An act of injustice, not charity

The Global Poverty Project has recently begun The End of Polio Campaign to rid the world of a disease which has disabled millions and pulled individuals further into poverty. Over the past 30 years the threat of polio has been reduced by 99 per cent over the past 30 years - it's end is in sight.

Sandra Opoku, from the Global Poverty Project, agrees: 

THE Australian government recently announced increases in funding for immunisation, and with the recent momentum around the eradication of polio, we should reflect on the facts of the global importance and impact of immunisation coverage.

It is in our best interest to address global public health issues, and it is also affordable for us to do so. Health is an essential human right and is recognised as a global public good by all United Nations-member states.

The gap in immunisation coverage rates between developed and developing countries is growing as most developing countries cannot afford the newer and more expensive vaccines that are being introduced. Furthermore, support for vaccines from developed countries has actually fallen over the last few decades.

Traditionally the Expanded Programme for Immunisation (EPI) is a national responsibility, but most developing countries actually rely on external assistance for new vaccine implementation and for scaling up existing programmes. For developing countries national decision-making around public health involves opportunity costs, with limited resources and competing priorities. Without guaranteed sustainable funding for the long term most countries, within sub-Saharan Africa in particular, would not choose to implement new vaccines into the EPI.

Much of the funding for vaccine distribution relies on international donors and multilateral institutions. The Global Alliance for Vaccines and Immunisation (GAVI) currently provides the bulk of sustainable resources for routine immunization. GAVI funding has allowed many developing countries, particularly in sub-Saharan Africa, to reach important targets of access, utilization, quality, safety, and equity.

Despite these huge gains in terms of lives saved, many challenges to immunisation coverage still remain today. Global commitment for vaccines has not been sustained. Many deaths still occur today from measles, tetanus, and polio even though vaccines for these diseases were integrated into the EPI decades ago.

Roughly 30 per cent of children globally are not being reached by the EPI and over 70 per cent of deaths in children under-five are still caused by vaccine preventable diseases.

Importantly, if vaccines are not successfully delivered to target populations with necessary coverage rates then the impact of the vaccine, cost-effectiveness of the intervention and public health benefits are minimised.

Currently priorities do not accurately reflect disease burden or cost-effectiveness of known interventions. The World Bank has estimated that developing countries account for over 90 per cent of the global disease burden, yet only around 20 per cent of global income, and 10 per cent of global health expenditure. To demonstrate global priorities, only 10 per cent of medical research is focused on diseases that are responsible for 90 per cent of the global disease burden.

The economic, practical, and moral incentives for developed countries to support vaccine distribution are high. Vaccines are the most effective public health tool available. 

The Copenhagen Consensus of 2008 listed the EPI as the fourth major solution to the world’s greatest challenges.

Furthermore, whilst it might sound crude, childhood vaccination saves the most lives per dollar invested than any other public health tool. Both the Diphtheria Tetanus and Pertussis, and the measles vaccine cost less than US$50 per life saved.

In fact the estimated benefits of implementing known and effective interventions that would address all the major diseases would actually be 7-30 times the cost.

Combine all these facts and it seems clear that the support for increased immunisation in developing countries should be a major global priority. Health is an essential human right. Developing countries will need increased support in order to gain the potential global benefits of immunisation. Effective and affordable interventions already exist and it makes sense to implement the EPI at high coverage rates in all regions, specifically those with high disease burdens.

It might also be the ultimate answer to eradicating ancient and costly diseases.

This is an act of justice.