Major Donation to Spur Vaccine Delivery

A $100 million donation from Bill Gates, chair of Microsoft Corp., could save the lives of more than 2.5 million children each year. The gift, announced today in New York City, will help to establish the Bill and Melinda Gates Children's Vaccine Program to speed distribution of vaccines against four childhood diseases in developing countries.

The new program, to be run by PATH, an international nonprofit health organization, is intended to improve delivery of new childhood vaccines against four widespread and potentially lethal pathogens:

* Haemophilus influenzae type B, which causes pneumonia and meningitis;

* Rotavirus, which causes severe diarrhea and dehydration;

* Hepatitis B, which causes cirrhosis and liver cancer, and

* Streptococcus pneumoniae, which causes ear infections and pneumonia.

Although vaccines against these microbes are already available in the United States and other developed countries, they kill more than a million children in the developing world each year. "Our program has a simple goal," Gates said at the press conference: "To make the vaccines you and I take for granted available to children no matter where they live."

The program builds on a hugely successful World Health Organization effort called the Expanded Program on Immunization (EPI). Over the last 20 years, the EPI has raised from 5% to 70% the proportion of children worldwide who are immunized against six preventable and potentially lethal childhood diseases--diphtheria, pertussis, tetanus, measles, polio, and tuberculosis. The expanded immunizations save about 3 million lives each year, all at a cost of less than $1 per child, says epidemiologist Mark Kane, an EPI program veteran who will head the new effort.

But immunizations with the four new vaccines cost about 10 times more, and that increased cost--as well as lack of political willpower--has slowed vaccine delivery to poor countries, Kane says. To bridge that gap, the Children's Vaccine Program will coordinate cost-effectiveness studies and vaccine trials to make sure the vaccines work in the developing world. It will also explore new ways of financing large-scale childhood immunization efforts, such as interest-free World Bank loans to poor countries.

Other health officials caution that the gift addresses only part of the problem. "You also have to develop a healthy infrastructure that can deliver vaccines, and that costs a lot of money," says Ciro deQuadros, director of the Special Program on Vaccines and Immunization for the Pan-American Health Organization. Even so, says Carol Bellamy, executive director of UNICEF, Gates's donation is certainly welcome. "The bottom line is that this money will keep more children alive."