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Global vaccine efforts offer hope to millions

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Tuesday, January 18, 2011

The editors of the British Medical Journal recently concluded that a 1998 study ringing alarm bells on a possible connection between vaccines and autism was an "elaborate fraud." It is the culmination of a more-than-decade-long controversy in which the charge was initially and frighteningly plausible, then embattled, then discredited by large-scale studies.

This is a particular blow to the parents of children with autism, who deserve more explanation and support than they are generally given. Autism has stubbornly resisted simple scientific explanation. This calls for more research and more practical help for parents - not less.

The vaccine controversy in America and Europe was made possible by the success of vaccines. If children in developed countries faced the serious prospect of contracting measles, mumps and rubella - leading, in some cases, to pneumonia, seizures, deafness, brain damage, infection of the spinal cord or arthritis - the value of vaccines would be more immediately obvious. During the 20th century, an average of 650,000 people died each year from measles, polio, rubella, smallpox and diphtheria. Now fewer than 100 do.

Only countries that possess herd immunity debate the importance of vaccines. Yet not every country enjoys such an advantage.

Vaccines are among the greatest scientific contributions to human welfare. They are also some of the largest humanitarian contributions of developed nations to the rest of the world. So it is unfortunate that a decade of vaccine controversy has overshadowed a decade of vaccine miracles.

In 2000, with startup money from the Bill and Melinda Gates Foundation, the Global Alliance for Vaccines and Immunization (GAVI) began operation, with the goal of introducing new or underused vaccines into poor countries. GAVI is an acronym that reeks of global bureaucracy, slow-moving secretariats and Geneva consultations. The organization, in contrast, has turned out to be innovative and effective.

The alliance - composed of foundations, donor governments, vaccine manufacturers, the World Bank and the World Heath Organization - has employed the free market instead of fighting it. It has raised private capital, and it has made advance commitments to purchase vaccines, in exchange for pledges by pharmaceutical companies to expand production and provide vaccines at lower prices. It has helped to strengthen the "cold chain" that allows for vaccine delivery at proper temperatures.

The result? By the end of 2008, 192 million children had received vaccinations against hepatitis B, and 41.8 million were protected against Hib (a type of bacteria that causes meningitis). During the alliance's first decade, GAVI-funded vaccines for these diseases - along with vaccines for pertussis, measles, yellow fever and polio - prevented more than 5 million premature deaths.

When it comes to human lives, the word "million" should not be passed over without comment. It was the unit of measure for 20th-century genocides. So it is remarkable that a poorly named international organization, almost unknown to Americans, with no apparent instinct for self-promotion, should count 5 million success stories. It is a demonstration, for anyone who doubted it, that foreign assistance can be effectively redesigned and focused on achievable outcomes. It is also living proof that science, guided by conscience, is one of the most powerful, hopeful forces of history.

This demonstration that the rapid expansion of vaccination is possible in the developing world creates an ethical challenge of its own. A vaccine for malaria is a few years away. Vaccines for HIV/AIDS, tuberculosis and dengue fever are probably more distant. But two vaccines - for rotavirus and pneumococcus - are available. These diseases, causing diarrhea and pneumonia, are the leading causes of death for young children in poor countries. But just a few early treatments would bring a lifetime of immunity. The Gates Foundation estimates that large-scale vaccination, in these cases, could prevent the deaths of 7.6 million children under 5 in the next decade. Again, note the "millions."

Many global problems are desperate but seem beyond our ability to comprehend or resolve. Sufficient support for GAVI from governments, foundations and individuals would solve much of the problem it is tackling. The answer for millions of dying children does not need to be invented, studied or tested. All this has already been done. Their hope lies within a locked room. And those with keys gain responsibilities.

michaelgerson@washpost.com


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