (which causes
liver cancer later in life), for
example, and over 60 countries
have added it to their routine
inunmmunization programmes. But
at a cost of $1.50 per child to
a(ldminister the three necessary
doses, the vaccine does not reach
many of those who need the protection most. Approximately $20
million would make the vaccine
available in sub-Saharan Africa.
Similarly, a new vaccicne against
ftilb (Haemophilus inl/lenz(tae
type ), which causes bacterial
pneumonia and meningitis) has
heen intr(oducetd in 24 developing countries. Now, $80 million
stands hetween the vaccine and
the lives of the millions of other
children at risk in developing
countries, where at least 400,000
(lie every year from the infections Hih causes.
The list does not eii(1 there,
however. There are new vaccines
oi the horizon to combat the
largest threats to children in

developing countries, stic;h as

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