Opinion: 'The moment of truth' for child survival

World Health Organisation (WHO) and Oral Rehydration Salts (ORS) Goodwill Ambassador Smriti Irani (C) holds a child being fed an ORS solution.
Credit: Manan Vatsyayana

In the 1970s, I joined the World Health Organization to help start and lead its new diarrheal diseases control program. The goal of the program was to reduce diarrheal mortality using a highly effective method of rehydrating patients by mouth using a solution composed primarily of salt, sugar and water.

In 1982, I wrote a paper with a colleague estimating that 4.6 million children under age 5 died each year from diarrhea — a shocking figure. Today, under-5 deaths caused by diarrhea have declined by 90 percent. Why? The treatment is inexpensive, easily administered at home, and it works.

In the late 1980s I was asked to help start the Acute Respiratory Infections Program at WHO, which had a similar goal of reducing childhood mortality from pneumonia by simply counting how many breaths a child had each minute and observing whether the breathing was labored. Children with rapid or labored breathing were given an oral antibiotic.

Preventing childhood diarrhea and pneumonia deaths and vaccinating children in the first six months of life was the essence of the Child Survival Revolution of the 1980s. But sadly, the revolution came to an end as much of the global health community shifted most of its attention and resources to HIV/AIDS.

In 2000, the United Nations and governments around the world set eight Millennium Development Goals. Number four was a pledge to reduce the global under-5 mortality rate by two-thirds by 2015.

But the newly released UNICEF report, Committing to Child Survival: A Promise Renewed, tells us that while we have made progress, more than 200 million children have paid with their lives because we failed to regain the momentum we had three decades ago. In 2012, most of the 6.6 million under-5 deaths were caused by preventable diseases like diarrhea, pneumonia, and malaria. And at our current rate of progress, by 2028 an additional 35 million children will die who would have survived had we met this MDG.

This is the moment of truth. The level of commitment that the world made to eradicating smallpox and improving access to antiretroviral drugs, especially in low-income countries, now needs to be applied to child survival. We need to accelerate our efforts to come as close as possible to achieving MDG 4 and ensure that what is not achieved is included in the post-2015 agenda. The technologies and approaches exist, and they are affordable.

The winning formula is global leadership and coordination, political commitment, adequate resources and strengthening of health systems in countries.

There is no excuse for letting millions of our children suffer and die because of our inaction. What are we waiting for?

Dr. Michael H. Merson is the founding director of the Duke Global Health Institute and the Wolfgang Joklik Professor of Global Health at Duke University. Previously, he served as director of the Diarrheal Diseases Control Program, the Acute Respiratory Infections Control Program, and the Global Program on AIDS at the World Health Organization. 

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