Miriam Alia is an Intensive Care Paediatric Nurse who has been working with MSF since 2005. She’s currently working as a Vaccination Advisor for MSF, after a stint as a Medical Coordinator in MSF teams deployed in emergency situations around the world.
How often do our medical teams come across children affected by pneumonia?
Unfortunately, pneumonia is a horribly common disease – it’s one of the top five diseases we see in the children who come to our clinics and it’s the main reason children in our care die - apart from malaria, the usual cause of children’s deaths in tropical regions. I’ve seen children sick with pneumonia in places where we work as far apart as displacement camps in Nigeria to tent cities in Syria and refugee encampments in Greece – in so many different contexts – but in all those places, pneumonia is the common killer of children under five years old.
Why is pneumonia such a threat to children’s lives?
The problem is that pneumonia is a common complication for a lot of other diseases affecting children, for instance measles. So, babies with measles will not die because of measles, they will die because of pneumonia. In such complicated cases, even if you have the treatment available for pneumonia, sometimes it’s too little, too late to save the child’s life.
Why are the children and communities we serve particularly vulnerable?
For many of our patients for instance in conflict zones, it’s often a major challenge just getting to a place where any medical treatment is offered. I’ve seen families who have walked for hours and hours with their child to get to a health centre that is functional. Sometimes they have to cross security checkpoints, or they have to wait for a bombing raid to stop, to journey to the health centre.
Describe some of the challenging situations you’ve worked in that make kids in our care very vulnerable to respiratory infections such as pneumonia.
I worked in the camps for displaced people in Syria. Syria is a very cold country in winter: it can be minus-5, minus-6 degrees. You can have snow and the snow will last for weeks, and people are living in tents—plastic tents, without a heater. So, my team and myself, we have seen children arriving in cardiac arrest because of hypothermia. So, imagine what the effect of these environmental conditions is on the spread of respiratory infections among children.
By contrast, when I was working in Central African Republic, our team had to negotiate with local armed forces to access a group of displaced people who had been cut off completely by the conflict for two years—they couldn’t go out of their area, and no one could go in. So, we had to negotiate to be able to put a medical team in there. The families, even if they wanted to get the vaccine to protect their kids, they could not, because they could not get through the military checkpoints to access medical care.
It’s best therefore to protect children before they fall ill, with the pneumonia vaccine wherever possible. Where is MSF using the pneumonia vaccine today?
We try to use the vaccine in all the places where we work, especially in humanitarian crises, refugee or internal displaced population camps. In the last three years, we have vaccinated children with the vaccine in Nigeria, South Sudan, Ethiopia, Central African Republic, Syria and in the refugee camps in Greece.
After we campaigned to get a lower price, MSF is now able to buy this vaccine at a lower ‘humanitarian’ price, but that lower price is not available for all governments, is it?
No—you’re right. In countries classified as ‘middle income’ countries, there is no discount on prices and the vaccine is largely unaffordable. For instance in Syria, the government can’t afford the vaccine for its population and the vaccine is only available in the places where MSF is working. In Jordan, too, the government has tried to negotiate a lower price with the companies but without success so far. And children are dying there as a result.
So many children are going without the protection of the pneumonia vaccine around the world? How do you as a medical professional feel about that?
When you work with children, you will see children die. You accept this. There are things that we cannot change … we don’t always have a solution. But when the disease is preventable by a vaccine and we cannot vaccinate children because we cannot pay for the vaccine, or the government cannot pay for the vaccine, I feel angry.
Gavi - the Vaccine Alliance – is currently giving an additional subsidy to the two big pharma vaccine manufacturers – GSK and Pfizer – on top of the price they pay these multinational corporations for the vaccine. With a new vaccine manufacturer expected to enter the market soon, what’s your message to Gavi?
Well, first, I’d thank Gavi, because they have dedicated a lot of resources and efforts to introduce this vaccine to places where it’s really needed.
But now it’s time for Gavi to invest donors’ money to buy the forthcoming new product so many more children’s lives can be saved. The pneumonia vaccines available now to Gavi – the Pfizer and GSK vaccines – eat up 40% of Gavi’s budget!!
With more affordable products, not only will governments in middle-income countries be able to offer the pneumonia vaccine to their kids, but also Gavi could buy more pneumonia vaccines for countries it is supporting, or use the money to buy other lifesaving vaccines.
MSF is working to ensure affordable access the pneumonia vaccine for all children in developing countries.
Read our Press Release "US$262 million subsidy should not go to pharma giants Pfizer and GSK for pneumococcal vaccine"