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Improve Global Health
In June 2018, German Chancellor Angela Merkel introduced a new plan for Germany to become a front-runner in global health. This plan was to fully come into action by the end of 2019. In addition, the BMJ Journal reported that the plan involved bringing in non-governmental representatives to provide their knowledge to develop a strategy for Germany to improve global health.

What is the Plan?

Germany worked with the World Health Organization (WHO) to develop the Global Action Plan for Healthy Lives and Well-Being for All program. One of the main goals of this initiative is to accelerate progress in seven key areas:

  1. Primary health care
  2. Sustainable financing
  3. Community and civil society
  4. Determinants of health
  5. Innovative programming in fragile and vulnerable settings and for disease outbreak responses
  6. Research and Development, Innovation and Access
  7. Data and digital health

These seven points focus on the main areas of mobilizing and enabling communities. They also focus on providing governments with the necessary funding and knowledge to help their people and ensuring the research and money is going to the areas that most need it.

Funding

Germany began working towards many of these goals as early as 2018. The Global Fund reports that Germany pledged 1 billion euros (roughly $1.094 billion) towards The Global Fund’s fight against diseases such as HIV, malaria and AIDS. Also, the website states that this was a 17.6 percent increase from its previous pledge. Germany is pledging this amount for a three-year period.

The website Donar Tracker notes that Germany donated 47 percent of its development assistance fund to multilateral, or multi-country, organizations. The website states that the main recipients of this funding were the previously mentioned Global Fund, the E.U. and Gavi. Gavi is an organization focused on giving impoverished countries access to vaccines.

Cooperation

The Global Health Hub Germany is a website that Germany hosts to improve global health. This website calls itself the platform for Global Health. The World Health Summit, which Berlin, Germany holds annually, helped to organize the launch of The Global Health Hub, claiming that its mission statement is one of cooperation.

The Global Health Hub Germany aims to inform people, get them working together and develop new ways for the world to improve global health. Additionally, it hosts frequent events and conferences aimed to give people the information they need to help improve global health. The website launched on October 29, 2019. Since then, it gained 555 members as of November 2019. Its members consist of activist groups and experts in the health field. The Global Action Plan for Healthy Lives and Well-being for All states Germany’s mission statement going forward to improve global health. Funding, cooperation and mobilization are just some of the ways that Germany aims to improve global health.

Jacob Creswell
Photo: Flickr

10 Facts About Life Expectancy in Guinea-Bissau
Guinea-Bissau, a small country in Western Africa, has a low life expectancy of 57.67 years.  However, life expectancy in Guinea-Bissau of both men and women increased by seven years over the last 17 years. In 2001, life expectancy in Guinea-Bissau was 50.368. Currently, men in Guinea-Bissau have a life expectancy of 55.6 while women have a life expectancy of 59.62. The increase in life expectancy in Guinea-Bissau is due to improvement in health care services, education, preventive measures and a reduction in child mortality.

10 Facts About Life Expectancy in Guinea-Bissau

  1. Child Mortality: The infant mortality rate in Guinea-Bissau continues to decrease. Child mortality was 125 for every 1,000 children in 2008 and that number decreased to 81.5 for every 1,000 children in 2018. Guinea-Bissau’s investments to provide mothers with children under the age of 5 with better access to health care contributed to the reduced child mortality rate. In addition, a U.N. report determined that an increase in vaccinations was extremely effective in reducing the child mortality rate. This was possible because of collaboration from organizations like the United Nations Children’s Fund, the World Health Organization and GAVI. However, there is still more that people can do to improve life expectancy in Guinea-Bissau, such as training more medical professionals to help with childbirth. In 2014, only 45 percent of childbirth had trained professionals available. The leading causes of death for children under 5 are communicable diseases, particularly malaria, diarrheal diseases and respiratory illnesses.
  2. The Leading Causes of Death: The leading causes of death in Guinea-Bissau in 2012 were lower respiratory infections including whooping cough and infection of the lung alveoli, along with HIV/AIDs, malaria and diarrheal diseases. Although malaria-related death is common, that number is declining due to both government and donor efforts from organizations like the Global Fund. These efforts include providing insecticide-treated bed nets and increasing education about malaria.
  3. Spending on Health Care: In Guinea-Bissau, both the government and individuals spend little money on health care. In 2016, the per capita average that people spent on health care was $39 while the government spent 6 percent of its GDP on health care. A U.N. report stated that in 2001, the African government pledged to increase health care expenditures to 15 percent. However, Guinea-Bissau has not yet reached that goal. In addition, the most vulnerable population that suffers from preventable illness and diseases, women and children, receive less than 1 percent of health care funds.
  4. Politics: One of the reasons the government faces difficulty in increasing health care funding is because of instability in Guinea-Bissau’s politics. Since Guinea-Bissau’s independence in 1974, the country has had four successful coups and 16 failed coups. The instability causes constant changes in government officials who are responsible for policies.
  5. National Institute of Public Health: In 2011, the creation of the Instituto Nacional de Saúde Pública (INASA) or the National Institute of Public Health helped bring different components of Guinea-Bissau health care together in order to provide adequate services. INASA works with both international donors, institution and the government to help with disease surveillance and preparation for health emergencies. The responsibility of INASA is to help create health policy in the country as well as to help place health care workers and officials throughout the country.
  6. Lack of Trained Medical Personnel: Guinea-Bissau does not have enough health care workers. It has 1.7 doctors for every 10,000 people, 1.4 midwives and nurses for every 1,000 people, three pediatricians and four obstetricians. For example, in 2014, Guinea-Bissau lost some of its health care workers due to brain drain (trained medical personal moving to other countries). In addition, the lack of adequate pay and failure by the government to pay its medical workers on time have led to strikes. According to a U.N. report, Guinea-Bissau would need to create incentives in order to better retain its health care workers.
  7. Training of Health Care Workers: Training health care workers in Guinea-Bissau is difficult because the country relies on international help from countries like Cuba. One of the main problems is that the training material is in Spanish instead of Portuguese. In addition, some of the reading materials are in e-book formats and students may not have access to computers to read the content. Furthermore, during medical training, there are not enough specialists to oversee or conduct the necessary training. There is hope, however, as the United Nations Population Fund (UNFPA) is helping provide some advanced training for medical professionals who require it.
  8. Vaccine Coverage: Although the lack of political instability has limited government spending in health care, Guinea-Bissau’s coverage rate is 80 percent due to help from the World Health Organization (WHO) and other non-government agencies. Children receive rotavirus and pneumococcal vaccines to help with respiratory and diarrheal illnesses.
  9. Accessibility to Health Care Facilities: In Guinea-Bissau, it can be difficult to visit a medical facility because of the lack of adequate roads. Although there are motorized boat ambulances, it can still be difficult to get to a medical facility in some regions in Guinea-Bissau. However, there are plans to build surgical centers in places like the Bijagos region to provide better access to health care.
  10. Community Health Programs and Workers: Community health programs and outreach have been effective in helping with the Guinea-Bissau health care system. These programs that community health workers (CHW) administer provide a community-based approach in helping with the health needs in Guinea-Bissau. Programs include spreading knowledge of childhood nutrition, malaria prevention, pneumonia and household hygiene, and providing several health services. There are around 4,000 community health workers and they are each responsible for visiting 50 households every month. During their visits, community health workers encourage families to adopt the 16 key family practices that can help reduce the number of diseases children may experience. These family practices include the promotion of mosquito nets and six months of breastfeeding, and handwashing, etc.  Community health workers also play a vital role in helping with literacy because of the high illiteracy rate in the country.

Although Guinea-Bissau’s life expectancy is low, there is hope that it will continue to increase due to continuous investment by international donors and non-government organizations. One of the best ways that Guinea-Bissau can provide better health care for its citizens is to strive to be more politically stable.

– Joshua Meribole
Photo: Flickr

 

Improving Ghana's Local Health
Ghana is a small West African country located on the Gulf of Guinea. Agricultural and mineral outputs mostly make up the country’s income. Ghana was the first African state to gain independence in 1957 and has a population of approximately 28,102,471 people. Although Ghana is one of the more stable countries in Africa and has one of the lowest reported HIV infection rates, the country still faces a multitude of health care issues. However, there has recently been a partnership between the Ghanian government and a tech company to work towards improving Ghana’s local health.

Illnesses in Ghana

A variety of illnesses in Ghana are similar to those occurring in developed countries, however, some of these illnesses can be more potent in areas like Ghana. These illnesses include trauma, women’s health issues, pregnancy complications and infections. HIV/AIDS hit Ghana slightly less than other African countries, but it still caused the deaths of 10,300 people in 2012. HIV/AIDS now stands at number six on the list of the top 10 causes of death in Ghana after malaria, lower respiratory infections, neonatal disorders, ischemic heart disease and stroke.

The anopheles mosquito can transfer malaria, but people can also transmit the illness through organ transplants, shared needles or blood transfusions. Malaria most commonly affects pregnant women and children. In 2012, malaria caused the deaths of 8.3 percent of the Ghanian population. It was also the leading cause of death among children under 5, dealing fatal damage to 20 percent of children in that age group. One of the primary reasons for visits to the hospital is infections. Medical professionals can easily treat most malaria cases with three days of pills from the government, however, some may suffer repeated bouts of malaria and it can be fatal is they do not receive treatment.

Ghana’s Medical Drone Delivery Program

In April 2019, Quartz Africa detailed that a community health nurse at the New Tafo Government Hospital in Ghana’s Eastern Region, Gladys Dede Tetteh, ran out of yellow fever vaccines. Mothers and their babies had to wait in a long line in the hot weather. The facility made an order for more vaccines, but in the past, deliveries often took two hours or more to arrive by road from the central medical stores. However, 21 minutes later, from 80 meters in the sky, a drone released a box onto a small lawn quad in the hospital. New Tafo Government Hospital was the first to sign up for Ghana’s new medical drone delivery program to receive medical products from unmanned aerial vehicles. The aim of this program is to reach hard-to-reach communities quickly and efficiently.

The Ghana Health Service’s Partnership with Zipline

The Ghana Health Service recently began a partnership with Zipline, a drone company with the mission of giving every person instantaneous access to medical supplies. Ghana’s Vice President, Mahamudu Bawumia, officially launched the medical drone program on Wednesday, April 24, 2019. Zipline is a partner of the United Parcel Service (UPS), which also provided support when it opened its Rwanda program. Zipline also gained support from the Bill and Melinda Gates Foundation and Pfizer. Zipline’s Omenako center in Ghana is the first of four centers that the company plans to construct by the end of 2019. Zipline also plans to provide supplies to 2,000 health care facilities in order to serve 12 million Ghanaians once it completes all four centers.

Each distribution center will have 30 drones that will work together to make 500 deliveries a day. Zipline approximates that it will be able to make 600 delivery flights a day in total. Many claim that the drones are some of the fastest delivery drones in the world. The drones can fly up to 75 mph, transport around four pounds, fly as high as 99 miles and operate in various types of weather and altitudes.

Zipline’s Role in Reducing Deaths and Providing Vaccinations

The World Health Organization states that “severe bleeding during delivery or after childbirth is the commonest cause of maternal mortality and contributes to around 34% of maternal deaths in Africa.” Ghana’s policymakers expressed that they believe that this new drone delivery system is the first step to improving Ghana’s local health by decreasing maternal and infant mortality rates.

The drones will deliver to 500 health facilities from the Omanako center which has vaccines and medications. With the aid of Ghana’s Expanded Program on Immunization (EPI), Zipline drones will be able to provide support to those suffering from yellow fever, polio, measles & rubella, meningitis, pneumococcal, diphtheria, tetanus and more. Gavi provides the vaccines, which is an international organization with the intention of improving children’s access to vaccines in poor parts of the world. Drones will be able to pass where ground vehicles cannot, such as where there is underdeveloped or poorly maintained road infrastructure. Many also expect that the drone delivery program will reduce wastage of medical products and oversupplied hospitals.

Zipline aims to improve access to vital medical supplies, which in turn will hopefully reduce mortality rates and add to efforts in improving Ghana’s local health. Zipline’s mission in Ghana has only just begun, but so far it has been able to significantly reduce the time it takes to deliver important health supplies. Getting medical supplies and vaccines faster may be able to save a few lives in the future as well. Health issues and diseases like malaria continue to be the major causes of death in Ghana, but Zipline and the Ghanian government are making steps towards improving access to health care.

– Jade Thompson
Photo: Flickr

Vaccines in Developing Countries “Thanks to vaccines, more children are now living to see their fifth birthday than at any point in history.” Dr. Seth Berkley, CEO of Gavi, said.

While this is an inspiring fact, the truth is that immunization rates in some developing countries are becoming stagnant.

The Plateau of Immunization Rates

The immunization rates of the vaccine for diphtheria, tetanus and pertussis (DTP) usually reflect the quality of the overall immunization coverage within a nation. In the last three years, the immunization rate for the third dose of DTP in Chad has remained at 55 percent. The immunization rate for DTP in Somalia has been about the same since 2009. Guinea, whose DTP immunization rates used to be around 70-80 percent 10 years ago, now has had a rate of 63 percent for the last four years.

This data is somewhat shocking, considering a global effort to prioritize vaccines began in 2000. The same year, Gavi, a global Vaccine Alliance, was created with the help of a $750 million donation from the Bill & Melinda Gates Foundation. Since 2011, Gavi has surpassed its own goals of decreasing child mortality, averting future deaths and increasing child immunization in the more than 60 countries that are Gavi-supported. In just five years, Gavi was able to provide vaccines to 34 million more children than what was anticipated, and the group began administering vaccines for pneumococcal and rotavirus one year ahead of schedule.

Maintaining the Vaccine Schedule

Nonetheless, groups like Gavi struggle to keep immunization active in developing countries after the child is no longer an infant. For example, the vaccine for human papillomavirus (HPV) is typically administered in two doses within 1-2 years for children above the age of nine. HPV can cause cancer, especially in those with weak immune systems, so it is important to time the vaccine administration effectively in order to be nearly 100 percent protected. Since there is no health plan that puts emphasis on older children, HPV becomes more of a threat in countries that do not enforce the strict vaccine schedule.

The World Health Organization has a plan to fix this. The Global Vaccine Action Plan (GVAP) is set to address health program expansion to include services beyond infancy by 2020. Ministers of Health from 194 countries agreed to support the GVAP, which includes nation-specific health program monitoring and strengthened leadership.

Negative Attitudes About Vaccines

Despite intervention from non-governmental groups, the plateau of immunization rates still exists. This may be due to negative attitudes towards vaccines in developing countries. The attitudes stem from the idea that vaccines are harmful or that the health workers are ingenuine. Citizens of three Nigeran states believed that the administration of the polio vaccine would spread AIDS in 2003, and in India, people believed that vaccines were a Western plot to instigate an undercover method of family planning to threaten Muslims. Researchers cite that a way to eliminate this anxiety is to take into account sociocultural behavior when implementing vaccine programs and to strengthen communication and advocacy in order to increase participation.

While negative attitudes towards vaccines contribute to plateauing immunization rates, the expensive price of vaccines may also be a contributing factor. In 2001, six vaccines from the World Health Organization cost less than $1. Now, 12 vaccines from the WHO cost up to $45.59. This can obtaining a vaccine for someone living in Madagascar extremely difficult – the monthly salary in Madagascar is $33.

Immunizations Eradicate Disease

By increasing immunization rates, diseases can begin to disappear. In the U.S., immunization rates in 2000 were at 91 percent for the measles, mumps and rubella vaccine, and the Center for Disease Control declared measles to be officially eradicated. Since then, diagnoses of measles have increased slightly among populations that are unvaccinated.

Despite these few diagnoses, the majority of the U.S. will never come in contact with measles. Dr. Jean Campaiola, hospital psychiatrist, describes this result as “herd immunity.” Herd immunity occurs when a certain percentage of the population receives the vaccine for a particular disease. For some diseases like measles, the percentage is at least 90-95, but for polio, the percentage is 80-85. This means that 20 percent of people could deny receiving the polio vaccine and still be protected from the disease because the remaining 80 percent were vaccinated.

“If this occurs rarely in a population, it’s not a big deal, but if it becomes more common, then previously eradicated diseases could make their way back into the general population,” says Dr. Campaiola. She said fears that the anti-vaccine attitude in the U.S. could cause previously eradicated diseases to re-emerge.

By administering more vaccines in developing countries, an entire community can be protected by herd immunity. Those most vulnerable to diseases (infants and the elderly) can be immune to certain diseases if more people around them receive vaccines.

In third world countries, governments spend $29 for each person’s health. In the U.S., the government spends $4,499. There is a clear need for vaccines in developing countries around the world, including a larger-scale project to improve coverage. Gavi’s next step in revolutionizing immunization is a five-year program to introduce sustainable health programs in low-income countries and to increase equitable use of vaccines. The U.S. has the power to spread the good message of vaccines, and someday, we can eradicate most major diseases all around the world.

– Katherine Desrosiers
Photo: Wikimedia

vaccine accessibility
Vaccines are second only to clean water in reducing the rate of infectious disease. Vaccines prevent about 6 million deaths every year, and those that have been in use for decades show a 99 percent decrease in the rates of people contracting those diseases. Unfortunately, vaccines are not affordable for many people living in poverty throughout the world, making them much more vulnerable to infectious disease. Several factors contribute to the current lack of vaccine accessibility in many parts of the developing world. However, there are also significant improvements that are being made in decreasing the financial gap between those who receive vaccinations and those who do not, helping make vaccines more accessible to everyone.

The Current Situation

The price of the vaccine doesn’t always reflect the cost: People in developing countries are not only paying for the cost of manufacturing the vaccine, but also for expensive shipping costs, refrigeration, tariffs on imports, and taxes on medical supplies. These additional costs are often much more than the cost of the actual vaccine, and they make what would otherwise be an affordable vaccine inaccessible to a lot of people.

Clinic visits cost money too: In addition to buying the vaccine with all of its fees piled on top, people also have to pay to visit a clinic to receive these vaccines. The hours of health clinics are often inconvenient as well, forcing people to forgo wages from work in order to see a doctor.

Many vaccines require multiple rounds: A lot of vaccines, such as RTSS for malaria, MMR for measles and the HPV vaccine require multiple rounds of vaccination in order to be effective. This simply compounds all of the other barriers to vaccine accessibility; those receiving the vaccine have to pay for treatment again as well as take time off of work to visit a clinic.

Doctors are few and far between: In many parts of the developing world, there are very few doctors, and these doctors are limited in the number of patients they can treat each day. Therefore, even if one can afford to pay for the vaccine and can make it to a clinic, there is no guarantee that they will be able to be seen by a doctor.

Improvements to Vaccine Accessibility

Local health centers’ capacities are being strengthened: Gavi, a non-governmental organization dedicated to providing vaccines to the developing world, is working to strengthen the capacity of existing health centers to deliver immunizations. Gavi is working to increase the proportion of people who are receiving a full cycle of vaccines rather than “dropping out” after the first dose by providing sustainable funding to health clinics across the developing world.

Foreign aid decreases the price of vaccines: Providing foreign aid specifically for vaccines decreases the cost to those receiving treatment, and in turn, spares families from having to pay far more for treatment if someone contracted an infectious disease. Foreign aid for vaccinations has the highest return on investment of any type of aid besides education.

People are going beyond wanting to vaccinate to actually vaccinating: The Poverty Action Lab at MIT is implementing research on how to motivate people from desiring to vaccinate to doing it. This research is increasing the numbers of people receiving preventative immunizations in the developing world and reducing the rates of disease.

Infrastructures to keep vaccines cold for cheaper: The governments of Ethiopia and Gambia have created cold chain infrastructures in order to reduce the cost of transporting vaccines that need to be refrigerated. These infrastructures are far from perfect, as some cold storage facilities in Ethiopia have not been kept as cold as they need to be in order to protect the vaccines.

However, progress is still being made in reducing the cost of vaccines and allowing them to be more accessible to those living in poverty. Gavi is working to implement more cold chain infrastructures in other countries in Sub-Saharan Africa.

Moving Forward

There is clearly still a long way to go in ensuring vaccine accessibility to everyone who needs it, but a lot of progress has been made in breaking down the current barriers to accessibility. Vaccines are much cheaper than the cost of treatment for those who have the diseases vaccines aim to prevent, and investing in vaccinations relieves the world’s poor of the additional burden of treatment costs. Vaccines are one of the greatest assets in our toolbox to fight poverty, and great strides are being made in the effort to make accessibility a reality.

Macklyn Hutchison
Photo: Flickr

UNDP Supports Universal Immunization Program in IndiaWith high risks of communicable diseases like bacterial diarrhea, malaria, hepatitis A and E and typhoid, there’s a rising necessity for a proper immunization program in India. The United Nations Development Programme (UNDP) has partnered with the Indian government and Ministry of Health and Family Welfare to design and put into effect an Electronic Vaccine Intelligence Network (eVIN). This project, known as Improving Efficiency of Vaccination Systems in Multiple States, has already run since 2014 and is to run until 2021 to strengthen the evidence base for policy-making related to vaccine delivery, procurement and planning, and ensure equity in availability.

As the world’s largest immunization program, eVIN technology has already shown results in enabling real time information on cold chain temperatures and vaccine stocks and flows in all 371 implementing districts in India. It has managed to achieve over a 98 percent reporting rate from vaccine storage areas, with over 2 million transactions logged each month, and developed the skills of over 17,000 government staff in store keeping, data operating or cold chain handling in over 550 batches of training programs.

The eVIN is setup on a mobile application that easily allows cold chain handlers to log stock positions at the end of each routine immunization day, which is then relayed immediately onto a web interface for assessment by health officials. In India, this can come to play an important role as geography and communications can pose an issue, like in the small hill-state of Manipur, where vaccine vials are carried over extensive distances to session sites by auxiliary nurses and midwives. Instances of stock-outs have decreased by more than six times here, and eVIN has enabled staff to learn how to use a smartphone and other technology, improving quality of work and management in the process.

This immunization program in India has also significantly empowered women health workers, giving them the opportunity to work with technology after attending regional and district eVIN training sessions. This allows them to manage stocks and temperatures themselves, bridges the digital divide in rural parts of India and ensures transparency alongside accuracy. Over 50 percent of cold chain handlers are women, and many are from older age groups.

EVin has taken India out of the unproductive days of delayed decision making, shortages and expirations, and has created an efficient health system that allows for valuable state-wide geographic, stock-out or excess stock and temperature overviews on each district’s centers. It also allows for large savings by reducing vaccine wastage and allowing for timely and quality injections, as in Rewa, where around $70,000 was saved after six months of eVIN activation.

Though led by the UNDP and Ministry of Health and Family Welfare in India, the Universal Immunization Program is largely supported by GAVI, a global vaccine alliance established in 2000. With support from GAVI and the Indian government, the Universal Immunization Program in India has immunized at least 65 percent of India‘s children and expects to immunize 27 million more each oncoming year.

Zar-Tashiya Khan

Photo: Flickr

GaviIn his proposed 2017-2018 budget, President Donald Trump has pledged to fulfill the U.S.’s $1 billion commitment to Gavi, the Vaccine Alliance. The program has helped immunize hundreds of millions of children and lowered the cost of vaccinations since its creation in 2000.

Gavi, the Vaccine Alliance is an international organization that “aggregates demand” for vaccines from the countries it supports— 60 percent of the world’s births take place in Gavi-supported countries. This demand sends “a clear signal to manufacturers” that these countries are viable markets for vaccines. Countries supported by Gavi pay for a portion of their vaccine programs, but as “a country’s income grows, its co-financing payments gradually increase to cover the full cost of vaccines.” Gavi relies on large donors to run this business model.

In January 2015, USAID dedicated $1 billion to Gavi in support of the organization’s plan to “immunize 300 million additional children and save at least 5 million lives by 2020.” The Obama administration was vocally supportive of global poverty reduction efforts— Obama addressed extreme poverty in three of his State of the Union addresses— but the Trump administration was not expected to contribute to poverty reduction efforts to the same extent. Trump’s pledge to Gavi is refreshing in the midst of the 32 percent overall cuts to international aid proposed in his budget.

Gavi’s website lists the U.S.’s contribution to the program for the period of 2016-2020 as $800 million. If Trump were to have cut the U.S.’s funding for Gavi, the organization would have lost close to a ninth of its $9.2 billion budget. Reducing aid to Gavi would have further damaged the U.S.’s aid reputation, as it spends the least on foreign aid of all developed countries, especially since other countries fund the majority of Gavi’s budget. Notably, the U.K. has contributed $2,515 million, Norway $922 million, and Germany $676 million for the same 2016-2020 cycle.

It is important that the U.S. continue to support international vaccination programs like Gavi, the Vaccine Alliance as they allow healthier populations to become more stable, self-sustaining and economically stronger. Gavi projects $100 billion in economic gain worldwide as more people are immunized and the world moves closer to global poverty eradication.

Caroline Meyers

Photo: Flickr

The South Asia region is home to over 1.7 billion people, 31.5 percent of whom are children. Across South Asia, up to one in four children is under-immunized or goes without vaccination. Since 1990, the region’s governments have made significant progress in increasing vaccination in South Asia as part of the United Nations Millennium Development Goal 4, which centers on strengthening routine immunization. Despite this, many barriers stand in the way of increasing immunization, such as a lack of funding, inadequate healthcare materials and a lack of consistent and reliable data on children’s vaccination needs.

In 2012, South Asia was one of many regions to adopt the Global Vaccine Action Plan in order to maximize the benefits of vaccination and aimed to achieve 90 percent of diphtheria-tetanus-pertussis (DTP3) coverage. Though progress has been made, with countries like Nepal and Bhutan achieving over 90 percent coverage, overall, South Asia lags behind other regions. Certain regions in Afghanistan and Pakistan have dangerously low immunization coverage and struggle with treatable illnesses such as meningitis and typhoid fever.

One of the main organizations trying to reverse these trends by increasing coverage in South Asia is Gavi, The Vaccine Alliance. Gavi has committed nearly $10 billion in funding for increasing immunization and vaccination in South Asia between 2000 and 2020. These funds are going towards vaccine development and implementation, especially in areas where refrigeration and effective vaccine delivery are not certain. One of Gavi’s most impactful developments was the introduction of a childhood pneumonia vaccine in Pakistan in 2012, making Pakistan the first country in the region to implement such a vaccine. Gavi has worked alongside UNICEF and the government of Pakistan, and they are still partnering to ensure the continued distribution of vaccines like this one.

Mixed success stories have been prevalent in the last decades when examining the efforts towards vaccination in South Asia. Bangladesh is one of the biggest success stories in the region; they heavily invested in health infrastructure and training after launching an Expanded Program on Immunization in the late 1980s. Since 1990, DTP3 has increased in Bangladesh by over 20 percent.

While certain South Asia countries struggle to implement uniform immunization measures, countries like India and Pakistan are changing things on a local level. Several districts in both states have implemented a system to recognize under-immunized communities and adopt corrective solutions. A recent breakthrough in India was the addition of a measles-rubella vaccine to their universal vaccination program.

As a region, South Asia lags behind other countries in terms of immunization and vaccination coverage, though certain countries have made great progress in the last decades. Thanks to the work of organizations like Gavi, the vaccine alliance, the future is brighter for South Asian children.

Nicholas Dugan

Photo: Flickr

Foreign aid
Angus Deaton won the 2015 Nobel Prize in Economics for his research on the effects of foreign aid on economic development in developing countries. The most important message to be taken from his work is that foreign aid is only one small piece of the equation. To say that foreign aid directly translates into economic growth is an oversimplification. Without transparent and effective governmental institutions and sound economic policies, research shows that aid is not always effective.

Foreign aid works when all of these different variables come together. It’s a simple equation. It has become popular sentiment to denounce aid as ineffective, based on specific case studies where all of these variables were not in place and results fell short of their targets. While not all aid is effective, this rhetoric flies in the face of all of the progress that has been made because of aid. The truth is that foreign aid works when all of the variables — effective institutions, policies, and transparency — are in place.

Aid has been especially effective in improving health in Least Developed Countries (LDCs). Malaria rates dropped by 51 percent between 2000 and 2012 after 300 million bed nets were given out by the World Health Organization (WHO). Ten million HIV-infected individuals are now receiving life-saving medicine. Tuberculosis rates have dropped by 45 percent since 1990, and 122 million children’s lives have been saved since 1990. This progress is largely due to the work of the Global Alliance for Vaccines and Immunization (GAVI), which has immunized 580 million children around the world. Extreme poverty has been cut in half since 1990, and African poverty rates have dropped by 10 percent since 1999.

These are huge success stories that deserve recognition. Foreign aid works. Not only does it work, but it is also in the interest of U.S. national security. Former Homeland Security secretary Tom Ridge said, “The programs supported by the International Affairs Budget are as essential to our national security as defense programs. Development and diplomacy protect our nation by addressing the root causes of terrorism and conflict.”

The questions asked in U.S. policymaking circles today shouldn’t be whether to cut aid or not; the question that needs to be asked is how to increase the efficacy of aid and to grow upon our successes. Cutting the International Affairs Budget would discredit all of the hard work and successes that have come out of these operations in recent decades.

Josh Ward

Photo: Flickr

Somalia
One of the world’s leading organizations in the fight for global health has just begun to carry out a nationwide campaign in Somalia to fight Cholera. Gavi, the Vaccine Alliance, issued a press release on March 15 announcing its comprehensive strategy to stop the spread of cholera among Somali citizens. This Gavi cholera vaccine campaign seeks to save potentially thousands of lives in the drought-stricken African country.

According to the Centers for Disease Control, the southern half of the continent (where Somalia resides) is home to the bulk of cholera cases reported worldwide, and those cases have a higher likelihood of causing death than in other regions. This is primarily due to the lack of access to safe, clean water and sanitation as the disease-causing bacteria, Vibrio cholera, thrives in public water sources and is spread through the waste products of those infected.

The situation in Somalia has been worsened by an ongoing harsh drought, which has forced people to use contaminated water and has hastened the spread of the disease.

Notorious for its contagiousness, cholera infected over 170,000 people globally in 2015. Year to date, more than 10,500 cases of cholera have been reported across 12 regions of Somalia, resulting in nearly 270 fatalities. The spread of the epidemic has been swift, with 400 new cases appearing in a single day in early March.

The Gavi cholera vaccine campaign plans to reduce these alarming numbers by delivering 953,000 doses of oral vaccine to a population of more than 450,000 people at risk of being infected. Administration of the vaccines will be completed by the Somali government, focusing on the regions of Somalia with the highest concentration of cases: Banadir, Beledweyne, and Kismayo. The doses will be administered over two waves, the first taking place from March 15-19, and the second from April 18-22.

The campaign marks an alliance between the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and Gavi, who has provided the vaccines themselves as well as an additional $550,000 to support the program.

“Cholera is a major health issue in Somalia. The current drought has worsened the situation for many. Therefore we’re very glad to have the support of Gavi to implement the first oral cholera vaccine campaign in Somalia,” said Dr. Ghulam Popal, Somalia’s WHO representative.

Recognizing that cholera is not bound by political borders, Gavi is also launching a simultaneous vaccine campaign of 475,000 doses in South Sudan. This latest campaign is another step in realizing Gavi’s continuous mission to save lives and protect the health of all people in lower-income countries.

Dan Krajewski

Photo: Flickr