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World: Gates, Others Working To Boost Childhood Immunizations

Street children in Tajikistan (file photo) (RFE/RL) Why is it that when Coca-Cola introduces a new product, it can be found almost immediately the world over, but the latest life-saving vaccines can be difficult to obtain? The simple answer is that consumers can afford to pay for vanilla-flavored Coke while vaccines can be prohibitively expensive. "Time" magazine selected Microsoft found Bill Gates and his wife, Melinda, as their People of the Year -- along with the rock singer Bono -- in large part for the work their foundation has done in trying to create a level playing field for children around the world with regard to immunization.

Washington, 28 December 2005 (RFE/RL) -- Acute respiratory infections, such as pneumonia, are the leading cause of childhood death in Central Asia.

The vaccine Prevnar, introduced in 2000, has proven effective in preventing the pneumococcus bacteria that causes many of these illnesses. But at $150 to $180 for the three doses required, it is too expensive to use to treat many children outside of the United States and Western Europe.

Growing Lag Time

Ruth Levine of the Washington-based Center for Global Development explains that the Bill and Melinda Gates Foundation has tried to address the problem of the growing lag time between when vaccines are introduced in wealthy countries and when they finally reach poorer countries.

"[The Gates Foundation] really did rejuvenate the interest in childhood vaccination and highlighted the fact that there was this big gap and that the international organizations should figure out how to do something about that because immunization is so effective," she said. "[Immunization] can address some of the leading causes of childhood death. It really is one of the few things that we actually know that if we can get it to the kids, it will save their lives."

The Bill and Melinda Gates Foundation -- called the world's wealthiest charitable foundation -- committed $750 million earlier this year to improve access to child immunizations, to speed up the introduction of new vaccines, and to strengthen vaccine delivery systems.

Three Million Children

Melinda and Bill Gates in Mozambique in 2003 (epa)

Bill Gates recently spoke about the issue. He noted that, at present, vaccines save the lives of about 3 million children per year, but that estimates are that another 3 million die for lack of immunization: "There're 3 million children who should be vaccinated each year who are not -- children [whose] lives would be saved if they were vaccinated. It's invisible because it's happening one at a time, and it's happening out of view. It's happening largely in Asia and Africa. And those 3 million, those aren't all you could save. There are new vaccines being invented that you could save another 3 million. When you think about this, it's pretty stunning."

The standard of health care for children in countries in the former Soviet Union exists somewhere in the middle of the quality spectrum between the United States and Western Europe at one end and sub-Saharan Africa at the other.

Dr. Mark Kane is a specialist on immunization at the Program for Appropriate Technology in Health, a nonprofit organization based in the U.S. city of Seattle that recently received $25 million from the Gates Foundation. He said, "Overall, the situation with vaccines is better in the [newly independent states] than in many other parts of the developing world, primarily because the countries actually have quite high rates of immunization coverage. And that's a legacy from the Soviet Union. In most of those countries, more than 90 -- even 95 percent -- of the children do get vaccinated, as opposed to some countries in sub-Saharan Africa where 40, 50, 60 percent of the kids get immunized. In that part of the world, immunization rates are much higher, and that's a very good thing. They're getting measles [vaccines]. They're getting polio [vaccines]. Now they're getting hepatitis B [vaccines]. But they're not getting things like Prevnar."

Lack Of Incentive

Prevnar may not, in fact, be the best vaccine for children in Eastern Europe and Eurasia, since it was developed for the subtypes of bacteria that are common in the United States. But drug companies lack the kind of incentives to make affordable products specifically designed for lower income countries.

The problem, Levine says, is not that the drug companies are necessarily greedy. Producing vaccines is a complex process. "It takes a long time to build up manufacturing capacity," she said. "They have to go through a lot of regulatory hurdles. So they do need to know how much of a market they have, not today necessarily, but in three years or in five years, when their next manufacturing facility is online. And, I mean, we see that in the U.S. and Europe with the flu vaccine. A kind of unsteady demand has led to a situation where the manufacturers don't know how much to produce year to year. And they don't want to produce too much because then they'll lose money."

Buying In Bulk

Groups like the Global Alliance for Vaccines and Immunizations (GAVI), with funding from the Bill and Melinda Gates Foundation, are trying to work with the drug companies on behalf of countries that may be too small to be able to negotiate cheaper prices for the vaccines they need. Dr. Mark Kane explains that "The larger volume you buy, the better price you get. And that, of course, has been a problem with some of the smaller NIS countries. The volume that they would order is not that great from the point of view of the vaccine manufacturer, so GAVI is able sort of, in a sense, to pool the orders for many of the 75 poorest countries in the world and have huge tenders and bids and so on and get very good prices. That's one of the reasons the hepatitis B vaccine is so cheap. That hasn't happened yet for pneumococcus."

Typically, it takes 10 to 15 years for new vaccines to be introduced into developing countries. Organizations like GAVI and the Gates Foundation are trying to cut this time in half. But by most estimates it will still take several years before vaccines for preventable diseases are affordable enough for widespread use.

In the meantime, according to the World Health Organization's current estimates, one child dies of a pneumococcal disease every minute.