Laos Photo Essay
by Paul O'Connell, GAVI Donor
"If you want to get someone's attention about the health crisis in Africa, 'show them the money.' Help them to understand the economic costs of disease pandemics, as well as the economics of disease control.
Above all, propose practical solutions based on a rigorous emphasis on costs and benefits."
— Former Prime Minister of Norway Gro Harlem Brundtland
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Japanese International Cooperation Agency representatives pose questions to a staff nurse during a visit at Phonghong District Hospital, Vientiane Province, Laos, as private philanthropist Paul O'Connell listens in.
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GAVI Country Support staff person Craig Burgess talks with Paul O'Connell about immunization programs in Laos as the two examine a vaccine vial.
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Phonghong District Hospital, Vientiane Province, Laos.
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Paul O'Connell reviews 2006 and 2007 immunization coverage rates with officials at Keoudom District Hospital, Vientiane Province, Laos, as Craig Burgess looks on.
The year was 2000, and Prof. Jeff Sachs of Columbia University's Earth Institute, one of the most effective and tireless crusaders against global poverty, was struggling to get the international community to focus on the global calamity of disease. Dr. Gro Harlem Brundtland, then the Director General of the World Health Organization, called Prof. Sachs and gave him the above advice. It is hard to find a better summary statement for why my wife Elaine and I support the GAVI Alliance.
Vaccine-preventable diseases impose two enormous burdens on the world, one direct, and one indirect. The direct burden is the more obvious: it is the suffering and death of millions of children and adults who are not protected from easily prevented diseases. The sheer magnitude of this burden is staggering. Every year, 9.7 million children die before their fifth birthday, and a quarter of these deaths are due to diseases that are preventable through vaccination. The problem with such statistics is that they are difficult to truly grasp. This is a real issue - the human mind is not very good at appreciating the scale of such large numbers. In absolute terms, the death toll is equal to half the total number of US children under five currently alive. Put another way, you could fill every professional football stadium in the United States five times over with the number of children who will die this year.
The scale of this suffering and death is justification enough to try to tackle the crisis. And yet, it is the indirect burden of vaccine-preventable diseases that presents an even more compelling motivation. Through careful and systematic research, the impact of disease on growth and overall economic welfare is now well understood.
There are two main channels through which it operates. First there are the direct costs on both families and health systems of caring for those who have contracted disease and are sick and dying. Such care-giving diverts scarce resources away from economic production and from other healthcare needs. Second, there is the impact on fertility of high childhood mortality. This is particularly acute among the one-sixth of the world's population that is mired in poverty, barely surviving at a subsistence level. Countries that have climbed out of such poverty and continued on the road of economic development all have one thing in common: they have gone through a demographic transition that has reduced family size. Research has shown that, in many cases, the key determinant of fertility is childhood mortality. Raising rates of vaccination and immunization are therefore central to this transition.
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