Poor children infected with HIV need access to vaccines

Today, from Haiti to Mozambique to Cambodia, we're better than ever at reaching people with life-saving treatments for HIV/AIDS, even in the poorest places in the world. But every day, 6,800 people are newly infected and nearly 6,000 more die of the disease.

With an AIDS vaccine still far off, reducing this toll requires not only more HIV-specific treatment, prevention and care, including for children, but also prevention of life-threatening infections - of which HIV-positive people are at particularly high risk because of weakened immune systems - pneumonia, for example.

The leading cause of pneumonia, a bacterium called the pneumococcus, kills 1.6 million people a year, mostly in Africa and Asia and mostly children.

Kids infected with HIV are especially vulnerable to serious pneumococcal infections like pneumonia and meningitis, with up to 40 times higher risk than other children. And once they're sick, HIV-positive children are far more likely to die from pneumococcal disease, especially when, as is frequently the case, they are not getting appropriate AIDS medication.

Unlike many other crises afflicting poor countries, however, this one is largely preventable. Children can be protected from these diseases for a lifetime by a simple vaccine. In rich countries like the United States, they are.

In poor countries, many of which have the highest rates of HIV in the world and account for 90 percent of all childhood pneumococcal deaths globally, the impact of pneumococcal vaccines would be especially great.

A new study published in the Lancet shows that pneumococcal vaccination is a crucial and effective lifesaver for HIV-infected children, whose greatly increased risk of infection makes them the biggest beneficiaries of the vaccine.

Unfortunately, the vaccine is not yet available in the developing world.

There is growing recognition, starting with the tide of global response to the AIDS pandemic, that it is morally unacceptable for people in poor countries to die of a disease from which people in rich countries are protected.

The earliest AIDS activists in the United States and Europe deserve great credit for bringing this injustice to light. Having persuaded their neighbors that ignoring the West's simmering AIDS crisis was short- sighted and inhumane, they turned their attention to the epidemic's horrific toll in Africa and the rising risks to Asia and Latin America. If people are resolved to ease the anguish of AIDS in San Francisco and New York, the activists argued, they should be just as determined to do so in Nairobi and Bangkok.

These days, few people are willing to accept that geography should determine who lives and who dies. Cost-effective interventions such as vaccines can level the playing field and are one of the best investments in global health.

Pressured by activists, the United States and other wealthy nations have agreed that everyone in the world should have access to AIDS prevention, treatment and care by 2010. Donor nations should expand that commitment to other life-saving interventions, including pneumococcal vaccination for children.

Distribution of a pneumococcal vaccine to all children throughout the developing world could save the lives of 5.4 million by 2030.

With continued support and cooperation, that target will be met. The Global Alliance for Vaccines and Immunizations (GAVI), along with key donors such as the Bill and Melinda Gates Foundation, Italy, the United Kingdom, Norway, Russia and Canada, is putting in place a $1.5 billion fund to pay for pneumococcal vaccinations around the world. The effort is great news for children in developing countries.

The same kind of commitment will be needed to finance vaccines for malaria and tuberculosis, currently in trials and expected to be available in a matter of years. And such an advance commitment, we trust, will one day help make an effective AIDS vaccine available in the developing world.

Until then, the pneumococcal vaccine will play a major role in protecting the world's children. It offers real hope for curbing the damage HIV can do to some very vulnerable kids and for saving many lives in the years ahead.