As a doctor with Médecins Sans Frontières (Doctors Without Borders) I cannot begin to count how many children I have witnessed first-hand die of vaccine preventable diseases. In the developing world, where I work, it is such a frequent occurrence that no one even talks about it. These children just become numbers and statistics.
In our hospital in South Sudan we have a whole room dedicated just to infants with tetanus. These babies are infected during birth and fall sick because their mothers haven’t been immunised. They come in stiff as a board, unable to swallow, their faces twisted into a ghastly grin — a horrible side-effect from this disease. They have difficulty breathing. Their tiny bodies are racked by muscle spasms and convulsions but the sedatives to address this can cause them to stop breathing. Most of these children will die, despite our best efforts. Pneumonia, meningitis, whooping cough and measles can be all equally devastating and all can be deadly. Even after all my years of working in this field, I still find it so difficult to talk about the individual children I’ve seen die. For us, the health professionals who treat these children, each death is a tragedy. A tragedy that could have easily been avoided.
So when I hear the debate rage in Australia about vaccination I hope the parents choosing not to vaccinate are truly aware of the tragedy this can result in and the risk it could expose the whole community to. When one person chooses not to get vaccinated and falls sick, the disease most likely won’t spread because everyone else around them has been immunised. This is called herd immunity. But once we see greater numbers choosing not to immunise, then you start to see the devastating effects and the potential for epidemics.
"Only 25 per cent of the world’s children have received the [pneumonia] vaccine. How many more children could be vaccinated if prices were reduced?"
A family that chooses not to vaccinate and whose child pulls through childhood without any disease might wrongly conclude that vaccination is not necessary. In reality, however, their child or children were protected because the majority of children around them could not carry the disease — herd immunity protected them. More than half of the children who die worldwide die of preventable diseases. A great many of them are vaccine preventable. If too many Australians choose not to vaccinate, we risk slipping backwards and people will start to see what I see every day in the field — avoidable suffering and deaths.
For me the facts are simple; childhood vaccines prevent people falling sick with diseases that kill. And the majority of the diseases that we vaccinate against are diseases that can kill. Where I work, we have an uphill battle just to make vaccines available. Women walk for hours and sometimes days to get their children to clinics. Our field staff brave conflict zones to reach the most vulnerable. Health ministries — who carry the real burden of disease — dedicate scarce resources to vaccination programs. And yet we are still not able to meet the needs. An estimated 21.8 million infants worldwide are still missing out on basic vaccines for diseases like pneumonia, whooping cough, measles and tetanus.
The reasons for not having better vaccination coverage in developing countries are many; from poor health infrastructure, security or logistical problems that affect supply. But one of the greatest obstacles I see is cost. For a large part of the world, and for humanitarian organisations like ours, the price of vaccines are simply too expensive. In a recent report we revealed that in the poorest countries the price to vaccinate a child is now a colossal 68 times more expensive than it was in 2001. The largest chunk of this is for the pneumonia vaccine, which is the number one killer for under fives. Only 25 per cent of the world’s children have received the vaccine. How many more children could be vaccinated if prices were reduced?
There is also a huge and unacceptable inequity between countries. For example, the Philippines pay more than Australia for the pneumococcal vaccine. South Africa more than Sweden. This is unfair and unjust. That is why at Médecins Sans Frontières we are fighting to make vaccines more available. In Australia, thanks to our robust immunisation program, and our ability to finance it, we are spared this fight. Most people here have never seen the diseases vaccines protect against. But when I look into that room in South Sudan, full of babies suffering from tetanus, I ask how can the importance of vaccination ever be questioned?
Dr Myrto Schaefer is Head of Medical Unit for Médecins Sans Frontières Australia.
First published in The Daily Telegraph, April 20 2015.