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Each year, pneumonia kills more children around the world than malaria, measles and HIV combined. Ray Suarez reports from Nicaragua on efforts to combat the lung infection, which is the leading killer of children under the age of five.
And, finally, tomorrow is World Pneumonia Day, highlighting a disease that continues to destroy lives around the world.
Ray Suarez recently traveled to Nicaragua to look at efforts to combat the problem there.
It's an unlikely place to see the results of a multimillion-dollar business deal, a one-room church in rural Nicaragua.
Here, children in the tiny village of Timal (ph) are receiving a lifesaving new vaccine, brought to market through a revolutionary business model. The vaccine prevents bacterial pneumonia. It's sorely needed in Nicaragua, where pneumonia is the number-one killer of children under five.
DR. BRIAN CHAVEZ, Nicaragua (through translator):
The main symptoms are difficulty in breathing, a fever, and loss of appetite, which leads to malnutrition. But these towns are difficult to access and families have a hard time traveling to a hospital, so for this illness, often death is the final outcome.
Even those babies who do make it to a hospital face daunting odds.
DR. FELIX SANCHEZ, Children’s Hospital, Managua (through translator):
Twenty percent of the children in this hospital are admitted for pneumonia, and more than half of them will die.
Infants, who don't have a mature cough reflex, are most at risk. Globally, pneumonia is the single biggest killer of children, accounting for nearly one in five deaths among young children, with an estimated 1.8 million deaths annually. Ninety percent of the pneumonia deaths each year occur in the developing world.
Nicaragua is poor, the second poorest country in the Western Hemisphere. Like other developing countries, Nicaragua could not afford a new vaccine like the one for pneumococcal pneumonia for its children without a steep price reduction. And that's just what it got with this pneumonia shot, a whopping 95 percent discount.
How do you get the cost of a vaccine down from about $100 a dose to less than $5? By assuring pharmaceutical companies a steady stream of revenue, by guaranteeing that all the children in a country will be vaccinated.
The pharmaceutical companies, in this case, Pfizer and GlaxoSmithKline, were promised a huge market of customers if they kept costs down.
Dr. Orin Levine runs the International Vaccine Access Center and teaches at Johns Hopkins University.
DR. ORIN LEVINE, Johns Hopkins University:
So the advanced market commitment basically says, we will assure that there's a market, that there is money on the table, if you make a vaccine that meets the needs of developing countries and if the developing countries demand it.
The unusual pharmaceutical deal was brokered by the Global Alliance for Vaccines And Immunization, now known simply as GAVI. The GAVI Alliance, which includes the Bill and Melinda Gates Foundation, also a NewsHour funder, donated $1.5 billion.
Without that cash, new vaccines do eventually make it to the poorest countries, but only after years of delay.
Dr. Seth Berkley is GAVI's CEO.
DR. SETH BERKLEY, GAVI:
That takes 15, sometimes 20 years, and that's usually the time lag between when these products appear and they get into those living in the poorest countries. What GAVI has tried to do is shrink that. And with pneumococcus, it's one of the first examples or best examples of a product that, a few years after it came out in the West, it already was being rolled out in the developing world. And that is a really exciting intervention.
Nicaragua was the first developing country to roll out the pneumococcal vaccine one year ago. It was a tragic case of bad timing for Diana Del Socorro Blanco Guevara (ph), whose 17-month-old daughter, Angie (ph), got sick and became gravely ill just as the vaccine was introduced here.
DIANA DEL SOCORRO BLANCO, mother (through translator): My daughter got worse suddenly. She got tired. She couldn't get enough oxygen. They took her in a room and told me they had to put a tube down her throat. They put I.V.s everywhere.
Angie died in early February, after weeks of struggling to breathe.
DIANA DEL SOCORRO BLANCO (through translator):
I suffered when I saw my daughter in the hospital. People said we should leave the hospital, but we stayed. We slept on top of cardboard, under trees. I don't want to see other mothers go through what I went through. I have never lost something I loved so much in my life.
DR. ORIN LEVINE:
Pneumonia is an illness and pneumococcus is a bacteria that infects everybody all around the world, but the consequences are uneven. So in places like Nicaragua, where people live in poverty, the consequences of the infection are more severe, because they may be undernourished, they may be living in an essentially more dangerous housing and environment. And they oftentimes lack access to the lifesaving antibiotics and oxygen therapy.
For every one child who dies from pneumonia in rich countries, 2,000 die in developing countries.
It makes me feel good to know there is a solution now for the children, so that mothers won't have to suffer what I suffered with my terrible loss. I think about her every day. You may not see it, but I am thinking of her. The memories, they are there every day.
Karla Maria Fonseca Cuadra (ph) is Blanco's neighbor. Fonseca saw how devastating the loss of Angie was to the baby's mother, and made sure to vaccinate her three children. One suffers from asthma.
KARLA MARIA FONSECA (through translator):
He is very susceptible to getting sick. His asthma has left him weak, but I imagine now, with the vaccine, he is much safer.
The beauty of science, when we make a big breakthrough, is when it brings about social justice, when it essentially eliminates the kind of disparities in risk that children in poverty face, and so by virtue of the fact that now we can get lifesaving pneumococcal vaccines to children in Nicaragua the same time we get them to children in Newark.
But delivering health care, bringing it to where people can get it when a government can only spend a few dollars a year per patient is a challenge, sometimes made even harder by government corruption.
So GAVI also requires that countries like Nicaragua show in advance they can reach at least 70 percent of their citizens.
In a way, it's kind of a carrot. It encourages countries to strengthen their systems and to reach every child in order to make themselves eligible to qualify for these new vaccines.
Nancy Vasconez is an immunization adviser for the Pan American Health Organization, PAHO, part of the United Nations. She says that promise of wide distribution is a huge undertaking for a developing country like Nicaragua.
NANCY VASCONEZ, Pan American Health Organization (through translator):
It is commitment the government makes. And the commitment doesn't last one day or one year. The contract is for 20 years. The government must pay personnel and supervisors to make sure the vaccine is used correctly and gets to where people live.
Nicaragua's health workers fan out, armed for battle with coolers filled with the vaccine.
NANCY VASCONEZ (through translator):
I know we can't measure the cost of death, but if we measure the number of years by which we prolong life and prevent debilitating illnesses, we can measure the cost of a life, and I believe the government of Nicaragua made the best investment.
The GAVI Alliance plans to continue its rollout to more than 40 countries, and hopes to prevent 700,000 deaths by 2015, and seven million deaths by 2030.
Oh, yes, it hurts all right, but that man with the needle just may be saving your life.
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