Vaccines for Children in Low- and Middle-Income Countries

Abstract

Vaccination is the centerpiece of preventive care of the well child. Vaccination has been one of the singular public health successes of the past half century, and its full potential remains unrealized. Pneumonia and diarrhea, two of the leading causes of child mortality, account for approximately 1.4 million deaths annually (Liu and others 2016); vaccination with currently available vaccines has the potential to prevent 59 percent of pneumonia-related deaths and 29 percent of diarrhea-related deaths (Fischer Walker, Munos, and Black 2013). Other leading causes of childhood deaths are already preventable through available and effective vaccines, such as measles and meningitis, and other diseases, such as malaria, may become vaccine preventable in the near future (Agnandji and others 2011; Liu and others 2012). Forecasts for vaccine use in the 73 countries supported by Gavi, the Vaccine Alliance, project that 17.7 million deaths will be averted in children under age five years as a result of vaccinations administered from 2011 to 2020 (Lee and others 2013). Childhood vaccination contributed greatly to progress made toward achieving the fourth United Nations Millennium Development Goal, a two-thirds reduction in childhood mortality between 1990 and 2015 (UN 2015), and the centerpiece of several other major global initiatives (PHR 2014; WHO 2012a). Vaccination is central to the health goal included in the post-2015 Sustainable Development Goals, which is on a critical pathway to delivering on its targets. In addition to the clear health benefits, vaccination has been one of the most cost-effective public health interventions (Brenzel and others 2006; WHO, UNICEF, and World Bank 2002). Based on 2001 data, the cost per death averted through routine vaccination with the six original antigens in the Expanded Program on Immunization (EPI) was US$205 in South Asia and Sub-Saharan Africa; estimated cost per disability-adjusted life year (DALY) averted was US$7 to US$16 (Brenzel and others 2006). New vaccines, although more expensive, have also been determined to be cost-effective in Gavi-eligible countries (Atherly and others 2012; Sinha and others 2007) (see box 10.1). This chapter describes the epidemiology and burden of vaccine-preventable diseases and provides estimates of the value of vaccines in health impact as well as broader economic benefits. The focus is on vaccination of infants during routine well-child visits and not on other important vaccines for older children and young adults, such as human papillomavirus vaccine, typhoid vaccine, and dengue vaccines.