WHAT'S NEW THIS THURSDAY: CONNECTING THE DOTS BETWEEN VACCINES AND HUNGER

Monday, 18th of March 2013

· CONNECTING THE DOTS BETWEEN VACCINES AND HUNGER

Also at http://www.guardian.co.uk/global-development-professionals-network/2013/mar/15/comic-relief-vaccines-malnutrition-gavi-alliance

Comic Relief started as a response to the 1984 famine in Ethiopia. Any solution to the persisting problem of global hunger must factor in immunisation

On Red Nose Day, we are reminded of the famine in Ethiopia that triggered the first Comic Relief, over 25 years ago. And as we reflect, we now know that the link between malnutrition and infectious disease makes for a particularly vicious circle.

A lack of nutrients can weaken the immune system, making it more vulnerable to infections and leading to diarrhoeal symptoms that inhibit the body's ability to absorb nourishment. And this also works both ways, enabling infectious diseases to tip a child suffering from marginal nutrition into a state of malnourishment. For as many as 250 million children under the age of five this cycle is a reality and one which dramatically increases their risk of stunted growth, blindness and other forms of illness.

While there is now general agreement that tackling hunger and its causes is one of the most pressing development challenges, there is still little consensus on how best to achieve this. What's more the role that immunisation has to play in breaking the infectious disease-malnutrition cycle seems largely overlooked.

For example, at last year's Olympic Hunger Summit, the British government vowed to bring about a 25 million worldwide reduction in the number of children left stunted by malnourishment before the Rio de Janeiro Olympics in 2016. To do this, they propose the development of drought resistant and nutrient-rich crops. Similarly, through its Purchase for Progress scheme, the UN World Food Programme is looking at providing resources to African farmers to grow nutrient-rich beans for emergency food relief.

Another approach being taken by the Scaling Up Nutrition programme – a global movement led mainly by developing countries – argues that quality is as important as quantity, that nutritional value is as important as addressing raw hunger. Others, like the "If" anti-hunger coalition are calling for more radical change, with a focus on some of the underlying causes of malnutrition such as the use of land for fuel instead of food and tax avoidance schemes for businesses in developing countries.

What none of these campaigns pick up on is the growing body of evidence suggesting the need to complement any fight against malnutrition with a fight against infectious disease. We know, for example, that vitamin A is essential for a healthy, functioning immune system and that children aged under two are less likely to die from measles when given vitamin A supplements.

In addition, malnutrition is a risk factor for pneumonia and diarrhoea, which are both known to impair the growth of children. Findings in Brazil demonstrate a bi-directional relationship between nutritional status and the duration of diarrhoeal illness – where a loss of zinc through diarrhoea can leave a child prone to further infection, prolonging the diarrhoea and further reducing their nutritional intake.

One way to avoid this is to vaccinate against measles and rotavirus, which can collectively protect children from some of the most common causes of diarrhoea.Rotavirus alone is the leading cause of diarrhoea-related death in children under five, claiming 450,000 lives every year.

In addition to preventing deaths, evidence is now emerging to show that vaccines can help prevent some of the chronic consequences of malnourishment. A study published last year in the Journal of Public Health showed that children in India with up-to-date vaccines against tuberculosis, diphtheria, tetanus, pertussis, measles and polio, were less likely to show signs of stunting. Similarly, vaccinating pregnant women against influenza has been found to reduce fetal growth retardation.

Recognising the links between a healthy immune system and a lack of nutrition, the World Health Organization (WHO) and Unicef have, since 1987, advocated that vitamin A supplements be given at the same time as the measles vaccine. Reiterating the importance of a joined-up approach, a report published last month by the World Bank concluded that Millennium Development Goals 1, 4 and 5 – to eradicate poverty and hunger, reduce child mortality and improve maternal health – will not be reached if the issue of malnutrition is not addressed.

The sector best placed to deliver most of the nutrition interventions needed to make sure this happens is the health sector, and not the agriculture sector.

The GAVI Alliance has immunised 370 million of the world's poorest children since 2000 through its efforts to improve access to vaccines in developing countries. However, with the global population projected toexceed nine billion by 2050, the challenge we all face in feeding everyone is unprecedented.

As the UK prepares to host this summer's G8 meeting at Lough Erne in Northern Ireland, malnutrition is already set to be high on the agenda. Let's just hope that immunisation is part of the equation.

Seth Berkley is CEO of the GAVI Alliance. He tweets as @GAVISeth