Washington

Booster shot: billions of dollars are still needed to get jabs to children in poorer countries. Credit: THE VACCINE FUND

Two donors this week gave US$1 billion to a project that immunizes children in the world's poorest countries against preventable diseases such as hepatitis B and yellow fever.

On 24 January, the Seattle-based Bill and Melinda Gates Foundation and the Norwegian government announced ten-year grants of $750 million and $290 million, respectively, to the Global Alliance for Vaccines and Immunization (GAVI).

That is a big sum, but, to put it in context, a further $8–10 billion will be needed over the next ten years just to get existing vaccines out to the children who need them, according to the World Health Organization (WHO). And that is before counting the extra costs of delivering new vaccines, such as shots against rotavirus and pneumococcus, as these come on to the market.

The sum of $10 billion is not much more than the international community has pledged to tsunami relief in three weeks. However, “the tsunami was a very visible demonstration of need in developing countries”, says David Fleming, director of global health strategies for the Gates foundation. “The issue with immunization is that millions of children are dying needlessly, but because deaths do not occur in a single disaster, it is harder to attract the attention of donors.”

Geneva-based GAVI, whose partners include the United Nations' children's fund, the WHO, governments and commercial vaccine-makers, was created in 1999 with $750 million of Gates funding, and other donors have since brought its total funding to $1.3 billion. “We think this is the best investment we've ever made,” said Bill Gates in a teleconference with reporters, pointing out that GAVI programmes have prevented the deaths of 670,000 children born between 2001 and 2003 in 71 countries.

“We boosted routine immunization coverage for diphtheria, tetanus and whooping cough from 53% in 2000 to 81% in 2003,” said Yoweri Museveni, president of Uganda, in a statement. “And because GAVI has a unique incentive system, our funding actually increased when we reached our immunization targets.”

As well as delivering vaccines, the large sums involved are indirectly encouraging more vaccine research, says Julian Lob-Levyt, executive secretary of GAVI. “Assurance of markets over the long-term encourages industry to invest greater resources in research and development for urgently needed vaccines, such as those for malaria.”

But much remains to be done. In 2002, 1.4 million children under five years of age died from vaccine-preventable diseases. In 2003, more than 27 million children went without vaccinations in their first year of life. Attacking this problem is key to reducing child mortality — one of the UN Millennium Development Goals, a series of commitments signed by all UN members in 2000. The target is to reduce the under-five mortality rate by two-thirds between 1990 and 2015, but so far the world looks as if it will need an extra two decades to achieve this.

Global health is on the agenda at the annual meeting of the World Economic Forum being held this week in Davos, Switzerland. Gates will take his place on a panel with Tony Blair, the UK prime minister, and the outspoken rock star Bono. Blair's government is pushing for an International Finance Facility that would raise $50 billion a year in development aid between now and 2015: the facility would sell bonds on capital markets that would be recovered by donor funds pledged over several decades. Gates says he is very excited about this approach.

“Modest amounts of resources can save large numbers of lives,” says Gates, regretting that making global health an international spending priority is “very, very difficult”.

“When people see tsunami victims on the TV, they do want to reach out; they do want to provide resources and help,” he adds. “We all need to think creatively about how we can tap into the human compassion that's there.”