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Global health tough sell: Immunizing against idiocy

Credit: UNICEF

News analysis 

As Americans swoon over everything Ebola, either from (often exaggerated) fear or that weird kind of excitement some get from pondering the apocalypse, more threatening but less newsworthy bugs continue to wander around, killing and maiming tens or even hundreds of thousands of people to little notice.

Namala Mkopi

Namala Mkopi

“In 2007, we had more than 7,000 children die from measles,” said Dr. Namala Mkopi, a Tanzanian physician who swung by Seattle this week meeting policy makers, editorial boards and anyone who would listen to his plea for expanding basic immunizations in poor countries. “We need to focus on the basics … and improving child immunization is a fundamental first step to improving the basic functions of a health system.”

Now, it’s considered a no-no in the global health community to pit one disease or cause against another, to say something like AIDS deserves more attention than malaria or that vaccines are better investments than reacting to outbreaks after the fact, but it happens anyway.

If it happens based on a hierarchical assessment of the threats and our ability to respond, that’s a good thing.

But it usually doesn’t happen that way. Donors, governments and humanitarian organizations tend to respond most strongly to public demand and concerns. And the media, which influences public opinion, tends to focus on the latest and newest threat as opposed to what may be the greatest or most damaging.

It’s not a very rational approach and can, on occasion, devolve into idiocy. Here’s The Daily Show’s take on our response to Ebola:

On the positive side, it was in part the irrational fear of Ebola (irrational in terms of its perceived danger to the U.S. or Europe) that finally prompted the Obama Administration and other Western powers to respond with a major disease control and treatment campaign desperately needed in West Africa.  So that’s good. Politicians can sometimes make good use of public hysteria.

Amid the current Ebola frenzy, Mkopi is traveling around the country trying to explain to Americans why his greatest fear is not that Ebola could come to Tanzania. No, his concern is if people – donors, governments and humanitarian organizations – will again lose interest in a plan, launched more than a decade ago, to improve health in poor countries starting with some easy, relatively cheap and unfortunately very boring tools: Vaccines.

The plan? It’s called the Global Alliance for Vaccines and Immunization, and got its start in Seattle at the beginning of the new millennium and as one of the first (and perhaps still biggest) global health projects launched by the Bill & Melinda Gates Foundation. GAVI has so far saved about 6 million lives, but it seldom makes the headlines.

That’s what concerns people like Mkopi, an African physician and activist. He got in trouble with the Tanzanian government in 2012 for leading a doctor’s strike complaining of low wages, lack of government investment in training and the health care system. He’s now an activist for GAVI, sponsored on his U.S. tour by the anti-poverty advocacy organization RESULTS.

“What we need, for Ebola and for all health risks, are better health systems,” he said. “By strengthening immunization, we can improve the entire health system…. If we focus first on getting a health worker out to a remote region to do vaccinations, that person remains to do other things like weigh children to check for malnutrition or treat them for diarrhea.”

Measles-Cases-616pxAfter the deadly measles outbreak in 2007, he said the government, with assistance from GAVI and other organizations, significantly stepped up measles vaccinations to the point that today Tanzania can boast more than 95 percent immunization coverage against this deadly but common disease.

That’s well above the United States average which, as the CDC chart to the right shows, is seeing this deadly killer gaining ground again as many American parents choose not to vaccinate their children based on the belief (not supported by evidence) that immunizations may cause autism or other disorders. Maybe calling this idiocy is too strong, but this trend is hardly evidence of rationality.

“We have also greatly reduced deaths from diarrhea and pneumonia thanks to vaccines against rotavirus (the cause of most deadly forms of diarrhea) and pneumococcus,” Mkopi said.

“I did my graduate thesis on the massive death toll caused by diarrhea in Tanzania,” he said. “The wards used to be filled with sick and dying children, to the point of three in a bed and some sleeping on mats on the floor. Now these wards are mostly empty. It is a huge change, an amazing thing.”

The threat from Ebola to Sierra Leone, Liberia and Guinea is serious, Mkopi said, and deserves the attention and big response it is getting from the international community. But this kind of tragedy will keep happening, he said, if poor countries can’t improve their ability to prevent, and react to, crises by first investing in the basics.

“I know it is not as exciting, but it is just as important. It’s basic,” Mkopi said.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.