Great ideas vs. implementation

Pneumonia, the largest killer of children, has recently found a worthy adversary: pneumococcal vaccine. This new generation of vaccines prevents the leading cause of pneumonia, pneumococcal infections, and is reaching developing countries at an unprecedented rate. Up to seven million deaths will likely be averted by 2030, largely due to GAVI and its partners. Additionally, preliminary results from a phase 3 clinical trial indicate that the number of malaria cases can be cut in half through a malaria vaccine known as RTS,S. GlaxoSmithKline is developing this vaccine with most of its support from the Bill and Melinda Gates Foundation.

These are incredible global health milestones and deserve tremendous praise. However, progresses in the development of vaccines are certainly not enough in the advancement of global health. Effective delivery of vaccines and adequate health systems need to be in place to ensure that the entire population of the countries in question is being immunized. Health worker shortages and the delivery of vaccines are major obstacles for most developing countries. GAVI, a major actor in the funding of immunizations in developing countries, contributes 20% of its total funding to support health systems, and delivery and overheads. The question now remains if the developing countries are prepared for the wave of new life-saving products coming through. National governments need major financial support to strengthen their healthcare infrastructure, increase the number of health workers and to improve their supply-chain management. With improvements in e.g. the vaccine cold chain, an estimated 30 million vaccine doses could be saved annually in the developing countries. Furthermore, vaccines that have been readily available for many years are in many cases not reaching the majority of a country´s population, indicating that there is something fundamentally wrong with the health systems in place. It has been estimated that nearly 79% of children received life-saving vaccinations against killer diseases, such as polio, tuberculosis, diphtheria, pertussis, measles and tetanus, a drastic increase from around 5% in 1974. However, these vaccines have been available for decades yet almost a quarter of the world’s children are not immunized against these killer diseases. What is preventing these vaccines from reaching the children? Higher investments in vaccine R&D need to be accompanied with Increasing immunization coverage through better health systems if better global health is to be achieved.

In Sierra Leone the wonderful proposal of providing free healthcare for pregnant women and children under five years old was implemented last year in an effort to tackle its high rates of maternal mortality and infant death. It garnered much praise from international donors which provided much of its funding. The free healthcare initiative has certainly produced a much higher number of pregnant women and children that receive healthcare. In the first month after the initiative was implemented, the number of women giving birth in hospitals and clinics increased by over 300% and government-run hospitals saw about three time as many children under five in the first 12 months of the program. However, the number of health workers and healthcare equipment has not increased sufficiently to match the demand and health workers are struggling to deal with the influx. This has in many cases resulted in staff exhaustion and a poor standard of care for patients and many women continue to pay for essential drugs, despite the free care policy. Whether the initiative has drastically decreased maternal mortality remains to be seen.

Malaria and pneumococcal vaccine and Sierra Leone´s free healthcare initiative are wonderful ideas that deserve tremendous praise. However, global health improvements don’t stop there. There needs to be in place a more holistic approach in ensuring that these great ideas are implemented in a manner that truly benefits the health of the populations in question.

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