Editorial: hope for the future

World Heolth • 46th Year, No. 2, Morch-Aprill993 Editorial Hope for the future Ten years ago nearly five million children died each year from diseases preventable by the vaccines used in the Expanded Programme on Immunization. During the past decade this toll on young lives has been reduced dramatically through increasing the coverage of immunization for measles, DfYf (diphtheria, pertussis and tetanus), poliomyelitis, and tuberculosis (BCG) in children during their first year of life. Deaths from neonatal tetanus are also being reduced by immunizing women during or prior to pregnancy. Immunization coverage in developing countries increased nearly fourfold from a base of approximately 20% in 1981 to reach the 1990 goal of 80% globally. WHO estimates that 3.2 million young lives were saved from measles, neonatal tetanus and pertussis in 1990 alone. Immunization programmes now reach more than 100 million infants each year. However, approximately 2.1 million children are still dying annually from the diseases that are preventable with the six existing Expanded Programme on Immunization vaccines. True, universal protection has not yet been achieved, since the vaccines are not 100% effective or are given too late, infants or their mothers do not receive the full series and become "dropouts", or some vaccines lacking adequate stability to withstand heat become impotent before use. Each year aiJ, additional estimated 7 million deaths'from bacterial and viral diseases, such as bacterial diarrhoea, meningococcal meningitis, hepatitis A, C and E, and rotavirus, dengue and acute respiratory infections, could be prevented with new vaccines. Many of these vaccines have already been developed or could be developed with existing technology. Several could potentially be incorporated into the Expanded Programme on Immunization by mid- decade. Millions of additional lives would also be saved each year if effective vaccines against malaria and other important diseases were developed. The international community has forged a new alliance, called the Children's Vaccine Initiative, to guide the use of new technology and facilitate the development of new and improved vaccines to control these diseases. The Initiative was founded by five organizations: the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank, the Rockefeller Foundation, and the World Health Organization (WHO). Working together under the Children's Vaccine Initiative "umbrella" are governments, nongovernmental organizations, international and national public health and research agencies, public and private foundations, and research groups and teams from private lames P. Grant 3 Df Hiroshi Naka;ima, DirectoriJenerol of the World Health Organization. industry. The Initiative is moving ahead with research and development of a heat-stable oral poliomyelitis vaccine, a single-dose tetanus toxoid vaccine, and an improved measles vaccine which can be given earlier in life. Task forces are analysing the global vaccine supply situation and are working with both public and private sector institutions to ensure that high- quality, low-cost vaccines will be available to meet the goals for the 1990s. Although the work has just begun, the Children's Vaccine Initiative offers an opportunity for the international community to work together, using our knowledge, resources, energy and, above all, our sense of humanity to fulfil the promise of new vaccines which will save the lives of millions of young children and contribute towards the eradication or elimination of diseases such as poliomyelitis and measles. • Hiroshi Nakaiima, M. D., Ph. D.