Infant Mortality Decline Not Enough

Bill Gates Speaks On Childhood Deaths
By James Achanyi-Fontem
Director of Publication
Cameroon Link
In his first 2009 annual letter, Bill Gates spoke about the work at his foundation: what has gone well, what hasn’t, and what the foundation is learning along with their partners.
In the letter, it is revealed that over the past 50 years childhood deaths have dropped dramatically. For example, in 1960, when there were nearly 110 million children born, almost 20 million children under 5 died. In 2005, when more than 135 million children were born, fewer than 10 million children under 5 died. Bill Gates acknowledged the statistics is one of the most amazing. The number of children born went up, while the number who died was cut in half. Two things caused this huge reduction in the death rate. First, incomes went up, and with that increase, nutrition, medical care, and living conditions improved. The second factor is that even where incomes did not go up, the availability of life-saving vaccines reduced the number of deaths. For example, measles accounted for 4 million children’s deaths in 1990, but fewer than 250,000 in 2006.
Despite this progress, 10 million children dying is still 10 million too many. Each death is a tragedy. In the United States young people dying is so rare. Many of the children dying are in the developing countries. It would be a huge breakthrough to cut that 10 million in half again, and Bill Gates believes can be done in the next 20 years.
What kills children under 5?
There are a few diseases, like diarrhea, malaria, and pneumonia, that cause over half of the deaths. The key to eliminating these conditions is the invention of a handful of new vaccines and getting them into widespread usage.
When Melinda and Bill first started their giving in the late 1990s, their focus was on reproductive health rather than childhood deaths. The idea behind was that they wanted to give mothers the tools to limit their family size to what they wanted would have a catalytic effect by reducing population growth and making it easier to feed, educate, and provide jobs for the children who were born.
But in 1998, they were surprised when a newspaper article showed that only a few diseases cause most childhood deaths and how much little money was being invested in creating and providing vaccines for these diseases. A particular type of diarrheal disease—rotavirus—was killing over 400,000 children each year. How could a disease they had never heard of get so little attention and kill so many children? Bill and Melinda sent the article to their father and asked him to look into how they could help.
A surprising but critical fact they learned was that reducing the number of deaths actually reduces population growth.
The strong connection between infant mortality rates and fertility rates
Contrary to the Malthusian view that population will grow to the limit of however many kids can be fed, in fact parents choose to have enough kids to give them a high chance that several will survive to support them as they grow old. As the number of kids who survive to adulthood goes up, parents can achieve this goal without having as many children.
This means that improved health is critical to getting a country into the positive cycle of increasing education, stability, and wealth. When health improves, people have smaller families and the government has more resources per person, so improving nutrition and education becomes much easier. These investments also improve health, and a virtuous cycle begins that takes a country out of poverty.
It was this huge revelation that led to Melinda and Bill Gates expanding their focus from reproductive health to all of the major infectious diseases. Today the foundation’s Global Health Program, which accounts for about 50 percent of their total spending, focuses on 20 diseases. The top five are: diarrheal diseases (including rotavirus), pneumonia, and malaria—which kill kids most—and AIDS and TB, which kill adults most.
Ten years have passed since Melinda and Bill were shocked by the number of deaths and lack of focus on rotavirus. Unfortunately, the death toll has not yet been reduced. Two vaccines for rotavirus are now being used widely in rich countries. The foundation needs to get the vaccines into use in poor developing countries, but there are some significant challenges that have caused delays.
Each country wants to be sure that rotavirus is a big enough problem in their country to justify adding the rotavirus vaccine to the set of vaccines that their newborn children receive. They need additional funding, because a new vaccine costs over $20 (CFA 10.000) per child—sometimes much more. Usually this cost comes down to less than $1(CFA500), but only after several decades. A particular challenge for vaccines is that they need to be kept cold in refrigerators because they spoil if their temperature gets above 40 degrees Fahrenheit for very long. So adding a new vaccine, like one for rotavirus that needs a lot of refrigerator space requires increasing the refrigeration capacity at every stage of the entire delivery chain, including very remote areas that don’t have electricity. The foundation is working with the GAVI Alliance, and others to get a rotavirus vaccine into widespread use.
In the past eight years, GAVI has added a vaccine to prevent liver cancer (Hepatitis B) and one to prevent respiratory disease (Haemophilus influenzae type b) to the standard group of six vaccines in a large number of countries. Nothing on the planet saves children’s lives more effectively and inexpensively than vaccines. The foundation gives a time frame of six years within which it will have enough distribution to have cut the number of rotavirus deaths in half. This is an ambitious goal, but it’s one of the key steps to cutting the overall number of childhood deaths from 10 million to 5 million, according to Bill Gates.
At the foundation they are getting even more focused on their top health priority, which is helping to make sure that vaccines are developed and delivered to fight these diseases. With a handful of new vaccines, they should be able to save a year of a person’s life for well under $100 (CFA50.000). If the foundation wastes $500,000 (CFA250.000) they are wasting 5,000 years of life. This is the kind of trade-off governments in poor developing countries should consider when they decide which areas to get involved in and which grants to request from donors.