Decreasing preventable deaths in Kenya

MARAGOLI, Kenya — In a small nurse’s office at Vihiga District Hospital in western Kenya, nurse Calvin Lang’at carefully explained to a mother a list of vaccines for the six-week-old baby in her arms. One of them was a pneumococcal vaccine, introduced just eight months ago in Kenya.

“This is a great vaccine,” Lang’at told me as she prepared the shot. “The numbers of cases of pneumonia have been reduced in the hospital. If you see pneumonia now, it’s with a child who didn’t get the vaccine.”

I was in the hospital outside of Kisumu on a trip sponsored by the Global Health Technologies Coalition, a Washington, D.C.-based group of 40 organizations that work in global health research and development. Lang’at said she was hoping that the vaccine would only be the start of a new rush of vaccines to save lives of babies in the developing world.

“I really would love to have a rotavirus vaccine,” she said, referring to another new immunization on the market that prevents a deadly form of diarrhea in children. Kenya says it will roll out the vaccine in 2013. “And malaria is such a problem here. If we can get a vaccine for malaria, we will really be taking care of the children under five years of age.” Just down the road from the hospital is one of the 11 sites in Africa testing the RTS,S malaria vaccine, the world’s most clinically advanced malaria vaccine candidate.

This made me think of some comments made earlier in the week by the outspoken US Ambassador to Kenya, Jonathan Scott Gration. He said that Kenya should look for additional sources of money for health programs, suggesting, at a time when Congress is considering cuts in global health, that donors’ funding may slip and Kenya should be prepared for that. Kenya funds roughly two-thirds of its overall health expenditures, and the US is its largest donor, paying for roughly 90 percent of the fight against AIDS, according to Kenyan officials.

Ambassador Gration also recently launched a campaign called "Let’s Live," which sets a target of reducing preventable deaths in Kenya by 50 percent by December 2012. That’s just 14 months away. The campaign will focus on four areas: maternal and infant mortality, HIV/AIDS, non-communicable diseases, and child health.

So how will Kenya reduce preventable deaths by 50 percent in the next 14 months?

It would be an historic feat. But the country could seriously decrease numbers of preventable deaths if it used currently available health tools, such as the rotavirus vaccine. US health officials are currently looking at whether they can help the Kenya government speed up the timetable for delivery of the vaccine, instead of waiting until 2013.

The history of global health is full of examples of major successes in driving down death rates due to the combination of political leadership and revolutionary technology. It happened in smallpox eradication, it’s happening with the polio eradication effort, and it’s happening, too, with the fight against AIDS. It may happen soon with meningitis because of a new vaccine launched just last fall in three African countries that stopped the spread of the disease cold.

Katherine “Kemy” Monahan, the new deputy executive director of the Global Health Initiative, told me earlier this week after a visit to the Kibera slum in Nairobi that major advances will happen with new health tools such as the pneumococcal vaccine and a possible microbicide for women to protect themselves against HIV infection.

“If I think of the one thing that has been most important in cost savings and advancements in global health, it would be research R&D,” she said. “Research and development can create whole new paradigms. It can cut costs dramatically with one new vaccine, or one new drug, or one new test. R&D is expensive on the front end but very cost effective once you start implementing it.”

Perhaps the best most recent example of research saving lives is the lab work over the past quarter-century that created a host of antiretroviral drugs to fight AIDS. Before these drugs were developed, the vast majority of AIDS patients died. Now, the average median years of life for someone with HIV in their 20s who is otherwise healthy is 50 years, according to Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases.

On this day at Vihiga District Hospital, nurse Lang’at said she was happy to be able to give the pneumococcal vaccine to children under the age of one. Six-week-old Colleen Kafandika screamed from the injection, but the moment of pain could save her life.

“I’m hoping for that rotavirus vaccine soon,” Lang’at said. “Why do you need to wait until 2013? If you want to reduce child deaths, we should use everything. We could use that vaccine now.”