Rethinking global access to vaccines

doi:10.1136/bmj.39497.598044.BE

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Our online table of contents is updated at least twice each day. Read all articles published in the last 7 days.
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
OPEN ACCESS: All research articles are freely available online, with no word limit. Find out more about the BMJ's open access policy. Submit your paper.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Dave A Chokshi, medical student 1,
Aaron S Kesselheim, instructor in medicine 2

¹University of Pennsylvania School of Medicine, 3434 Sansom St, Philadelphia, PA 19104, USA
²Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Correspondence to: D A Chokshi daveash{at}med.upenn.edu

Accepted 16 January 2008

Barriers to dissemination of life saving vaccines in low income countries can and should be overcome, argue Dave Chokshi and Aaron Kesselheim

Inadequate access to vaccines in low and middle income countries results in more than two million deaths each year.1 Two thirds of these deaths occur in children under the age of 5. Hepatitis B virus and Haemophilus influenzae type b (Hib) vaccines are now starting to be used in low and middle income countries, but they were licensed for use in the industrialised world more than two decades ago. Our difficulty in disseminating well established vaccines casts doubt on our ability to promote widespread use of new ones, such as those for diarrhoea associated with rotavirus infection and for human papillomavirus (a causative agent of cervical cancer) (table)⇓. Currently, over 99% of the 440 000 annual deaths from rotavirus associated diarrhoea and 93% of the 260 000 annual deaths from cervical cancer occur outside the 60 wealthiest countries.2 3

View this table:

In this window
In a new window

Development and dissemination of rotavirus and HPV vaccines

Challenging widely held beliefs

Three arguments have historically dominated discussions about the cause of unequal access to vaccines in poorer countries: the primacy of healthcare infrastructure; constraints imposed by insufficient funding; and the belief that vaccine approval in high income countries is a precondition for discussing access in other settings. Recent experiences have shown how each of these contentions is open to challenge.

Primacy of infrastructure

Must poor healthcare infrastructure be addressed before large scale vaccination can succeed? The claim that poor infrastructure is a more fundamental—and therefore more pressing—problem than access to vaccines must be distinguished from the claim that local logistical hurdles must be overcome to achieve equitable access. Those who agree with the former contention believe that ensuring supplies of food and clean water and building roads will do more for public health …