In the Shadow of AIDS in Africa

The last U.S. president, the U.S. Congress and millions of everyday Americans have made fighting AIDS in Africa a priority. The appalling notion that HIV is passed from infected mothers to their children, that it kills 90% of them before their fifth birthday, and that effective treatments exist but aren't being used was the basis for a nationwide, non-partisan movement. Launched in response to this outcry, the $15 billion President"s Emergency Plan for AIDS Relief (PEPFAR) is the largest global health initiative ever created.

There is another disease killing children in Africa with the same lethality as AIDS. Sickle cell disease is also passed on from mothers (and fathers) to their children, more than 90% lethal by age five years, and like AIDS, it can be managed.

An inherited blood disorder that disproportionately affects Africans and persons of African descent, sickle cell disease results in the production of abnormal, misshapen red blood cells that can't easily pass through small blood vessels. As a result, these cells are destroyed rapidly in the body, causing anemia, jaundice, gallstones, and pronounced organ and tissue damage. Sickle cell patients, especially young children, are also easily overwhelmed by certain serious bacterial infections.

The online edition of The Lancet last week included new data from Tom Williams and colleagues in Kilifi, Kenya showing children with sickle cell disease have about 30 times the risk of serious infections by two vaccine-preventable bacteria, pneumococcus and Hib. It also showed that these children rarely reach their fifth birthday and that these infections are a major cause of death.

Like with AIDS, a set of basic steps and interventions can substantially improve the lives of children with sickle cell disease in Africa. Strengthening health systems is critical for both. In each case, a child's survival and quality of life can be improved most effectively when the health system can diagnosis their condition at birth and then provide a series of continuous treatments and preventive therapies. Today's announcement of $1 billion in new funding for health systems through the GAVI Alliance, World Bank, and the Global Fund could represent a major advance if it is used wisely.

This health system approach begins with women delivering their children in a health facility equipped with the tests needed to diagnose these diseases. It continues with access to care that regularly follows the child's development and provides life-saving therapies like penicillin prophylaxis for children with sickle cell disease and anti-retroviral drugs for children infected with HIV.

While building stronger African health systems, we can also grant these children access now to life-saving Hib and pneumococcal vaccines. Children with sickle cell disease and those with HIV infection are up to 30 to 40 times more likely to get pneumococcal disease and are at an elevated risk of Hib infections, both of which cause pneumonia, meningitis and other life threatening illnesses. But sadly most of the children who need these vaccines the most have yet to receive them. Together, these pneumococcal and Hib vaccines would give these children a great chance to beat these serious, common and preventable infections.

Progress is being made to grant access to these vaccines but it is precarious. The GAVI Alliance, an international vaccine partnership, buys these vaccines at reduced prices and then passes them on to poorer countries for nearly nothing. Perhaps recognizing the importance these vaccines will play for the children in their countries with sickle cell disease and HIV, African countries have been at the forefront of introducing pneumococcal and Hib vaccines. Already, nearly all African countries are currently using or plan to implement the Hib conjugate vaccine, and more than a dozen have applied to the GAVI Alliance for pneumococcal conjugate vaccines. As a result, the children in these countries are now in a position to benefit from these vaccines at the earliest possible moment.

This progress, however, is at risk. The GAVI Alliance is in urgent need of a financial replenishment or it will be unable to buy the vaccines that are needed. Additional support from US citizens and the US government could help avert this impending crisis in child survival.

Countries like Botswana, Equatorial Guinea, and Gabon are not eligible for GAVI assistance but not quite rich enough to fend for themselves in the international market. Protecting children in these countries means that we need new financing and vaccine pricing solutions to ensure that no at-risk child is left behind.

It seems odd that Americans could be so motivated to address the appalling inequalities behind just one terrible disease and then ignore the other. Isn't it time to consider expanding our support for children in Africa so that we can protect them from both of the lethal blood diseases of the continent -- HIV and sickle cell disease?

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