October 27, 2008

By Wolfgang Kerler

Although a safe and effective vaccine has been available for eight years now, 1.6 million people still die from pneumococcal diseases every year, making it the number one vaccine-preventable cause of death worldwide. More than half of the victims are children.

“Pneumococcal diseases are probably the greatest killer worldwide that you rarely hear about,” Orin Levine, executive director of the PneumoADIP project (Pneumococcal Vaccines Accelerated Development and Introduction Plan) at Johns Hopkins Bloomberg School of Public Health, told IPS.

“Although they are causing as many deaths as tuberculosis and more than malaria, they do not get the same attention.”

There are only 26 countries among the 193 members of the World Health Organisation (WHO) where most or all children are being immunised against pneumococcal diseases such as pneumonia, meningitis or sepsis. Twenty-four of these countries are highincome countries representing less than one percent of the cases of illness.

“The overwhelming majority of deaths occur in Sub-Saharan Africa and South Asia,” Levine said. “Together those two areas account for almost threequarters of child deaths caused by pneumococcal diseases.” The above numbers are the result of research on the worldwide introduction of pneumococcal conjugate vaccine (PCV) released by the U.S. Centers for Disease Control and Prevention (CDC) and WHO Friday. The research revealed that no low-income country offers PCV to children as a part of its national immunisation program or has PCV in widespread use — although at least one child dies of pneumococcal diseases in poor countries every minute.

“Pneumococcal disease is found all over the globe, but all too often strikes those who are young, poor and least equipped to fight it,” said Matthew Moore, medical epidemiologist at the CDC.

“While optimal diagnosis and management of pneumococcal disease saves lives, many children and adults do not have access to this care.” According to Levine from PneumoADIP, the lack of public awareness is the major reason for these deficits. “If there is a disease you have never heard of and it is not a priority to prevent it, there is not much interest in funding the efforts to fight it,” he said.

For poor countries, the high costs of vaccines have been an obstacle to their large-scale introduction. However, during the next 10 years, global immunisation funding for new vaccines and immunisation systems could be as much as 8 billion dollars, according to estimates released by the Pneumococcal Awareness Council of Experts (PACE).

“We call on governments internationally to take advantage of this progress in health care and ensure life-saving pneumococcal vaccines are available to the people who need it most,” Levine said.

He stressed that although “the price of action will be measured in dollars, the price of inaction will be measured in child deaths that could have been prevented.”

The GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunisations) — a project of which PneumoADIP is a member — has dedicated 1.5 billion dollars “to make pneumococcal vaccines available for a subsidised price for the world’s poorest countries,” Levine said.

From early 2009 on, Rwanda and Gambia are likely to be the first two countries to benefit from this programme. Six other countries — Central African Republic, Democratic Republic of Congo, Guyana, Honduras, Kenya, and Nicaragua — have also been approved by GAVI for the introduction of PCV into national immunisation programmes.

The pneumococcus is a bacterium that causes serious infections like meningitis, pneumonia and sepsis. In developing countries, even half of those children who receive medical treatment will die. Every second surviving child will have some kind of disability.

One of the reasons why Sub-Saharan African countries are especially hard hit by pneumococcal diseases is the fact that persons infected with HIV are up to 300 times more likely to have a pneumococcal disease than those who are HIV-negative. More than 60 percent of HIV-infected persons are living in Sub-Saharan Africa. In 2000, a new pneumococcal conjugate vaccine became available which is now licensed in more than 90 countries. Studies in the United States revealed that the country has almost completely eliminated pneumococcal diseases of children since infants began receiving routine vaccination eight years ago.

To raise awareness and to urge governments, donors and industry alike, more than 100 professional medical societies, institutions and organisations from around the world joined the Pneumococcal Awareness Council of Experts (PACE) Friday and made a unified call to action. Levine, who is a co-chair of PACE, stressed that “We are just beginning to take the steps that are necessary to combat pneumococcal disease. And while we are encouraged by what we begin to see, we must further expand these efforts.”