South Africa is set to become the first country in Africa to provide its children with a life-saving vaccine that experts say could prevent the deaths of an estimated 5.4 million children globally in the next two decades.
Children are the main victims of pneumococcal diseases such as meningitis and pneumonia, and those who survive are often left intellectually impaired, suffer hearing loss or a legacy of seizures.
At the opening of this year's Regional Pneumococcal Symposium in Johannesburg, South Africa's deputy minister of health, Molefi Sefularo, said a new breed of pneumococcal vaccine - known as a conjugate pneumococcal vaccine - would become available in the public health system in April 2009.
South Africa would also be the first country in the developing world to self-finance introduction of the vaccine, despite its hefty price tag.
Dr Shabir Madhi, Principal Investigator and Deputy Director of the Pneumonococal Diseases Research Unit at Witwatersrand University, said the new vaccine was expected to cost an extra US$70 million on top of the $10 million the country already spent annually on vaccinating its children.
Pneumococcal diseases account for almost 350 out of every 100,000 infant deaths below the age of one in South Africa, and Sefularo said infection rates had risen steadily since the mid-1990s as a consequence of AIDS. HIV-positive children are almost 40 times more likely to develop pneumococcal diseases than their peers.
The haves and the have-nots
Although the World Health Organization (WHO) first urged countries to take up the new vaccine in a 2007 position paper, cost has been a huge stumbling block.
The vaccine is now available in much of Western Europe and the United States, but researcher Till Barnighausen of South Africa's University of KwaZulu-Natal noted that in the United States it has gone down in history as the most expensive vaccine introduced in the last 100 years.
"When most people usually talk about pennies per doses, here we are talking dollars per doses," he said. According to work presented at the conference by Barnighausen, it may be as much as 15 years before the vaccine's price drops to levels that would make it accessible to most developing countries.
Donor countries and organizations like the Bill & Melinda Gates Foundation have pledged more than US$3 billion towards rolling out the vaccine through The Global Alliance for Vaccines and Immunization (GAVI), according to Dr Olin Levine, executive director of PneumoADIP, dedicated to accelerated vaccine access. Rwanda, the Democratic Republic of Congo and Kenya are three of the four African countries approved for receiving the funds.
Sefularo said although South Africa faced a host of competing funding priorities, the government had dedicated itself to lowering the child mortality figures. Researchers and health workers also stressed the potential long-term cost-effectiveness of the vaccine in terms of health savings.
"Most economists have been trained for years to see health as an expenditure, not as an investment," said Levine, urging other governments to follow South Africa's lead.
Witwatersrand University's Madhi said that a South African study - which excluded social costs - found that the break-even point for the vaccine's cost effectiveness was about $20.
"The cost we're getting the vaccines at is slightly higher than that, but again, there are lots of indirect benefits that weren't included in the cost effectiveness analysis," said Madhi. These included the protection offered to non-immunised members of the community, which helped make the vaccine value for money.
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