By: Dagna Constenla, PhD, MPhil, MPH, Director of Economics and Finance, International Vaccine Access Center (IVAC)
In Bangladesh, training experts to determine what a bout of diarrhea, measles, or pneumonia truly costs – and better evaluate investments in vaccines
While vaccines are widely regarded as one of the most cost-effective public health interventions we still lack evidence on the broader economic impact of vaccines, including the costs of illness of vaccine-preventable diseases.
Launched by the Johns Hopkins International Vaccine Access Center (IVAC) in 2011, the Decade of Vaccine Economics project estimates the global economic benefits, costs, financing, funding gap, and return on investment in national immunization programs.
As part of the project’s fourth phase (DOVE IV), my team at IVAC, in collaboration with icddr,b, is collecting primary data on the costs of illness associated with diarrhea, measles, and pneumonia. This research will help stakeholders in Bangladesh and other countries make more informed decisions about the true economic burden of childhood diseases—and provide evidence to support ongoing investment in the vaccines targeting these diseases.
DOVE IV will estimate both the cost of treatment and productivity losses in both public and private settings across multiple levels of care. Using robust data collection methods, our team will quantify the costs of disease control interventions. These data could help inform the ongoing financial commitment and prioritization of national immunization programs around the world.
Building capacity in Bangladesh for costing studies on common childhood diseases
During the first phase of DOVE IV, we are building capacity for research on the ground. To this end, our team met with icddr,b experts in Dhaka, Bangladesh July 26-28.
Attendees discussed standardized methods for collecting, entering, and monitoring cost data. In addition, field research officers and field research assistants learned the use of these methods in participating healthcare facilities, pharmacies, and households in Bangladesh.
Participants, such as our two Field Research Officers, Tajmul Haque and Palash Matsuddi, and our four Field Research Assistants, Md. Joynal Abedin, Md. Mosabbirul Hasan, Md. Kamal Hossain and Rakibul Haider Chowdhury below, engaged in role-playing activities and case study exercises to reinforce data entry and data monitoring procedures.
Shortly after the training, a pilot test was conducted to assess the applicability of data collection tools in the Bangladesh context and to evaluate the accuracy of entering data electronically.
Micro-costing study on childhood illness
The next phase of the project will consist of primary data collection on the costs of illness associated with diarrhea, measles, and pneumonia— taking into account both public and private settings across multiple levels of care (I took the photo above of Md. Zahid Hasan, Md. Joynal Abedin and Md. Mosabbirul Hasan conducting a caregiver interview in the Diarrhea Hospital in Dhaka). The project’s data collection will take place in two divisions starting in 2017. This is a prospective and retrospective micro-costing study that includes three components:
An assessment of costs for child health services at the healthcare facility level;
An assessment of costs for child health services at the pharmacy level; and
An assessment of the costs of accessing care by caretakers.
We look forward to sharing results by the end of 2018.
Thanks to the Bill & Melinda Gates Foundation for supporting this project.
Team members focused on this effort include my colleagues Jorge Martin del Campo and Gatien de Broucker of IVAC as well as Sayem Ahmed, Wazed Ali, and Jasim Uddin of ICDDR’b.
Thanks also to the other members of the study team—the Line Director, Maternal Neonatal Child and Adolescent Health and Program Manager, Expended Program on Immunization of the Ministry of Health and Family Welfare of the Government of Bangladesh.
By Dr. Kate O’Brien, Executive Director, International Vaccine Access Center (IVAC)
Yesterday we were saddened to learn that former President George H.W. Bush was hospitalized with pneumonia. While the majority of people affected by pneumonia in the US are adults, around the world each day this condition claims the lives of an estimated 2,500 children under age 5.
Back in September, when Secretary Hillary Clinton suspended her campaign due to pneumonia, I wrote about the under-recognized toll this illness takes on communities around the world. As we find ourselves on the eve of a new presidential administration, it’s imperative to repeat the message and remind policymakers of the common needs of families around the world.
Pneumonia, an infection of the lungs, is exceedingly common around the world, with an estimated 450 million cases annually. In the US, we have ready access to trained physicians with the know-how and equipment to make a diagnosis and, when necessary, we have antibiotics and oxygen therapy to treat illness. These interventions have been proven effective, and the vast majority of people who contract pneumonia in the US make a full recovery.
Sadly, this is not true everywhere. In impoverished countries, timely, appropriate, and affordable treatment is often not available, especially for young children whose course of illness can take a downturn very quickly. In parts of Africa and Asia resources are scarce, and HIV infections, crowding, and indoor air pollution are prevalent and put people at risk. The prevention measures we take for granted, such as vaccines and hand washing, are too often not available. The price of pneumonia in these countries is higher infection rates, more illness and, sadly, more deaths, especially in children younger than 5 years of age.
Over the past 15 years, public health professionals and policymakers have been able to assure significant progress. Vaccines to prevent the deadliest causes of pneumonia are rapidly being deployed in countries in most need—thanks to Gavi, the Vaccine Alliance, and country governments. Gavi, to which the US government is a major contributor, makes it possible for low-income countries to buy and deploy tens of millions of doses of life-saving vaccines, including against pneumonia, to millions of children. As more children have access to vaccines and medicine to prevent and treat pneumonia, we see less disease, fewer lives lost, more families climbing out of poverty and fewer families thrown back into the downward cycle of poverty which is otherwise incurred simply by trying to get medical care to save their child’s life.
Yet, much work remains. More than 900,000 young children still lose their lives to pneumonia each year. These children need access to the same tools as our own children to prevent, diagnose, and treat this common illness.
More than anything else, we must put pneumonia on our collective radar as a global health problem that requires attention—not just when there’s a new media headline. How many people know that globally pneumonia is the leading cause of death for children under 5 years of age? Pneumonia is so common that it’s nearly invisible.
Can this change? Absolutely. We have the opportunity to raise the profile of this illness and reveal just how pervasive it is. We hope President Bush makes a speedy and full recovery. Meanwhile we continue to advocate for adequate resources for families, governments, and communities everywhere to prevent and treat this illness. What improves the lives of people in countries around the world is also good for the US. It’s simple: Hopeful, healthy communities create a world where we all thrive, including here at home.
Kate O’Brien, MD, MPH, is the Executive Director of the International Vaccine Access Center and Professor at the Johns Hopkins Bloomberg School of Public Health. She is a pediatric infectious disease physician, epidemiologist and vaccinologist.
By: Dignamartha Kakkanattu, Social Media & Communications Assistant, International Vaccine Access Center
During Thanksgiving in the U.S., much well-deserved gratitude goes to the obvious all-stars in our lives: family, friends, teachers. But one group that doesn’t seem to get enough thanks are child health advocates. During World Pneumonia Day on November 12, they broke the silence on pneumonia, the leading infectious killer of children under 5.
As an aspiring health advocate, I’ve had the opportunity to work with the Stop Pneumonia team at the International Vaccine Access Center to help turn up the volume. How? We created the Pneumonia Fumbler Challenge, which asked people to say the following tongue twister five times fast for the under-fives: Pretty please prevent pneumonia to protect precious lives.
Advocates, and children, who accepted the challenge lent their voices to the scores of children who have a high likelihood of catching and dying from pneumonia: the poorest of the poor in developing countries. In 2015, approximately 920,000 children died from pneumonia—ending more young lives than Zika, Ebola, malaria, tuberculosis, and HIV combined.
Among participants around the world were future public health professionals—my classmates—at the Johns Hopkins Bloomberg School of Public Health. They took on the Pneumonia Fumbler Challenge while attending a World Pneumonia Day reception co-hosted by the Child Health Society. Through a little confusion and lots of laughter, the students shed light on the need to stop pneumonia in order to improve child health globally.
We need more voices to bring attention to pneumonia, a disease so common that its deadly nature is overlooked by country leaders and policy makers. We need voices to ensure that protective and preventive interventions—such as breastfeeding, adequate nutrition, and vaccines—are available to children in developing countries. We need voices to educate health professionals and caregivers about identifying pneumonia in its early stages. We need voices to secure treatment measures, such as amoxicillin and oxygen therapy, in low-resource settings.
The Pneumonia Fumbler was just one fun way to remind the world that all children should have resources to achieve good health and avoid preventable diseases, such as pneumonia. This Thanksgiving, I’m grateful to everyone who participated, and for the countless other campaigns and events advocates organized. Thank you for your voice—and the opportunity to amplify it worldwide.
Dignamartha Kakkanattu is an MSPH student at Johns Hopkins Bloomberg School of Public Health working on pneumonia advocacy at the International Vaccine Access Center.
By Dr. Kate O’Brien, Executive Director, International Vaccine Access Center (IVAC)
Everyone may get 15 minutes of fame, however, for common illnesses such as pneumonia headlines are scarce. While Secretary Clinton’s pneumonia diagnosis is viewed by most through a political lens, the candidate’s announcement has also sparked a curiosity about an illness contracted by millions every year.
Pneumonia, an infection of the lungs, is exceedingly common around the world with an estimated 450 million cases annually. In the US, about a million people seek hospital care for pneumonia with a cost to the health system of more than $10 billion each year according to the American Thoracic Society.
While the cost of pneumonia in the US is staggering, in too many countries the price is even higher. In the US, we have ready access to trained physicians with the know-how and equipment to make a diagnosis and when necessary, antibiotics and oxygen to treat illness. While some may balk at the cost, these interventions have been proven effective, and the vast majority of people who contract pneumonia make a full recovery. Sadly, this is not true everywhere.
In parts of Africa and Asia resources are scarce, and HIV infections, crowding, and indoor air pollution are prevalent and put people at risk. Also, the prevention and treatment measures we take for granted, such as vaccines and hand washing, are too often not available. The price of pneumonia in these countries is higher infection rates, more illness and, sadly, more deaths, especially in children younger than five years of age.
For most of my career I have been engaged in the fight against pneumonia. I have worked with nonprofits, governments and businesses to help families everywhere have access to the tools they need to fight this illness. We have made considerable progress. Vaccines to prevent the most deadly causes of pneumonia are rapidly being deployed in countries in most need—thanks to Gavi, the Vaccine Alliance, and country governments. As more children have access to vaccines and medicine to prevent and treat pneumonia, we see less disease and fewer lives lost. Yet, much work remains. More than 900,000 young children still lose their lives to pneumonia each year, these children need access to the same tools as our children, to prevent, diagnose and treat this common illness.
There is also a need to invest in innovations that will help those who contract pneumonia in the US and around the world. For example, pneumonia can have bacterial, viral, or occasionally fungal causes. Currently, there is no reliable test that will identify the cause of the infection in every case. The conventional method involves imaging, bloodwork, or cultures that are inconclusive in more cases than not. Physicians typically treat with antibiotics in case the infection is bacterial, but often the pathogen remains unknown. A test to identify the pathogen would help health workers everywhere to treat pneumonia appropriately and reduce unwarranted antibiotic use, this will help to address issues of antimicrobial resistance which threaten to undermine our ability to treat infections.
More than anything else, there is a need to put pneumonia on our collective radar as a public health problem that requires attention. Last year, pneumonia took more young lives than Zika, Ebola, malaria, tuberculosis, and HIV combined. Globally pneumonia is the leading cause of death for children under five years of age. Yet, pneumonia flies under the radar; it is so common that it is nearly invisible.
Can this change? Absolutely. This week, pneumonia is in the headlines and people are talking about their experience (or their parent’s or their child’s) with the illness. While pneumonia’s 15 minutes of fame may be about to run out, the chance to make a difference remains.
Kate O’Brien, MD, MPH is the Executive Director of the International Vaccine Access Center and Professor at the Johns Hopkins Bloomberg School of Public Health. She is a pediatric infectious disease physician, epidemiologist and vaccinologist.
This article was originally published on the VaccinesWork blog and is cross-posted here with permission.
A little girl with her vaccination card. Photo: Gavi/Doune Porter
Doctors from across Pakistan gathered in Islamabad last Thursday to fight a disease that’s threatening children across the country. This time it wasn’t polio they were working against, but pneumonia, which kills as many as 71,000 children every year in Pakistan.
The event, held to mark World Pneumonia Day, aimed to empower key influencers to better advocate to stop pneumonia and discuss challenges to its prevention. It took place at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), which itself sees many cases of the disease with a daily turnover of over 500 children in its outpatient department from in and around Islamabad.
The entrance to the seminar. Photo: Huma Khawar.
The pneumococcal vaccine was rolled out in Pakistan in 2012 as part of the routine immunization schedule, when it had already helped children in many other countries avoid pneumonia. It is also proving effective in Pakistan, as Dr. Asad Ali, from Aga Khan University Karachi, demonstrated by sharing preliminary findings from the vaccine impact assessment in Sindh. He explained that even one dose of pneumococcal vaccine is highly effective against the main germs that cause pneumonia (pneumococcus and Hib).
However, pneumonia is still one of the major killers of children under five years old in Pakistan. A major reason is limited routine immunization coverage – a little more than 50% of children are covered by a basic set of vaccines nationally, and the numbers of children immunized has even been declining in Balochistan. As a result, pneumococcal vaccine faces challenges reaching children across the whole country through this system, and so its population-level effects cannot yet be expected to be significant.
Doctors estimated that this underperformance is fuelled by caregivers’ lack of awareness. Too few parents know that the vaccine is necessary for child health, free-of-cost and available at immunization centers nationally. Yet improving vaccine coverage is crucial, as once infected, access to treatment options for infants remain limited especially in Pakistan’s rural, impoverished regions. Dr. Syed Saqlain Ahmad Gillani, National Immunization Program Manager, concluded the session by voicing support for a public-private health sector partnership to increase routine immunization coverage in the country.
One presentation from the day. Photo: Huma Khawar.
Facing such a challenge, medical professionals are not the only ones who need to advocate for vaccination against pneumonia. Following the conclusion of the main session, an advocacy session tailored for teachers and headmistresses of public schools was initiated during which they were informed of the need to prevent pneumonia through other proven, low-cost techniques such as immunization, sound hygienic practices and balanced diets for infants and exclusive breast feeding for six months, ensuring good nutrition.
The teachers also shared various risk factors which make children more prone to pneumonia. Poor parental healthcare seeking was one: when children with severe pneumonia often undergo of trial and error at the field levels, before they actually reach the health facility for the right treatment in time.
Exposure to indoor smoke, which in rural Pakistan is an issue for more than 60% of families, is also damaging beyond imagination. There, an average household size is seven, which makes overcrowding (i.e the number of people sharing same room where children sleep) is another important factor contributing to pneumonia.
The teachers agreed that, more than ever before, we know how to protect and prevent children from catching pneumonia, and how to treat those suffering with this illness. They returned home to spread the message.