Decision Time on Vaccines

A child who dies before the age of five is robbed of a life, and also of the chance to participate and contribute to her community and country. For leaders in Ethiopia, determining how to best ensure that children survive and live productive lives is not easy.

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Should the country invest in healthcare, infrastructure, or education – or something else entirely?

There is a low-cost proved investment that not only gives children a healthy start in life, but is cost-effective with long-term benefits for prosperity: vaccines.

A new study from the Johns Hopkins Bloomberg School of Public Health estimates that between 2011 and 2020, the majority of countries in Africa will collectively see a net economic benefit of 224 billion dollars by investing in immunization programmes. The study also found that, in 94 low- and middle-income countries around the world, for every dollar invested in vaccines during the decade, there will be an estimated return of 16 times the costs, taking into account treatment costs and productivity losses.

In Addis Abeba later this month, ministers of health and finance, as well as other national, traditional and religious leaders from across Africa will gather to discuss the unbeatable value of immunization at the first-ever Ministerial Conference on Immunization in Africa. This moment presents the perfect opportunity to celebrate the successes on the continent, look seriously at what needs to be done to make sure all children get the vaccines they need, and then to commit to making that happen.

There is a history of continental commitment to vaccines. Four years ago, Ethiopia promised, along with other African nations and other World Health Organization (WHO) member countries, to support children’s health by setting a goal of universal access to immunizations by 2020 as part of the Global Vaccine Action Plan (GVAP).

There is much to celebrate in the progress made both before and since. In 1990, more than one in five children died before the age of five in Ethiopia. Today, that number has been reduced by two thirds. This has even outpaced the rest of Africa, where child deaths dropped 55pc between 1990 and 2012.

This is thanks in large part to the impact of vaccines, and the strength of the country’s Health Extension Program (HEP) that is delivering those vaccines. Twenty five years ago, fewer than half of Ethiopians received the DTP3 (diphtheria, tetanus and pertussis) vaccination. Today, it is 84pc percent. And, after years of successive vaccination campaigns, Ethiopia has been free of wild polio virus since 2014.

Ethiopia has been making strong progress. With the government’s focus on quality and equity within the new Health Sector Transformation Plan, the country is demonstrating its commitment to reach all children – even in the most difficult to reach areas – with the vaccines they need. While there are real challenges to achieving universal coverage with vaccination, this strong commitment from the government is essential.

So while Ethiopia’s leaders deserve credit for these exceptional gains, we cannot allow the momentum to falter. Not only will we save lives by committing to vaccines, but we will be doing so using proved and cost-effective tools. And this is where the economic argument becomes even more compelling.

Investment in clinics, health workers, and healthcare delivery systems creates jobs and puts in place a basic infrastructure that can help save even more lives through the daily delivery of healthcare. It also builds resilience to deal with health crises. Strong primary healthcare systems are critical to our long-term development, and the Health Extension Program in Ethiopia is an excellent example of increasing access and creating a base for continued improvements in quality programming that will reach all children.

It is better to prevent a disease than to treat it, both from a moral and an economic standpoint. Treating vaccine-preventable diseases places an enormous strain on public health systems by redirecting scarce and valuable resources, and slowing economic progress. This is a widely supported perspective, which is why the United Nations included vaccines for all – as well as universal health coverage – as key to achieving the Sustainable Development Goals (SDGs).

Progress, we know, is not inevitable. Gains can be reversed. So with Africa’s leaders coming together in Ethiopia this month, now is the time to stand together and recommit ourselves to providing universal access to vaccines. In doing so, we will commit to more than the health of children. We will be committing to both the health of Ethiopia, and of all of Africa.


By Ayo Ajayi (PhD)
is Director of the Bill & Melinda Gates Foundation’s Africa team.

Published on Feb 23,2016 [ Vol 16 ,No 825]



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