In Africa, the struggle to survive starts early. For every 1,000 children born, more than 170 die before age 5 -- often for want of vaccines that could easily have saved them. In contrast, in 2002, Norway lost four children under 5 per 1,000 born.
There are significant and seemingly intractable economic and environmental reasons for this gap, but there is also great promise. With the proper investments and political will on the part of national and international leaders, immunization can save the lives of millions of children in the poorest regions of the world. Among the most important and cost-effective public-health tools ever invented, vaccines should be seen as a cornerstone of international development.
Yet, in 2003, more than 27 million children -- most of them among the world's poorest -- missed out on key vaccines during their first year of life.
It is unacceptable that, also in 2003, more than a million children died from diseases for which vaccines are routinely administered to children in wealthier countries.
Governments of both rich countries and poor have boosted the amount of money they give for vaccines, but not enough to cover the long-term commitment that vaccine programs need. Unicef and the World Health Organization reported recently that the world is far from meeting the internationally-agreed Millennium Development Goal of reducing childhood mortality by two-thirds by 2015. Given current trends, the United Nations agencies say, the immunization-coverage rates needed to achieve this goal will not be met until 2037.
A major infusion of resources is required to reverse decades of underinvestment in health-service delivery systems and to support countries in crisis. WHO estimates that an additional $8-billion to $12-billion (U.S.) is needed over the next decade to provide vaccines against yellow fever, hepatitis B and haemophilus influenzae B, and strengthen routine immunization coverage in the poorest countries.
We have a proven solution for how such resources can be used efficiently and effectively, as demonstrated by a groundbreaking new global immunization initiative: the Global Alliance for Vaccines and Immunization (GAVI).
GAVI and its financing arm, The Vaccine Fund, bring together under one umbrella a unique group -- national governments from industrialized and developing countries, Unicef, WHO, the World Bank, the Bill and Melinda Gates Foundation, the vaccine industry, public-health institutions and NGOs. Their common goals are to increase access to essential vaccines among children in poor countries, to improve injection safety, and to accelerate the development and introduction of new vaccines for diseases such as rotavirus and pneumococcal pneumonia, which together took more than two million lives in 2002.
By the end of 2003, GAVI support for immunization in low-income countries had averted an estimated 670,000 premature deaths (both childhood and adult) among children born from 2001 through 2003 -- an impressive achievement within only three years of its launch. Hepatitis B vaccine is now being funded in 50 of the more than 70 countries that GAVI supports (with gross national income less than $1,000 U.S. per capita).
Uganda and Norway have played an integral part in GAVI's initial success. Norway, which has already provided more than $100-million (U.S.) to GAVI, has said it will give almost $300-million more through 2010, and Uganda has committed its resources to dramatically increasing the immunization rate among its children.
GAVI's funds were used in Uganda to promote immunization throughout the country; improve vaccine-refrigeration systems; train immunization teams; expand the number of locations where children can be vaccinated; and build up the ability of local districts to manage immunization efforts.
As a result, 81 per cent of eligible children were immunized against diphtheria, tetanus and whooping cough (DTP) in 2003 -- an increase of 23 per cent since the launch of GAVI in 2000. And in 2002, with funding from GAVI, Uganda introduced a new combination vaccine that immunizes children against DTP, while also protecting them from hepatitis B and haemophilus influenzae B.
The achievements of GAVI and its partners have been recognized today with the announcement of a second $750-million (U.S.) grant over 10 years from the Gates Foundation. Nine countries and the European Union have also contributed significant resources to this alliance. But increased resources and political will are still needed if efforts to immunize children in the poorest countries are going to be significantly scaled upward.
What will it take to create a world in which a child's chances of living past 5 will not depend so strongly on which country he or she calls home? The answer is more money, a commitment on the part of rich and poor countries alike to place vaccines high on their public-health agendas, and a proven system, such as that of GAVI, for channelling new funds to the people who are most in need.
Yoweri Museveni is President of Uganda. Jens Stoltenberg, leader of the Norwegian Labour Party and former prime minister of Norway, is also a board member of The Vaccine Fund.