Mary Gallagher is based in Jordan and works on MSF’s A Fair Shot campaign, pushing to reduce the price of the pneumonia vaccine in developing countries.
“You are going to love this room,” announced Dr Anas. He was taking me on a tour of MSF’s mother and child hospital in Irbid, a town in northern Jordan, close to the border with Syria. And he was right, I was happy to find myself walking into a room of babies sleeping peacefully. Most of them had been very unwell, but they didn’t look it; they were already well on the way to recovery.
Except for Abdullah. Abdullah looked really sick. He was lying in an incubator and struggling to breathe. When he gasped through the oxygen tube, his chest looked like it was collapsing under his ribcage and falling into his spine.
I’ve worked on MSF’s A Fair Shot campaign for over a year, campaigning to lower the price of the pneumonia vaccine (PCV), but this was the first time I’d seen a baby sick with the disease. And it was difficult to watch. It was harder still when I realised that the young woman walking towards Abdullah’s incubator was the same woman I’d seen crying and looking exhausted in the corridor earlier that morning.
Anyone would be distraught in this young mother’s situation. Abdullah was four days old, underweight and clearly in pain. His mother asked Dr Anas what he thought of Abdullah’s condition – something she did whenever he passed. She had already asked him three times that morning. Dr Anas smiled as he answered, “You can see as well as I can that he is looking better all the time”. If this was better, I can’t imagine what Abdullah had looked like the day before.
Abdullah’s mother is a 17-year-old Syrian refugee. When I asked if she knew other children who had got sick with pneumonia, she said that she’d never heard the name of the disease, but that it was normal for children to get very ill with chest infections like this. She said that her older child, who is two, had also been very unwell but, like Abdullah, he had been given antibiotics and was okay now.
A vaccine would not have helped Abdullah directly; at just a few days old, he is too young to receive it. But the fact that suffering like this is so common, so unremarkable, is something that has to change. Children like Abdullah are so vulnerable because many governments around the world cannot afford to buy the vaccine that could protect them.
It is an under-reported fact that pneumococcal disease kills more children under five than any other disease. Nearly one million children die from it each year. Many of those children die in so-called middle income countries – countries not quite poor enough to qualify for assistance and discounts from organisations like Gavi, the Vaccine Alliance, but not wealthy enough to pay sky-high prices.
Jordan falls into this category, and the government has been outspoken on the need for fairer vaccine pricing and a more transparent market. With an average vaccination coverage rate of 99 percent, it is a country that is good at vaccinating its children. It does so regardless of the child’s status – refusing to differentiate between Jordanian children and the growing number of refugees that the country hosts (currently there are 656,170 officially registered refugees from Syria alone, and more when including non-registered refugees). But the pneumonia vaccine – known as the pneumococcal conjugate vaccine (PCV) – has thus far proved to be prohibitively expensive. The only two companies that make it, Pfizer and GlaxoSmithKline (GSK), have refused to offer the country a fair price.
The most recent prices offered to Jordan were 43.05 JOD (US$60.90) per child for the vaccine made by Pfizer and 36.54 JOD (US$51.51) per child for the vaccine made by GSK (this is the cost of all three doses required to fully protect a child). These numbers add up; according to the Jordanian Ministry of Health, the total cost of purchasing the vaccine is estimated to be between 12.2 million and 14.4 million JOD. This is a staggering amount of money when you consider that, if introduced, the cost of the pneumonia vaccine alone would represent between 57 and 67 percent of the country’s entire current immunisation budget (and approximately 3 percent of the total health budget).
The result of these high prices is that, when children get sick with pneumonia in countries like Jordan, they will continue to rely on antibiotics to get better (if indeed they have access to treatment). This is a solution that comes once a child is already very sick, and so it is unnecessarily cruel. It is also unsustainable: globally we are facing the threat of antibiotic resistance, and so the use of antibiotics in situations like this – where a protective tool already exists, but is unaffordable – is irresponsible.
The good news in this story is that, just ten days after I first met him, Abdullah has completely recovered from pneumonia. Dr Anas tells me that the baby is back to a healthy weight, has been feeding well and has already been discharged from hospital.
Abdullah was lucky. But there is no reason to leave the health of young children to chance. We must demand that Pfizer and GSK make their vaccine affordable for countries like Jordan.
MSF’s hospital for mothers and children in Irbid
In November 2013, Médecins Sans Frontières (MSF) opened a mother and child hospital in the northern Jordanian governorate of Irbid. The hospital provides services for Syrian refugees and vulnerable Jordanians residing in the local community, which have become even more important due to increased pressure on Jordan’s health system.
In the hospital’s maternity unit, skilled staff are on hand to manage complicated deliveries and carry out caesarean sections. The hospital also has a neonatal unit for premature babies. With Syrian refugees in Jordan facing increasing economic and social difficulties, a mental health support programme was opened in 2014 for Syrian children, which now includes outreach activities to reach out to Syrian refugee communities in the north of Jordan and surrounding governorates.
 DTP3 coverage in 2015 (latest year for which data is available). Source: www.who.int/immunization/monitoring_surveillance/data/jor.pdf