Ensuring that vaccines are distributed fairly

Thirty million children are still not getting the vaccines they need, and every year between two and three million children die of easily preventable diseases. Recent studies provide further confirmation that it is the poorest children who suffer most.

“Figures from countries in Africa indicate that only a third of the poorest children are given vaccines, while two-thirds of children from better-off families are vaccinated. This shows that it is not sufficient to simply increase the resources put into vaccination programmes; we also need to improve our knowledge and discuss strategies for developing vaccines and distributing them fairly all over the world,” says Professor Ole Frithjof Norheim of the Department of Social Medicine and the Centre for International Health at the University of Bergen.

Outstanding young investigators

Ole Frithjof Norheim trained as a medical doctor, but took his Ph.D. in the theory of fair rationing. He has received considerable funds from the Research Council of Norway in order to study the ethical basis for prioritizing health resources in countries where these are extremely limited. This is part of the Research Council’s new scheme for outstanding young investigators. Norheim has worked for some time in Tanzania , where the annual per capita public health sector budget is about $8.00, a figure which faces decision makers with extremely difficult choices. What are the most sensible measures to use the money on?

“When we consider which diseases ought to be prioritized, for example with vaccines, there are three main criteria involved: the number of people who are affected or who die of a given disease, the cost efficiency of treatment and our knowledge of the effects of treatment. We also need to evaluate how sure we can be of our knowledge. Since the vaccines have often been developed in western countries, we do not always know enough about how they will act when they are used in developing countries,” says Norheim, who mentions that in terms of cost efficiency, the new hepatitis B. vaccine is a winner.

Pneumonia and diarrhoea

In addition to the usual vaccines that all Norwegian children are given, effective vaccines for certain types of pneumonia have also been developed. Their availability, however, varies a great deal from one country to another, and this is largely due to the lack of money. Researchers point out that there is a great need to develop vaccines against the most common forms of pneumonia and diarrhoea, diseases which together still kill more than four million children every year. The unfairness of this situation is not only obvious at international level, but within any given country there may be great differences. Even in developing countries where they have good vaccination programmes, it is by no means certain that the children who most need help are those who receive it. Norheim emphasizes that the situation is complex and that it may involve a number of different causes.

Nevertheless he points out that the lack of knowledge is one important cause.

“In addition to good information campaigns it is also important to improve access to medical care. Many people, for example, cannot afford to travel to the nearest doctor”.

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