Wednesday, January 18, 2006

THERE AREN'T a lot of things that could save half a million children annually, but an effective rotavirus vaccine could. This diarrheal disease is one of the world's top killers -- less murderous than AIDS (which caused an estimated 3.1 million deaths last year) or malaria (a bit over 1 million), but remarkable for the fact that its name is not widely known. Earlier this month the New England Journal of Medicine published the promising results of large-scale clinical trials for two rotavirus vaccines. It seems a breakthrough has arrived.

The question is how quickly the vaccines can be deployed in the poor countries where nearly all the deaths happen -- and, by extension, whether other new vaccines can be put to use quickly, transforming life expectancy in the poor world. History counsels caution: Every year, about 27 million children don't get the basic shots that are standard in rich countries. But two major efforts have recently improved the odds of deploying new vaccines widely.

The first is the global polio eradication campaign. Starting in 1998, polio immunization drives have greatly reduced the burden of this paralyzing disease; in India, for example, the number of cases has fallen from 75,000 annually to fewer than 100 last year. With enough persistence, polio may be eradicated; but in the meantime, the campaign has created an infrastructure for delivering vaccines -- everything from detailed registries of the children living in each village to supplies of cold boxes for transporting doses to remote clinics. The progress against polio has created thousands of motivated health care workers and, just as important, millions of parents who have learned to trust the health system.

The second promising development is the creation in 2000 of the Global Alliance for Vaccines and Immunization, which aims to tackle financial and other obstacles to the broad deployment of vaccines. So far the alliance has disbursed about $700 million, enabling millions of extra children to be vaccinated and saving an estimated 1.7 million lives. But this is just the beginning: Governments and private donors have committed a further $5.1 billion, about $3 billion of which will come via a new mechanism that uses financial markets to front-load aid spending. If the rotavirus vaccines had been developed 10 years ago, there would have been a scramble to find money to pay for them. Now, millions of dollars are available.

Failure is still possible. Last month The Post's Justin Gillis reported on the delays in launching clinical trials in Asia and Africa, which will hold up deployment of rotavirus vaccines there. But enough is going right in this field to dream of a real turning point. The more vaccines are put to use, the stronger the delivery infrastructure becomes and the stronger the incentive for firms to invent more vaccines -- which in turn will further energize the delivery system, leading to still wider deployment of vaccines and even greater financial incentives to inventors. To enable that virtuous cycle, rich countries must continue their support for the Global Alliance for Vaccines and Immunization, and poor countries must make the most of the opportunities created by the alliance's money. It is not an iron law of nature that life expectancy has to be 32 years more in rich countries than in sub-Saharan Africa.