Infectious diseases and poverty

Already today it is possible to greatly increase the impact vaccines can have on poverty, by using the tools we have at hand. Efforts should be concentrated in two areas:

  1. Immunizing children with the available 11 vaccines against IDs recommended by WHO.

Despite WHO recommending 11 vaccines, immunization coverage remains tracked via DTP3 coverage (3 doses: combined diphtheria-tetanus-pertussis vaccine). A coverage of 84% in 2013 (WHO 2015) appears high and may indicate the mission is almost accomplished: in reality 22 million children remain unimmunized (WHO 2015). Coverage rates for other crucial vaccines, e.g. Hib and Rubella, are merely around 50%, while for Pneumococcus and Rotavirus, among the major causes of deaths under 5 years of age (Unicef, WHO 2014), are even lower: 25% and 14% respectively (Fig. 1).

Figure 1: Global coverage (2013) for the 11 vaccines recommended by WHO

Ghealth
Source: CDC (Harris et al. 2014), WHO (WHO 2015), Unicef (Unicef and WHO 2014)

Besides targeting prevention programs more towards early age and reducing young children’s mortality through better planning and implementation of the primary series immunizations, newborns could benefit more from vaccines even before they establish their own immunity. During this period (usually until 4 to 6 months of age), infants are exposed to several pathogens. Vaccinating pregnant women during the third trimester against these pathogens induces immunity in the mother and, through the transplacental transfer of antibodies, in the newborn baby (Rappuoli et al. 2014).

2. Including in decision-making methods capturing the full benefits of vaccination reaching well into a child’s life through adulthood, positively affecting the wider community and ultimately national economies (Berkley 2014, Barnighausen et al. 2014a)

The level of contribution vaccines can offer to the reduction of poverty and economic/personal development is largely underestimated (Bloom 2015). Research findings suggest that improvements in life expectancy translate into higher annual growth added to income per head. Once protected from IDs and resulting sequelae (disabilities), vaccinated children will grow up to be healthier children with improved cognitive development and longer periods of school attendance. Parents will be able to work instead of caring for a sick child, generate more income, save money, increase their spending power and improve their personal and economic development. (Berkley 2014) Findings from studies in the Philippines demonstrate that vaccination-related improvements in cognitive capacity and resulting test scores in children had a return on investment as high as 21% (Bloom 2015). At the same time, the burden of IDs for humankind is not only reflected in the number of cases and deaths they cause, but also in resulting sequelae. For example, diarrhoeal and enteric diseases, besides being the second most frequent cause of deaths after pneumonia, result in life-long disabilities for children and their families. High incidence of enteric infections in countries lacking safe water and adequate sanitation disrupts intestinal functions resulting in up to 43% stunted growth, affecting one-fifth of children worldwide and one-third of children in LMICs.

Besides the health-related implications, the resulting life-long and chronic sequelae have a very serious impact on the capacity of children to become economically independent, greatly impacting on their personal development and on the wealth of the communities they belong to (Guerrant et al. 2013).
Vaccines are not the only solution to economic development and the reduction of poverty, but it is a fact that their impact is largely underestimated: more accurate analysis is needed to correlate increased coverage with the 11 recommended vaccines and the contribution they can offer to the reduction of poverty in Low Income Countries.