Pneumonia is the most common cause of childhood mortality. In countries where the rate of child death is highest, the disease, characterized primarily by the inflammation or buildup of fluid inside the microscopic sacs in the lungs that absorb oxygen (alveoli), has been described by the United Nations Children’s Fund and the World Health Organization as the major “forgotten killer of children.”
This is because little attention is paid to pneumonia despite the fact that the disease kills over 2 million children—more death than AIDS, malaria and measles combined.
“Immunizing children against pneumonia will provide the greatest benefit to public health. Vaccines are cost-effective, offer lifelong protection and are fundamental to development. And yet, despite all these, immunization coverage is far from universal and faces significant obstacles in both developing and developed countries,” informed Dr. Edith Maes, a senior research fellow and former associate professor at Maastricht School of Management in The Netherlands.
Avert
Based on a number of studies done in middle-income countries alone, Maes informed that the use of pneumococcal vaccines will avert over 11 million cases of pneumococcal disease and over 300,000 premature deaths in the next 10 years.
“We should pay more attention to this disease. The benefits of vaccine programs—in particular, their economic effects via improved health—have been underestimated, thereby causing the rate of return to be underestimated,” she said.
Maes added that by reducing illness and long-term disability, vaccines also generate savings for health systems and families.
“Parents spend less time looking after their sick children. By helping children stay healthy and away from pneumonia, vaccines remove a major barrier to human development. They boost development through direct medical savings and indirect economic benefits such as cognitive development and educational attainment of children, labor productivity of their parents, more income and savings for the whole family,” sheexplained.
Double dividend
Maes believes that investing in health pays “double dividend” especially in low- and middle-income countries.
“It is widely recognized in the global health community that vaccination is one of the world’s most important and cost-effective public health measures, with positive socioeconomic effects on society. Thus, health is not only a direct source of human welfare but also an instrument for raising income levels,” she said.
To prove her point she referred to the so-called disability-adjusted life years or DALYs as an effective way to determine the cost effectiveness of getting immunized against a major killer disease.
“To measure the lost value of a healthy life year free of illness and disability, public health refers to DALYs, which combine the years of life lost due to premature death (mortality) and loss of full health due to illness and disability (morbidity),” she explained.
Cost-effective
The Commission on Macroeconomics and Health of the WHO has classified interventions that gain a year of healthy life (i.e., a DALY averted) at a cost that is less than the gross domestic product per capita as very cost-effective. Those averting each DALY at a cost between one and three times the GDP per capita are cost-effective.
“Moreover, I would like to stress that based on so many previous studies, one of the important investments that a government could undertake is making sure the children are immunized against all major vaccine-preventable diseases including pneumonia. Yes, the government will have to invest today but consider the huge healthcare costs that the administration could avert now and in the future,” she explained.
She added that the development of new generation pneumococcal vaccines have been proven to be cost-effective in middle- and low-income countries stressing that those that protect against the largest number of serotypes is highly cost-effective.
One example is the 13-valent pneumococcal conjugate vaccine (Pfizer’s PCV13), which offers one of the broadest serotype coverages against invasive pneumococcal disease (it protects against 13 strains).
Considering that about 90 percent of pneumococcal disease victims in the Philippines are below 5 years old, the potential public health benefits of this vaccine in reducing the burden of pneumococcal disease could be significant. PCV-13 is indicated for the prevention of invasive disease, pneumonia, and otitis media (chronic middle ear infection) caused by Streptococcus pneumoniae (serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) in infants and children from 6 weeks to 5 years of age.
“With the emergence of drug-resistant strains, it is a definite call to action for countries in this region to make vaccination with the broadest coverage pneumococcal conjugate vaccine part of their routine immunization schedules,” urged Maes.