As a second year doctoral student in the Global Disease Epidemiology and Control program with the International Health department at Johns Hopkins Bloomberg School of Public Health, I am excited to be conducting research at the Basse Field Station in The Gambia, working on pneumococcal conjugate vaccine (PCV) coverage and case surveillance sensitivity analyses. In short, I am looking to see how well the vaccine is being delivered and how efficient we are at detecting new cases of clinical and radiological confirmed pneumonia.
Why did I decide to leave the comforts of American living and spend my summer away from my friends and family? Because globally, pneumonia is the leading cause of death in children under 5 years old, and 3 injections of the pneumococcal vaccine reduced death by 16% overall compared to children of the same age who did not receive the vaccine. Sixteen percent may not seem like a lot, but considering that over half a million children die each year due to S pneumoniae, (or the pneumococcus) this vaccine can prevent the needless death of 80,000 children—nearly twice the number of children under 5 years of age currently living in Baltimore City.
This is not my first trip to Africa; I spent 3 months volunteering at a small private hospital just outside the capitol of Ghana. My experience at this health facility was the impetus for my entrance into the field of public health. I spent most of my time in the medical laboratories and touring the hospital wards. One morning on rounds, I saw a 40 year old man with diabetic foot ulcers that cut to the bone. Afterwards, I thought to myself that this condition was completely preventable with routine treatment; would rarely happen in the United States, and shouldn’t be acceptable. The band U2 encapsulates this sentiment perfectly in their song Crumbs From Your Table. “Where you live should not decide/ whether you live or die.”
This lyric also holds true in regards to the pneumococcal vaccine. As United States citizens, we receive this vaccine because our standard of living and strong routine immunization system make this vaccine relatively affordable and easy to incorporate into a child’s immunization schedule. In The Gambia, the vaccine would have been priced out of the typical Gambian’s budget—meaning that because these children were born in a less affluent country, they are at a health status disadvantage. Fortunately, the GAVI Alliance, a global health partnership of public and private stakeholders, is able to subsidize this vaccine such that Gambian children have access to the same protection against pneumococcal disease as children in Grand Rapids.
With the existence of such a life-saving tool in our arsenal of public health interventions, it is imperative that all countries get a chance to be on a level playing field. Understanding the reasons why some children receive the vaccine and, importantly, why some children do not, helps inform the medical system about gaps in vaccine coverage, and makes possible the implementation of public health interventions, such as outreach immunizations and educational campaigns, which address these disparities.
Until next time, fo tuma doo, Dustin
Dustin Gibson is a PhD Student at Johns Hopkins Bloomberg School of Public Health