Assessing the local context of disease: politics, economics and data driven strategies for pneumococcal vaccination
Pneumonia is a leading cause of childhood mortality worldwide, responsible for approximately 18% of deaths. Developing countries bear a majority of the burden of pneumonia morbidity and mortality. Estimates of pneumonia burden are driven by political and economic interests and have shifted over time as specific organizations and individuals have entered the debate. These estimates are used by global health “experts” to direct resources toward vaccine research and justify scale up of vaccination campaigns. The introduction of several new pneumococcal conjugate vaccines (PCVs) has provided a mechanism by which to achieve significant mortality reduction. The World Health Organization recommends countries include PCVs in national immunization campaigns. The cost of such vaccines, however, is prohibitively high for many developing countries which are already burdened by inadequate and poorly funded health systems which cannot support inclusion of new expensive vaccine interventions. I explore how geographic methods can be used to examine the local context of disease, identify the most vulnerable populations, and design geographically targeted vaccine strategies which may offer significant cost savings over universal vaccination. Implications for the design and implementation of public health programs will be discussed.
