WHO: Vaccine effort saves 2.3m young lives

Immunization rates reach record high, review finds

By John Donnelly, Globe Staff  |  January 27, 2007

WASHINGTON -- Just six years ago, the effort to get vaccines to children in poor countries had fallen apart. Donors, including the US government and UNICEF, had sharply cut back funding and coverage levels had plummeted.

But in 2000, Microsoft founder Bill Gates decided to make childhood vaccines his first priority in a new mission to aid global health, committing $750 million over five years to create a group now called the GAVI Alliance . The result s of his largesse, which helped persuade governments to increase their own contributions, were published yesterday: Immunization rates of children worldwide have reached a record high, and the alliance prevented roughly 2.3 million deaths in the past six years, according to a World Health Organization review.

During that period, 28 million additional children have been protected against diphtheria , tetanus, and pertussis , increasing overall immunization rates for those early-childhood diseases to 77 percent last year, up from 63 percent in 1999. Vaccination coverage in sub-Saharan Africa against the three diseases now stands at 73 percent, higher than South Asia.

"It is a remarkable achievement. No one would have believed that sub-Saharan Africa could have achieved this five years ago," Julian Lob-Levyt , the alliance's director, said in an interview.

In 2000, the Bill & Melinda Gates Foundation funded $325 million of the organization's $329 million budget; in the first six years, the foundation has given $983 million, while 17 countries have donated a combined $990 million. The US government is the second largest contributer, giving $353 million.

Gates has done much of the pushing himself.

In a news conference yesterday at the World Economic Forum in Davos, Switzerland, Bill and Melinda Gates both said they were extraordinarily pleased with GAVI's success, but believed that much more can be done. Last year, they pledged another $750 million over 10 years to the alliance, which also announced yesterday it would be expanding its focus to help improve health systems in developing countries.

Six years ago, "the vaccination rate across the world was declining and it was a sad state of affairs," Melinda Gates said. "When Bill and I first heard about this, we kept saying to ourselves, 'How can that be? We have all these incredible vaccines for our children in Europe and in the United States, but they don't get delivered to the developing world.' "

Bill Gates added that "Vaccines are a miracle thing, and as we can add, some day, perhaps a malaria vaccine, some day a TB vaccine, or an AIDS vaccine, the infrastructure and the capacity that GAVI has built out" will prove essential to saving millions more lives.

Arthur Allen , author of the just-published "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver," compared Bill Gates to John D. Rockefeller, two businessmen who "used their billions to do something good for humanity." Rockefeller started his foundation 93 years before Gates started his; Rockefeller tried to eliminate diseases such as hookworm , yaws, and yellow fever.

The GAVI Alliance's model is simple: it has given money to 70 of the world's 73 poorest countries to increase immunization rates, but doesn't tell them how to spend it. Instead, the alliance sets goals of percentages of children vaccinated; if the country reaches the goals, it gets more money.

After a country delivers its report, the GAVI alliance checks the accuracy. In the past five years, 35 countries passed an audit, while 15 failed, although no nation has failed in the past two years.

One success is Sudan.

"We told our district people, and district governors, that if we immunize more children, this will help us get more resources to the country," Dr. El Tayeb A. El Sayed , Sudan's director of child health and immunization, said yesterday in an interview from Geneva.

In 2002, Sudan's coverage for diphtheria, tetanus, and pertussis stood at 64 percent; after three years, and $5.7 million from GAVI, coverage increased to 83 percent. In the country's war-torn Darfur region, El Sayed said, his teams developed a "hit and run" strategy, in which vaccinators would arrive in camps, vaccinate as many children under 1 year old as possible, and then leave . In Darfur, they have reached between 50 and 60 percent of children.

The alliance also has expanded coverage of vaccines not widely available in poor countries, including those for hepatitis B and yellow fever. In the last six years, 136 million more children have received at least one of these three vaccines, according to the alliance.

John Donnelly can be reached at donnelly@globe.com