A shot in the arm for MDG 4 in Africa

Abstract

On Feb 14, 2011, the introduction of a pneumococcal conjugate vaccine into Kenya's national immunisation programme will mark a turning point for reducing child mortality in Africa. Through a novel finance mechanism pioneered by the GAVI Alliance and its partners—the Advance Market Commitment (AMC)—a vaccine specific to the serotypes most prevalent in developing countries will become rapidly available at affordable prices.Every year, over 1·5 million children younger than 5 years die from pneumococcal diseases, with the highest burden in Africa. In Kenya alone, about 30 500 children died in 2008 from pneumonia. Yet it can take 20 years before pneumococcal vaccines routinely available in developed countries become affordable for low-income countries; even then, these vaccines are not specific for developing countries. By contrast, the vaccine being rolled out in Africa covers the 1, 5, and 14 serotypes prevalent in the region.The AMC provides incentives to the manufacturers by guaranteeing a market and subsidising costs to ensure supply. GlaxoSmithKline (PCV10) and Pfizer (PCV13) have agreed a set maximum price of US$3·50 per dose for 10 years, most of which will be paid for by GAVI and six donors. The same vaccine costs $70 per dose in the USA.However, Médecins Sans Frontières has expressed concern that this commitment might hamper competition, and thus impede lower vaccine costs. Some suppliers could provide the vaccine at lower costs, although manufacturers must be WHO qualified and be able to supply the high quantities needed now.Faster and more affordable access to pneumococcal vaccines for Africa and other developing countries will be crucial to meet Millennium Development Goal 4, to reduce child mortality. For the first time, children in low-income countries will have the same access to an effective pneumococcal vaccine as do children in Europe and the USA. Now that access to a suitable vaccine has become a reality for developing countries, governments must invest in integrated health-care infrastructures and plan for a future in which they no long rely on donors for sustainable vaccination programmes. On Feb 14, 2011, the introduction of a pneumococcal conjugate vaccine into Kenya's national immunisation programme will mark a turning point for reducing child mortality in Africa. Through a novel finance mechanism pioneered by the GAVI Alliance and its partners—the Advance Market Commitment (AMC)—a vaccine specific to the serotypes most prevalent in developing countries will become rapidly available at affordable prices. Every year, over 1·5 million children younger than 5 years die from pneumococcal diseases, with the highest burden in Africa. In Kenya alone, about 30 500 children died in 2008 from pneumonia. Yet it can take 20 years before pneumococcal vaccines routinely available in developed countries become affordable for low-income countries; even then, these vaccines are not specific for developing countries. By contrast, the vaccine being rolled out in Africa covers the 1, 5, and 14 serotypes prevalent in the region. The AMC provides incentives to the manufacturers by guaranteeing a market and subsidising costs to ensure supply. GlaxoSmithKline (PCV10) and Pfizer (PCV13) have agreed a set maximum price of US$3·50 per dose for 10 years, most of which will be paid for by GAVI and six donors. The same vaccine costs $70 per dose in the USA. However, Médecins Sans Frontières has expressed concern that this commitment might hamper competition, and thus impede lower vaccine costs. Some suppliers could provide the vaccine at lower costs, although manufacturers must be WHO qualified and be able to supply the high quantities needed now. Faster and more affordable access to pneumococcal vaccines for Africa and other developing countries will be crucial to meet Millennium Development Goal 4, to reduce child mortality. For the first time, children in low-income countries will have the same access to an effective pneumococcal vaccine as do children in Europe and the USA. Now that access to a suitable vaccine has become a reality for developing countries, governments must invest in integrated health-care infrastructures and plan for a future in which they no long rely on donors for sustainable vaccination programmes. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimatesS pneumoniae causes around 11% (8–12%) of all deaths in children aged 1–59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden. Full-Text PDF Global, regional, and national causes of child mortality in 2008: a systematic analysisThese country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions. Full-Text PDF