The Right Fight

The Baltimore Sun
May 5, 2009
By: Thomas F. Schaller

 U.S. Lags In Tackling A Top Killer Of Children
Hopkins Expert Wants To Change That

Like many 42-year-old fathers of two, Orin Levine was periodically distracted during our Sunday phone conversation by his playful daughters, Abby and Jessie. It's difficult to talk uninterrupted when your 6-year-old and 4-year-old are giggling and scurrying about, petitioning for your attentions.

Orin Levine is happy to be distracted, however. He knows better - indeed, firsthand - what the devastating alternatives look like for certain parents in less fortunate corners of the globe.

Dr. Levine is an associate professor at the Johns Hopkins Bloomberg School of Public Health and a leading expert on pneumococcal disease - which, like some mysterious and frightening force in a Will Smith movie, is the relatively overlooked killer of up to 1 million children annually worldwide.

Actually, scratch "mysterious," because there's no mystery about the causes and consequences of childhood pneumonia. The bigger mystery is why the United States isn't taking a lead role in eradicating this killer. If we can spend $165 billion to salvage the AIG executives' bonuses, surely we can come up with half that to save a few million kids' lives.

The pneumococcus bacterium is common and usually harmless; about one in six children in American day care facilities have it. The real problem is when bacteria move from the upper respiratory track down into the alveoli of the lungs, where the pulmonary system does the vital work of circulating oxygen into the bloodstream and carbon dioxide out. The pneumonia that ensues initially makes it harder to breathe but, left untreated, will eventually deprive the body's other organs of sufficient oxygen.

In developing nations, pneumococcal diseases like pneumonia, meningitis and septicemia can account for up to 10 percent of childhood fatalities, and death comes as quickly as three days. The "lucky" survivors often suffer lifelong physical and mental damage. In third world countries, this fate can be almost as bad as death because at least one adult will be needed to supervise and care for that child around the clock, thereby crippling the family financially.

Dr. Levine co-chairs the Pneumococcal Awareness Council of Experts and currently serves as the executive director of PneumoADIP (Accelerated Development and Introduction Plan), an organization supported by the GAVI Alliance and dedicated to accelerating access to the pneumococcal vaccine for children in the 72 poorest countries.

He just returned from a trip to Rwanda, the first of those 72 nations to opt into the program. With the cooperation of Rwandan health minister Richard Sezibera, the GAVI Alliance and Wyeth Pharmaceuticals, on April 25 a medical team immunized the first two dozen children in a rural village an hour outside the capital city of Kigali.

"This is fundamentally about kids and parents, not immunology and statistics," he told me. "It's about rectifying a fundamental injustice that, by virtue of global roulette, affects children because of where they're born."
For Dr. Levine, the reality was brought home with the story of an African mother, Tiemany Diarra, who had to watch helplessly as her younger daughter died of pneumococcal pneumonia in the same hospital where her elder daughter had earlier died the same way. The two girls, he recognized, were roughly the ages of his own daughters.

Eleven other countries have been approved for the pneumococcal immunization program, a number Dr. Levine expects will expand to 20 by year's end. As more nations come on board, the long-term goal is to prevent 5 million to 8 million child deaths by 2030.

So far donors have committed $1.5 billion to purchase an estimated 200 million vaccine doses. This commitment overcomes a major hurdle of signaling to any pharmaceutical companies interested in producing the vaccine that there will be a sufficient demand to warrant new infrastructure and staffing investments to manufacture the doses. But with an eventual demand of 200 million doses per year, more funding is urgently required.

Finding the money is always difficult, but it doesn't help when Norway, a country with a population and gross domestic product one-fiftieth of the United States', has committed more money ($75 million) than we have ($72 million).

For President Obama - whose foreign policy philosophy de-emphasizes "democracy promotion" in favor of "dignity promotion" via human rights safeguards, economic development and disease eradication - this is a chance to put the money where his mouth is.

"There will always be funding challenges, and the U.S. government must step up," said Levine.

Thomas F. Schaller teaches political science at UMBC. His column appears regularly in The Baltimore Sun. His e-mail is schaller67@gmail.com.