10 November 2011

Pneumonia: Progress Made, Success on the Horizon

The case for vaccines is quite simple: they save lives. Rallying people around them can be a bit tougher. One such example is Pneumonia; responsible for 1.5 million deaths in children in 2008. Of that number, roughly 75% occur in only 15 countries. A new Johns Hopkins University study reviews the 15 countries and finds good news. The authors write, "The speed at which [the newest-generation pneumococcal vaccines(PCV10 or PCV13)] are being introduced in low-income countries is unprecedented and is expected to have tremendous health impacts. It is estimated that by 2013, 11 of the 15 countries profiled will have introduced the pneumococcal vaccines into their national immunization programs."

Vaccines are a powerful and simple solution. The study finds that from 2010 to 2019, costs averted due to direct and indirect effects of the vaccines range from $986 million to $1.2 billion. Roughly 85% of the sum would have been used to treat pneumonia. “Vaccines and antibiotic treatments are like two safety nets that work together – vaccines provide a first line of defense, while antibiotics ensure that children who get through the first net don’t die,” said Orin Levine, JHU professor and executive director of International Vaccine Access Center (IVAC).

The study by Dr. Levine, et al, Cost effectiveness of child pneumococcal conjugate vaccination in GAVI-eligible countries (gated), has some pretty stunning findings. As summarized in the abstract:
Depending on the formulation used, PCV could avert 294,000-603,000 deaths and 9.3–17.6 million disability-adjusted life-years (DALY) annually. The majority (91%) of the DALYs averted would be through the vaccine's direct effects in children under-5. Using WHO thresholds and a negotiated average dose cost, PCV would be highly cost effective in 69 of 72 GAVI-eligible countries. This finding was robust when assumptions regarding disease epidemiology and vaccine-related effects were varied in sensitivity analyses. The current analysis supports PCV introduction in GAVI-eligible countries owing to its potential to avert substantial numbers of deaths at relatively low incremental costs.

The GAVI Alliance estimates that 3.6 million children have been vaccinated against the virus this year. To mark World Pneumonia Day on Saturday, GAVI will be expanding to a new country. CEO of the GAVI Alliance Seth Berkley, M.D. comments, “As of Saturday, when Malawi introduces the pneumococcal vaccine for its children, it will become the 16th of the world’s lowest-income countries to take this step – and this is just the beginning. Thanks to our donors, we plan to support the rollout of these vaccines to nearly 60 countries by 2015.”

Fortunately, GAVI received a big boost this summer with pledges from large donors that amounted to $4.3 billion. The funding is starting to materialize, the questions are now directed towards implementation. Thanks to the JHU study, we have further evidence that vaccines are not the end, but are a significant player in reducing pneumonia deaths.

Check out a report card for the 15 countries responsible for the majority of pneumonia-caused child deaths and some more information about the study for those of you who cannot view the gated study:

Photo Credit: GAVI/11/Riccardo Gangale