Public and private sectors need to work together on a sustainable plan to align priorities on vaccination: a priority setting based on simple microeconomic or isolated cost-effectiveness analysis will not capture the full benefits of vaccination: doing so, vaccines will remain significantly undervalued, underused and therefore we will not fully leverage their contribution to the achievement of the GC and the SDGs.
We argue that vaccines play a key role in directly supporting the achievement of at least 6 of the 14 SDG3 targets. We hold that better comprehension and assessment of the full benefits offered by vaccines and their optimal deployment, will facilitate development of comprehensive strategies to reduce burden of IDs paralyzing countless communities in LMICs, directly and significantly contributing to the achievement of SDG3. Coincidentally, reducing morbidity and mortality due to IDs will contribute indirectly to the achievement of five other SDGs, as illustrated in Box 1.
Box 1. Impact of vaccination against infectious diseases on SDGs
|Goal 1. End poverty in all its forms everywhere|
|Today, poverty has to two major causes: conflicts and infectious diseases, blocking economic and social development. Preventing the infectious disease component of this vicious cycle will improve life and increase each individual’s contribution to their communities. Reducing sequelae, such as stunted growth and cognitive impairment, repeated infection and nutrient malabsorption caused, for example, by diarrhoeal diseases, will ultimately reduce poverty. (Guerrant et al. 2013)|
|Goal 4. Ensure inclusive and equitable quality education and promote life-long earning opportunities for all|
|As reported above, vaccination-related improvements in test scores in children, had a return on investment as high as 21%. (Barnighausen et al. 2014a) Children free from IDs and life-long sequelae will become young workers with more personal achievements and longer, more satisfying personal working lives, reaching economic independence earlier in life.|
|Goal 5. Achieve gender equality and empower all women and girls|
|In the words of Seth Berkley, GAVI Alliance CEO: “Vaccination is one of the most gender equitable public health interventions ever. GAVI supports the immunization of about 60% of the girls born in the world“. (Berkley 2013) Moreover, reduction in the incidence rates of diseases affecting primarily children will allow mothers and female caregivers to reduce the time they have to devote to sick children, especially in countries where women bear the main burden of childcare. (Berkley 2014)|
|Goal 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all|
|Reducing the negative effects of IDs will have a very positive economic impact on families, allowing their members to work, be economically independent, save money not spent on medicines or medical care, enabling their communities to benefit from healthier workforces. Lower child mortality will reduce birth rates, resulting in a general improvement of women’s health, giving higher financial stability to the entire family, as both parents will be able to regularly pursue a profession.|
|Goal 10. Reduce inequality within and among countries|
|The first step to realize the demographic dividend is improving health, especially women’s and children’s health, resulting in decrease in the number of births in each family, as children’s survival rates will be significantly higher. With more people contributing to the economy and fewer people needing support, countries will have better prospects of rapid economic growth. (General Assembly of the UN 2015)|
An even more compelling case for the role that the prevention of IDs through vaccination can play for fostering the development of nations and helping achieve the GC in Health in 2035 has been made by Rappuoli et al, comparing the relationship between ID incidence, life expectancy and national income in high-income countries in the last century with the current situation in LMICs (Rappuoli, R., M. Pizza, G. Del Giudice, and E. De Gregorio. 2014. “Vaccines, new opportunities for a new society.” Proc Natl Acad Sci U S A 111 (34):12288-93. doi: 10.1073/pnas.1402981111). The analysis shows, on the one hand, how life expectancy at birth and per-capita income are strongly positively correlated, and on the other how both are strongly negatively correlated with the incidence rate of IDs: the relationship becomes clear when looking at specific indicators for the US in the last century. Life expectancy at birth has risen from 47.3 years in 1900 to 78.7 in 2014 (Arias 2014, National Center for Health Statistics 2015), while coincidently deaths caused by IDs fell from over 50% to less than 5%, a marginal percentage mainly due to two diseases, today already vaccine-preventable: influenza and pneumonia (Fig. 1 and 2).
Figures 1 and 2: Causes of death and life expectancy in the US in the 20th century
Source: Rappuoli et al. 2014.
Van Panhuis et al. studied the reduction in IDs incidence rates vs. the introduction of vaccines targeting them. The analysis started with the smallpox vaccine introduced in the US around 1800, and compared life expectancy at birth, before and after vaccine licensure. Assuming that the difference between incidence rates before and after vaccine licensure for these diseases was attributable solely to vaccination, the authors estimated that a total of 103.1 million cases of these IDs have been prevented since 1924. Of those hypothetical cases, approximately 26 million were prevented in the past decade. (van Panhuis et al. 2013. “Contagious diseases in the United States from 1888 to the present.” N Engl J Med 369 (22):2152-8. doi: 10.1056/NEJMms1215400). A similar trend can be observed today for life expectancy and incidence rates for communicable diseases in countries worldwide, when considering their income level (Figs. 3 and 4).
Fig.3 and 4: Causes of death, life expectancy and per-capita income 2013
Source: Rappuoli et al., 2014.
The graphs clearly show a reduction of causes of total deaths in LMICs for 2013, strikingly similar to the one in the US in 1800. Communicable diseases in LMICs are still causing >50% of deaths, and life expectancy at birth is around 40 years. In the same year, in other countries, as IDs’ contribution to total deaths decreased, life expectancy at birth increased and country income increased.
Comparison of Figs. 1 and 2 with 3 and 4 clearly gives us a vision of how to attain the GC and, as a consequence, boost chances to reach the SDGs.