Cutting immunization aid: Penny wise, pound foolish?
CMAJ 1997;157:1202
Some of the things we take for granted in Canada can make the difference between life and death in other countries. Immunization is one example. After evaluating the impact of immunization programs in my country, Senegal, I concluded that the termination of Canada's International Immunization Program, as recently announced by the Canadian International Development Agency (CIDA), would be regrettable.
Children in developing countries are often victims of a vicious cycle of malnutrition and infectious disease. Although some of them face more elaborate forms of injustice, such as displacements caused by armed conflict, we would be shamefully guilty if we did not at least continue to fight battles already being waged, principally in the areas of maternal and child health, malnutrition and vaccination.
Every year infectious disease kills 2 million children under age 5. The ailments that kill them are not exotic, but rather diseases such as measles, mumps, diphtheria, neonatal tetanus and tuberculosis. In spite of this terrible toll, global vaccination programs, which Canada has supported until now, currently save more than 3 million lives per year. The Canadian contribution has been about $6 million per year, which is less than 0.3% of the CIDA budget. An evaluation by the Canadian Public Health Association showed that these projects have not only efficiently accomplished immunization goals but also trained local primary care providers.
Can we really afford more foreign aid? For the North, financing the eradication of polio, neonatal tetanus and measles can be considered an investment, not aid. After these diseases are eradicated, costly annual domestic immunization programs will no longer be needed. The eradication of smallpox alone has saved millions around the world.
It is estimated that polio, which continues to cripple more than 80 000 children per year, could be eradicated forever by spending $180 million per year for 5 years. The US currently spends $380 million a year to immunize American children against polio, which would be unnecessary if the disease was eradicated. Canada and other Western countries waste proportionately similar amounts each year. It is not surprising that the US has recently increased spending on international immunization programs.
Cancelling Canada's international immunization program is a bad idea, and I can't watch it go without voicing a note of protest.
Ismaila Thiam, MD
Department of Nutrition
University of Montreal
Montreal, Que.
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