India votes to save lives

India loses one child every eight minutes to pneumococcal disease. Today, there is a vaccine to help reduce the far-reaching effects of this deadly disease.

Little Raju was rushed in by his anxious parents into the emergency room; the 10-month-old infant was struggling to breathe and turning blue despite his high fever. His mother could not believe how quickly things deteriorated. “His fever just began yesterday”, she wept, “will he live now?”

Our medical team was in rapid response mode. Oxygen and antibiotics were in place to treat his severe pneumonia, but without a ventilator or breathing machine, that was rare in a small hospital like ours, his chance of survival was tenuous. This was in the mid-1990s, and pneumococcus was a familiar harbinger of death in very young children. As doctors working in a district hospital in southern India, etched behind our hopeful façade, was frustration at the lack of effective tools that could prevent this devastating illness.

Today, as pediatricians and public health specialists, we are grateful for and encouraged by the tools we now have to prevent pneumonia, including new vaccines. Yet, much work remains. Pneumococcus is a bacterium that can cause diseases such as pneumonia and meningitis. These conditions are responsible for untold suffering and economic hardships in many thousands of families. Among children who survive meningitis, more than a quarter suffer from serious neurological consequences such as deafness, paralysis and mental deficiency.

Pneumococcus is a leading cause of vaccine-preventable illness and death among children less than five years of age in India and the world. More than one-fifth of the deaths globally due to pneumococcus occurs in India. In India, one child dies from a pneumococcus-related illness every eight minutes. How can we accept this?

Antibiotics are excellent tools to treat illnesses caused by pneumococcus. Unfortunately, they are often administered too late. Some strains of pneumococcus, of which there are more than 90, are resistant to commonly used antibiotics. This makes treatment even more complicated and expensive. Fortunately, in our toolkit today, we have a safe and effective vaccine against pneumococcus called pneumococcal conjugate vaccine (PCV). While more than 90 different strains of pneumococcus can cause repeated illnesses, only a handful cause most of the severe disease. Most of these strains have been captured into the pneumococcal vaccine.

It was a momentous occasion when the first PCV was licensed in the United States for use in infants and young children in 2000. Today, India is taking initial steps to bring this vaccine to every child. By starting in the highest burden areas in India, the government is taking a wise and brave decision. It is important that the hardest-to-reach children have easy access to this vaccine.

India will stand firmly with the global community and more than 130 countries who have already introduced PCV in their health programmes, including our neighbours Pakistan, Afghanistan, Nepal, and Bangladesh.

Some have asked, “How well does this vaccine work?” The vaccine India will introduce provides protection against more than two-thirds of all the strains that cause serious disease in children both here and in other similar countries. Clinical trials from around the world have shown that children who receive PCV are about 80 per cent protected from getting a serious pneumococcal infection caused by a strain present in the vaccine. Countries that have introduced the vaccine have seen substantial reductions in hospitalisation rates for pneumonia in children within a few years of introducing the vaccine. Overall this vaccine has been shown to prevent the death and suffering of numerous cases of pneumococcal disease.

Children under five years of age are most vulnerable to disease caused by pneumococcus. However, these bacteria also affect other age groups, particularly older children and elderly individuals above 65 years of age. The strategy of vaccinating the youngest individuals has an added bonus — it also provides protection to the rest of the population, through a phenomenon termed “herd protection”. Pneumococcus resides in the nose and throat passages of a large proportion of healthy children. The act of immunising them with this vaccine virtually wipes out the strains of pneumococcus in the vaccine from the nose and throat of children who are vaccinated. This reduces disease transmission and indirectly helps prevent individuals who are too young or too old to be immunised from being getting sick from pneumococcal disease. Pneumococcal vaccines have been given to millions of children around the world and have been shown to be safe.

The pneumococcal vaccine launch slated to take place at Mandi, Himachal Pradesh, on Saturday, May 13, this year is a laudable milestone for India and the world.

As the vaccine becomes an integral part of the national immunisation programme over the next few years, far fewer precious lives will be lost unnecessarily. We applaud the decision of the Government of India to introduce this lifesaving vaccine that will save children’s lives, reduce suffering, and see healthier children go on to become productive adults.

India’s vote is certainly a win for children like Raju and for the country.

Dr Anita Shet is a pediatrician and public health infectious disease specialist, and serves as an Associate Scientist for the International Vaccine Access Centre at Johns Hopkins University.

Dr Mathuram Santosham is a pediatrician and a public health expert, who serves as Senior Advisor for IVAC at the Johns Hopkins University, where he is also a Professor of International Health and Pediatrics.