By Ngozi Okonjo-Iweala
Who is responsible for child health in government? The answer is everyone. The buck shouldn’t stop with health ministers; protection of child health needs to be a concern for all government, and all governments.
After all, children are not only the most vulnerable members of society, they are also a nation’s future. And, if this alone weren’t enough to make childhood disease prevention a national priority, compelling new evidence suggests it also makes sound economic sense, too.
With more than 30 vaccine doses administered worldwide every second, immunisation is already recognised as one of the most cost-effective health interventions. But a new study, published this week in the journal Health Affairs, now puts a more precise figure on it. According to this, for every dollar invested in childhood immunisation we can expect to save $16 in healthcare costs, lost wages and lost productivity due to illness. If you take into account the full value people place on living longer, healthier lives, then that return on investment increases even further to $44.
But if vaccines are such good value, why are one in five children globally still not getting access to even the most basic shots, with many countries having immunisation coverage rates of below 50 per cent, the vast majority in my home continent of Africa? And why are 1.5m children still dying every year from vaccine-preventable diseases?
Part of the problem is political will, particularly from finance ministers, thanks to a lack of understanding within governments that vaccines aren’t just good value for money, but are an investment. In addition, there is a widespread assumption within governments and beyond that childhood mortality is a matter only for health ministers. In reality, it has implications for just about every aspect of government.
Preventing illness through immunisation can have a huge impact in helping to contribute to the social and economic well-being of individuals, families, communities and countries. A healthy infant does not need medical treatment or care, both of which come at a cost. She also has a greater chance of growing into a healthier child, who is able to attend school and ultimately become a more productive member of society. And instead of caring for a sick child, her parents are in a better position to go out to work and increase their own ability to earn, which means they will have a greater disposable income to feed back into the economy.
All of this is not just good for boosting local and national prosperity; strong routine immunisation programmes also form a vital part of robust universal health systems, which are themselves critical to helping national leaders achieve economic and development targets. To put a figure on it, this latest study, which looked at 94 low and middle-income countries, predicts that between 2011 and 2020, childhood immunisation stands to offer up to $1.43tn in economic benefits.
However, if we wish to harness these benefits, as well as further economic returns beyond 2020, then we need to see greater long-term domestic commitment towards immunisation. Since 1990 we have seen childhood mortality more than halve and since 2000 witnessed more than 500m additional children receive vaccines, thanks to organisations like Unicef, the World Health Organisation and Gavi, the Vaccine Alliance, of which I am the board chair. But if this kind of progress is to be sustained then we need to see strong immunisation policy backed up by long-term health spending allocation.
This means we need to stop preaching to the choir by focussing only on health ministers, and instead engage all aspects of government, in particular finance ministers. As former finance minister of Nigeria, Africa’s largest economy, I know how important it is for health ministers to make a better case for immunisation to finance ministers when it comes to defending their health budget. They need to make finance ministers understand the critical role that reducing infectious disease has in boosting the economy, and the role they have to play in making that happen.
That is why the forthcoming Ministerial Conference on Immunization in Africa is so important. Taking place in Addis Ababa later this month, it brings together leadership across all government levels throughout the African Union, towards the common goal of universal childhood immunisation in Africa.
To some extent we have already seen some very positive signs of progress, not least with the former president of Tanzania, Jakaya Kikwete, agreeing to become Gavi’s global ambassador for immunisation to spread the word to his peers about the benefits and value of vaccination that he saw in his own country.
In addition, we have seen increases in spending on health. Over the next five years we expect to see the 39 poorest African governments contribute around $6bn towards the cost of immunisation. If childhood mortality is to continue to fall, we will need to ensure that in the years to come that figure continues to rise.
Ngozi Okonjo-Iweala is chair of the board of Gavi.