Monday, 13 June 2011

Immunisations, Diarrhoea & The Missing Link

The decision today to pledge a further £814million towards a vaccination programme (GAVI) to reduce the impacts of pneumonia and diarrhoeal diseases is admirable and welcome. In these times of economic difficulty the decision to make international development a key part of coalition policy must be applauded. We cannot balance our books on the back of the poorest people and it is fantastic that the UK can be global leaders in this sector. The percentage of our GDP that we spend on overseas aid is very small, currently 0.56% rising to 0.7% in 2013 – less than 1p for every pound that we earn. Yet this contribution can and does make a significant difference in the lives of people around the world. Our aid budget costs each person in the UK around 44p a day to help some of the billions around the world who have to live on less than £1.50 a day. That 44p each day puts millions into school, improves access to healthcare and vaccinations, prepares communities for natural disasters to reduce the impacts and cost of rebuilding, gives people clean and safe water – stopping them walking for hours to collect some… and many other things.

However the announcement today, in particular the immunisation programme to reduce deaths due to diarrhoeal diseases must be set into its correct context:

Firstly… The vaccination to reduce the number of deaths from diarrhoeal diseases is only for those cases caused as a result of the rotavirus, accounting for on average 39% of childhood hospitalisations as a result of diarrhoeal diseases. In order to fully address the problem of diarrhoeal diseases there also needs to be significant investment in, and prioritisation of access to clean and safe water, improved sanitation and more hygiene promotion (WASH). Simple measures such as increasing handwashing can reduce the number of deaths by anything between 33-44% – but this requires investment in sanitation facilities, community hygiene workers and education programmes. Investment in clean water supplies is also fundamental to reducing the risk of disease. Oral rehydration cannot be done without clean and safe water. Dirty water carries bacteria and viruses, which can result in serious disease and adverse effects on health.

Secondly… Funding for the vaccination itself is the easy part; the difficult part is the administration of this vaccine. Investment in the health-sector to ensure there are health-workers to administrate the vaccine is required also. This point was raised in David Cameron’s Q&A session following his speech by Save the Children, and Cameron recognised this as a requirement also.

Thirdly… There are the challenges of infrastructure, and poor access to many of the poorest communities due to lack of or very poor roads. These vaccines are no use in a box, on a shelf, in a storeroom… they only have use if administered to those in need.

In conclusion, the reduction of diarrhoeal diseases requires an integrated approach and cannot be done solely through immunisation. The UK contribution to GAVI must be welcomed, however it would be good to see an integrated strategy to deal with this preventable disease through both immunisation and significant improvements to water, sanitation and hygiene promotion. Earlier posts have set out the fundamental role of geologists in locating and developing water resources – and this case study highlights why clean water sources, improved sanitation and hygiene promotion are fundamental to the reduction of disease and poverty in communities across the developing world. Immunisations are a good and positive step forward - but the 'missing link' is improved WASH... which should be playing a much more prominent role in the discussions and debates taking place today.