Neil French: A new source of hope for children in Malawi – the introduction of pneumococcal vaccines

Pneumococcal disease causes probably at least half of the pneumonia cases in Malawi. It also causes meningitis, blood poisoning, and otitis, which if it doesn’t kill can leave a child disabled, deaf, and disadvantaged for the rest of their life.

Vaccination is one of the most straightforward health interventions we have. The pneumococcal vaccine introduced in Malawi on 12 November with the support of the GAVI Alliance, will have a huge impact on the lives of children, saving lives, preventing disability. We need to give the best chance to children to grow up healthy, achieve success at school, and enter the workforce as healthy and educated young adults.

Malawi has made great strides in reducing child mortality over the last 10 years. There have been many factors responsible for this, better malaria control, control of HIV, food security (which was very much a home grown Malawian achievement), and new vaccines have been vital to this. Hib vaccine introduction in 2001 has seen the disappearance of this infection as a public health problem, an infection that used to be one of the leading causes of pneumonia and meningitis. The introduction of pneumococcal conjugate vaccines will save many more lives.

Delivery of vaccines has been treated as a priority by the Ministry of Health in Malawi. With political support and dedicated staff Malawi has achieved consistently high vaccine coverage (93% in 2009 according to the WHO figures). Malawi is certainly going to get maximum benefit from these vaccines.

With 80% of the population living in rural areas, access to healthcare is limited and prevention is therefore even more important. When your child gets sick there are no on-call general practitioners or 24 hour pharmacies. The nearest health clinic may be several miles away, which can mean long hours of walking or cycling as so many people have no access to any form of motorised transport. A shortage of trained staff and medicines can lead to further delays, which can mean a deterioration that increases the chances of permanent disability and even death. Vaccination can prevent many such tragedies by protecting children from illness in the first place.

It all seems so simple, and it is. Every single country in Africa has the ability to deliver vaccines. Given basic support, there is no reason why all children should not benefit from the life saving effects of these medical wonders. But aren’t these vaccines too expensive? The simplest response to that is to ask – how can the most advantaged and fortunate in this world not help and support the most disadvantaged and vulnerable? But in more hard nosed economic terms, vaccines are actually one of the most cost effective health interventions that exist. We should note that these vaccines have long term economic as well as health benefits and that international organisations such as the GAVI Alliance and their partners are making sure vaccine prices for the poorest countries are dramatically reduced. It’s hard to see any losers when it comes to widespread vaccine implementation.

I have seen huge changes in the past 15 years working in Africa and a growing sense of optimism here in Malawi. Within their own lifetimes, people have seen a transformation in health matters – people don’t have to die of HIV, children don’t have to die in infancy. There are lots of reasons to be optimistic about health in Malawi – as well as in Africa. Disease burden and death remain unacceptably high but we have knowledge and tools that can be used right now – the pneumococcal vaccine is one of these tools, Malawi will follow with rotavirus vaccines, which will protect children against the leading cause of severe infant diarrhoea. In other parts of Africa the scourge of meningitis epidemics is being controlled by vaccines. And what of the future beyond these current vaccines? There are early signs of a practical malaria vaccine, whilst new tuberculosis, cholera, dengue, and typhoid vaccines are all in later stages of development. These are exciting times.

Neil French is professor of infectious diseases & global health at the University of Liverpool. He has spent most of the last 18 years working on pneumococcal disease in Africa, nine of those years in Malawi. He has reported on vaccine effects and he assisted the successful Malawian bid to GAVI to fund pneumococcal vaccine.