Times of India, May 2013
A pivotal clinical study of India's first indigenous rotavirus vaccine...
The Most Important Question in Global Child Health Today: Why are 3 Million Children Dying from Two Diseases we know how to Prevent and Treat?
One of the biggest challenges in global health is matching resources to the areas where the most lives can be saved.
It is a very serious problem, because resources are always scarce, and when they are not targeted to those areas where the most good can be done, the opportunity cost is measured in lives lost. No single issue frustrates me more than this one, because it is a failure of information, easily corrected, that is causing millions of human lives, mostly children under 5, to be lost every year.
Let’s talk about the areas where the most children’s lives can be saved. This is essentially a function of two things – a) the leading causes of child mortality and b) the existence of cost-effective interventions. Let’s start with child mortality. Thanks to Bob Black and his team at Johns Hopkins Bloomberg School of Public Health we know what the leading killers of small children are and we know exactly where children are dying.
So what are the leading killers of small children? Pneumonia and diarrhea, which together claim almost 3 million children every year – more than double malaria, AIDS and measles combined. And where are most of these deaths occurring? They are concentrated in just six countries – India, Pakistan, Afghanistan, Nigeria, Democratic Republic of Congo and Ethiopia.
And do we have cost-effective interventions that can prevent and treat pneumonia and diarrhea? Yes we do. We are not waiting around for vaccines – the pneumococcal and Hib vaccines target the leading causes of pneumonia and the rotavirus vaccine targets the leading cause of severe diarrhea. The introduction of these vaccines in the United States has slashed child pneumonia and diarrheal deaths to almost zero.
On the treatment side, most cases of pneumonia can be cured with antibiotics and diarrhea can be treated with oral rehydration salts and zinc supplementation. Each of these treatments costs lest that $1.
So why are 3 million children dying from two diseases we know how to prevent and treat?
I believe that this is the most important question in global child health today and the answer is a failure of information.
Donors, government and private sector, should act to maximize their social investments. For a given amount of financial aid, donors should be focused on how they can save the most lives, and particularly the most children’s lives, as children have a lifetime of contributions to society ahead of them.
But donors have not targeted significant resources to pneumonia and diarrhea. These two diseases remain the most underfunded areas of global child health relative to their massive disease burden. I’ve thought long and hard about this. Why are donors ignoring the diseases that kill the most children, especially when we have interventions that could save more than 1 million children’s lives every year if they were available in the developing world?
And the answer is…most donors don’t know. There has been a monumental failure of information. We have not yet succeeded in establishing global health institutions that advocate across diseases, guiding donors to those investments in those countries where most lives could be saved.
But there are signs that this is beginning to change. The President’s Global Health Initiative with its focus on using government aid $ more wisely has singled out pneumonia and diarrhea and vaccination as areas where government $ can deliver the largest, immediate social returns.
And earlier this year at the World Health Assembly, Health Ministers passed a resolution acknowledging that Millennium Development Goal (MDG) 4 will not be reached without a new focus on pneumonia. It remains to be seen whether G8 and G20 leaders will follow suit and whether the UN will shine a light on pneumonia and diarrhea at the Review Summit on progress towards the MDGs in September.
Just imagine what it could mean if resources did flow into fighting pneumonia and diarrhea over the next decade. According to Gates Foundation estimates, vaccines against pneumonia and diarrhea can prevent more than 7 million child deaths over the next 10 years. Combining vaccines with treatment pushes that number above 10 million, according to WHO and UNICEF estimates.
I am not aware of any other intervention currently available that can save children’s lives on this scale. There should be no more persuasive argument than this one when it comes to donors targeting their scarce $.
One of the biggest challenges in global health is matching resources to the areas where the most lives can be saved.
It is a very serious problem, because resources are always scarce, and when they are not targeted to those areas where the most good can be done, the opportunity cost is measured in lives lost. No single issue frustrates me more than this one, because it is a failure of information, easily corrected, that is causing millions of human lives, mostly children under 5, to be lost every year.
Let’s talk about the areas where the most children’s lives can be saved. This is essentially a function of two things – a) the leading causes of child mortality and b) the existence of cost-effective interventions. Let’s start with child mortality. Thanks to Bob Black and his team at Johns Hopkins Bloomberg School of Public Health we know what the leading killers of small children are and we know exactly where children are dying.
So what are the leading killers of small children? Pneumonia and diarrhea, which together claim almost 3 million children every year – more than double malaria, AIDS and measles combined. And where are most of these deaths occurring? They are concentrated in just six countries – India, Pakistan, Afghanistan, Nigeria, Democratic Republic of Congo and Ethiopia.
And do we have cost-effective interventions that can prevent and treat pneumonia and diarrhea? Yes we do. We are not waiting around for vaccines – the pneumococcal and Hib vaccines target the leading causes of pneumonia and the rotavirus vaccine targets the leading cause of severe diarrhea. The introduction of these vaccines in the United States has slashed child pneumonia and diarrheal deaths to almost zero.
On the treatment side, most cases of pneumonia can be cured with antibiotics and diarrhea can be treated with oral rehydration salts and zinc supplementation. Each of these treatments costs lest that $1.
So why are 3 million children dying from two diseases we know how to prevent and treat?
I believe that this is the most important question in global child health today and the answer is a failure of information.
Donors, government and private sector, should act to maximize their social investments. For a given amount of financial aid, donors should be focused on how they can save the most lives, and particularly the most children’s lives, as children have a lifetime of contributions to society ahead of them.
But donors have not targeted significant resources to pneumonia and diarrhea. These two diseases remain the most underfunded areas of global child health relative to their massive disease burden. I’ve thought long and hard about this. Why are donors ignoring the diseases that kill the most children, especially when we have interventions that could save more than 1 million children’s lives every year if they were available in the developing world?
And the answer is…most donors don’t know. There has been a monumental failure of information. We have not yet succeeded in establishing global health institutions that advocate across diseases, guiding donors to those investments in those countries where most lives could be saved.
But there are signs that this is beginning to change. The President’s Global Health Initiative with its focus on using government aid $ more wisely has singled out pneumonia and diarrhea and vaccination as areas where government $ can deliver the largest, immediate social returns.
And earlier this year at the World Health Assembly, Health Ministers passed a resolution acknowledging that Millennium Development Goal (MDG) 4 will not be reached without a new focus on pneumonia. It remains to be seen whether G8 and G20 leaders will follow suit and whether the UN will shine a light on pneumonia and diarrhea at the Review Summit on progress towards the MDGs in September.
Just imagine what it could mean if resources did flow into fighting pneumonia and diarrhea over the next decade. According to Gates Foundation estimates, vaccines against pneumonia and diarrhea can prevent more than 7 million child deaths over the next 10 years. Combining vaccines with treatment pushes that number above 10 million, according to WHO and UNICEF estimates.
I am not aware of any other intervention currently available that can save children’s lives on this scale. There should be no more persuasive argument than this one when it comes to donors targeting their scarce $.
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The failure of information goes much deeper than the donor
Thanks for this comment - the failure of information clearly goes much deeper than the donor. It's the same for pneumonia as recent research by UNICEF in countries like Sierra Leone is showing. Moms do not know much about what causes pneumonia and diarrhea and often believe in magical causes and solutions. But even if Moms did know more about how to seek treatment for pneumonia and diarrhea the health decisions are often made by fathers-in-law, brothers-in-law and mothers-in-law in that order. Educating families and particularly those in the family who make the health decisions is a critical part of reducing child pneumonia and diarrhea mortality in developing countries.
Children are dying for lack of knowledge
'No single issue frustrates me more than this one, because it is a failure of information, easily corrected, that is causing millions of human lives, mostly children under 5, to be lost every year.' The key issue is a failure of basic life-saving information at the level of the individual sick child. In a developing country, if you are a child sick with diarrhoea, your chances of survival depend largely on the health knowledge of your mother, carer, and/or health worker.
Children are at high risk of receiving inappropriate and dangerous care. Tragically, this is despite the best intentions of their carers. Given these facts, it is not surprising that the high death toll from diarrhoes continues. 'We estimate that, annually... 356 million [children with diarrhoea] did not get increased amounts of fluids...' 'Diarrhoea case management in low- and middle-income countries - an unfinished agenda'. Birger Carl Forsberg, Max G Petzold, Göran Tomsona & Peter Allebeck. Bulletin of the World Health Organization 2007;85:42-48
'[diarrhoea management] figures indicate poor knowledge about proper treatment of diarrhoea not only among mothers but also among health-care providers... 42% of mothers in Maharashtra still believe that a child with diarrhoea should receive LESS [my emphasis] fluid and less food than normal... Anti-diarrhoeal drugs are widely known to be ineffective and often harmful in the treatment of severe diarrhoea. They are a distraction from dehydration, which is the real danger. They are capable of further dehydrating the child, and they are an unnecessary expense for the mother. In Maharashtra, however, of the 77% of all children who are brought to a medical facility when ill with diarrhoea, 78% receive some form of anti-diarrhoeal drug (pill, syrup, or injection).' Wadhwani N. An integrated approach to reduce childhood mortality and morbidity due to diarrhoea and dehydration.
'We know that diarrhoea is one of the leading causes of child mortality in specific areas in Africa, and yet in most cases we have the knowledge of how to prevent it effectively. Bridging that simple knowledge-to action gap would save thousands of lives.' Bailey C & Pang T. Health information for all by 2015? Lancet. 2004 Jul 17-23;364(9430):223-224.
Best wishes, Neil Pakenham-Walsh Dr Neil Pakenham-Walsh MB,BS Coordinator, HIFA2015 Co-director, Global Healthcare Information Network
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