When I first started working on child health, one in five children died before their fifth birthday from diseases such as diarrhoea, pneumonia, tetanus, whooping cough, and measles.
At the time when I was still living in India, I remember talking to people who thought disease was a natural way to curb populations. Especially at home, people had a laissez-faire attitude towards the fate of the almost 4.5 million children under five who died in the country every year from preventable diseases and the millions more that suffered unnecessary disability and poverty.
Four decades on, child mortality in India has been cut to 1.2 million per year, eradication of diseases is no longer merely a theory. When political and economic will is in place, miracles do happen.
Key lessons from these last 40 years can help us build an equitable world where no child dies from preventable disease.
Something amazing happened in the 1960s—and it wasn’t related to the Beatles or landing a man on the moon. The decade had seen enormous outbreaks of smallpox—especially in India, which accounted for nearly 60% of all reported cases.
In 1967, in the shadow of 131,000 cases of smallpox, the World Health Organization (WHO) launched a campaign to completely eradicate the disease from the face of the earth.
Smallpox had existed for at least 3,000 years and no disease had ever been eradicated. So the vision (some might call it arrogance) it took to even contemplate that it was possible to consign a disease to history books was transformational.
In 1975 the last case of smallpox was seen in South Asia and, in 1980, the WHO declared the disease eradicated. This declaration redefined what was possible and ignited a broader movement to save children from preventable disease.
Some of the best ways to save lives are also the simplest.
The first few hours of life are the most critical and dangerous for newborns, and immediate breastfeeding can be the difference between life and death. That first suckle is like a powerful vaccine that helps kick-start the baby’s immune system and protects it from diseases and harmful bacteria.
While we’ve learnt the power of simple solutions, innovations along the way have saved millions of lives. In the 1980s, diarrhoea was the leading child killer. That was until small sachets of oral rehydration salts (ORS) were introduced to help children recover. In the last three decades, ORS is credited with saving over 50 million lives across the world.
Success breeds momentum. After the eradication of smallpox, other global eradication campaigns against polio and guinea worm were launched in the 1980s and cases have dropped exponentially. Both diseases are now close to eradication.
As globalisation kicked into gear, so did the world’s ambition.
By the turn of the millennium, leaders committed to a set of global goals, including the two-thirds reduction of child mortality by 2015.
The pledge was ambitious and spurred another round of investment and political commitment: the creation of Gavi, the Vaccine Alliance, which aims to introduce new, more effective vaccines to poor countries.
Gavi has been supplying India with hepatitis B and polio vaccines since 2002—but this is not a one-way relationship. India manufactures more than half of Gavi-procured vaccines, and in 2014 it became the first implementing country to also become a Gavi donor.
Thanks to Gavi’s efforts, vaccines against pneumonia and diarrhoea, the two biggest child killers, are being rolled out around the world. By 2020, the Global Vaccine Action Plan estimates that the use of pneumococcal, rotavirus, and haemophilus influenzae type b (Hib) vaccines will have saved approximately five million lives.
Experts once said that polio would never be eradicated from India. This year the country celebrated five years without a single case—an amazing achievement. Now India is building off its polio legacy by introducing the rotavirus and pneumococcal vaccines—nationwide—to tackle diarrhoea and pneumonia.
The political momentum in tackling these deadly diseases is not just found in India; across the region we’re witnessing the rollout of new technologies to improve the cold chain system to keep vaccines cold longer so that we can reach the most marginalized communities.
Looking forward, the shocks from climate catastrophe—like the drought we’re seeing at the moment—present real challenges to how we tackle disease and the growing calamity of antimicrobial resistance and threat of disease pandemics. I know that we still have a lot of hard work to do; too many children still suffer from preventable disease.
However, we’ve successfully eradicated smallpox; polio and guinea worm are both moribund and child mortality has been cut dramatically. Transformational change is possible. But it only happens when we first believe it and then back it up with financial, political and human resources.
In the words of the Nobel laureate Gabriel Mistral: “We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. Children cannot. Right now is the time their bones are being formed, their blood is being made and their senses are being developed. To them, we cannot answer ‘tomorrow’. We must answer today!”
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