We want to take out the biggest problems strategically and continue the process with the next biggest problem OR, better yet, group them together and solve multiple problems at once. The Measles Campaign and IMCI function in this strategic and systematic way.

Addressing potable water, sanitation, rotavirus, rubella, pneumococcus, and diarrheal diseases comes next.

What is Next?

Right now Nets are the best solution to malaria, but progress is being made on vaccines. Click here to see the lastest report as a pdf.

Thinking systematically and strategically, once these problems are treated, what lynchpins remain? What are the future hurdles of success for Africa as a continent?

See the article on child survival in the Lancet for more information on what children all over the world are dying from and what preventative measures can save many of them.

Diarrheal Diseases
When a child suffers a bout of diarrhea, food is not absorbed into the system and is wasted. Reducing diarrheal disease will improve this. Multiple bouts of diarrhea can be fatal, particularly when they happen along with other diseases. A child that would survive diarrhea, or ever several bouts, may die when the diarrhea hits during a case of malaria, or vice versa. Reducing one disease lowers mortality from others.

Oral Rehydration Therapy (ORT) was introduced in 1979 and is now given to the majority of children with diarrhea. The annual number of death attributable to diarrhea in children under 5 has dropped from about 4.5 million in 1980 to 1.5 million today. Using the PolioPlus model, cost-effective interventions like ORT can be successfully delivered through national programs. Both the cause and the treatment can be addressed.

Rotavirus
Rotaviruses are universal. Rotaviruses cause diarrhea. The good news is that infection typically confers lifelong immunity. The bad news is that rotaviruses kill between 450,000 and 800,000 children per year, placing it among top infectious killers. With the decline in measles, rotaviruses move to 5th place. Only malaria and pneumococcus are deadlier for children.

"All humans are infected by the time they're 5 years old, …regardless of economic status." Remarked virologist H. Fred Clark of the children's hospital of Philadelphia. India suffers the most deaths from rotavirus. Significant numbers of deaths also occur in China, Southeast Asia, Africa and Latin America. The US loses only an estimated 50 children per year to rotavirus infections suffering a cost of a billion dollars or more in the process.

The other good news is that workable vaccines for rotavirus infections are on the way. The Chinese have a vaccination on the market, but the product is not universally accepted. Several American and European varieties are in Phase III testing, some with 75% or better positive results in earlier trials. Researchers expect workable vaccines by the end of 2005.

Additionally, Rubella vaccines exist. Vaccines for various subtypes of developing countries are under development.

Plus, Pneumonia (Pneumococcus) vaccines exist. Vaccines for various subtypes of developing countries are under development.

First, do no harm…
The key is to make vaccines safe for children to take. It is not necessary for a vaccine to work 100% of the time to be useful. It is better to confer immunity on some or a majority of those who take it than that they have no immunity at all. Rotaviruses are killers. Even saving half the children dying from rotavirus-related diseases would save nearly a 1000 children a day. Current vaccines achieve double that.

The typical path for vaccine development is to go from good to better to excellent over the course of several years. Additional research will make them better and better.

Rotaviruses are not only some of the biggest and deadliest diseases, but one of the hardest to crack. Rotavirus vaccine research started in the 1950's. Only in the last 20 years has science improved to the point where it could develop effective and safe vaccines. As with malaria, diversity of subtypes makes it even more wily a foe.

Yet with each new discovery and as each old disease is conquered, researchers can focus ever more talent, technology and insights on the remaining illnesses. It may not take another 50 years to knock off the rest of the childhood killers. Let's hope not.

Beyond Mass Vaccination
What can replace mass vaccination campaigns? Integrated Management of Childhood Diseases (IMCI). The initial results of the IMCI program indicate that childhood mortality can drop by 43% in children under five and 49% in infants up to age one. The results continue to improve suggesting a virtuous cycle where healthier people fend off disease better. Once healthcare systems are strengthened, local systems can deliver immunizations and treatments. Mass vaccination along with distribution of ITNs and other add-ons can help free up a system crushed by disease so that local communities can address their own disease burdens.