Scarcity of pneumococcal vaccine where it is needed most

By Julian Lob-Levyt, The Lancet, 28 November 2009

28 November 2009 -- In your Sept 12 issue, two studies that estimate the global and country-level burden of childhood disease caused by Streptococcus pneumoniae (pneumococcus)1 and Haemophilus influenzae type b (Hib)2 show concrete evidence of a troubling disparity. A disproportionate toll of these diseases, particularly pneumococcal disease, is levied on African and Asian children. An article from Kenya3 has further shown that African children with sickle-cell disease are particularly vulnerable to bacterial infections such as pneumococcal disease.

Yet, these are precisely the children and the places that lack access to life-saving vaccines. Although Hib vaccine—thanks to a concerted multiyear collaborative effort—has or is planned to arrive in nearly every country in the world by next year, none of the ten countries with the highest pneumococcal disease burden routinely provides the pneumococcal conjugate vaccine.

This chasm between the places where the most children lose their lives to pneumococcal disease and where life-saving vaccines are available can be closed. The GAVI Alliance provides assistance to eligible countries to introduce the pneumococcal vaccine sustainably through innovative donor-led financing mechanisms such as the Advance Market Commitment for as little as US$0·15 per dose. Our hope is to introduce the vaccine in 42 countries by 2015.

Strong evidence is an essential component of successful child health interventions. Armed with robust new studies such as these, now is the time to act by maintaining our commitment to provide financial assistance to resource-poor countries and supporting policy makers to prioritise prevention.

References

1 O'Brien KL, Wolfson LJ, Watt JP, et alfor the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009; 374: 893-902.

2 Watt JP, Wolfson LJ, O'Brien KL, et al for the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 2009; 374: 903-911.

3 Williams TN, Uyoga S, Ndila C, et al. Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective cohort and case—control study. Lancet 2009; 374: 1364-1370.