Immunizations climb, then falter.

• Author: Kane, Hal
• Position: World immunization levels

A dramatic worldwide push that began in the mid-1980s has succeeded in extending immunizations to four of every five infants. Immunization rates that were only about 25 percent in the 1980s rose in a decade to 80 percent. By the end of 1990, vaccines administered under the United Nations Expanded Programme for Immunizations--protecting against tuberculosis, tetanus, diphtheria, pertussis, measles, and polio--had dramatically reduced illness from diseases that accounted for about 16 percent of all child deaths. The push to reach the 1990 goal led to a slight relaxation of efforts, however, and a falloff in 1991.

Although such a fall had been anticipated, it was fortunately smaller than expected for the developing world, at about 3 percent. In 101 developing countries, immunization levels were maintained or increased in 1991, and in 28 countries they fell. Asia had little or no falloff, as did the Middle East and North Africa. Most of the Americas remained stable, though rates dropped in Brazil and Venezuela. But sub-Saharan Africa's immunization rates fell about 10 percent in 1991.

In 1992, rates remained about constant, except the rate for the vaccine given to pregnant women to protect infants from tetanus, which fell. All vaccination rates are expected to rise again during the 1990s.

Vaccines are now delivered to 100 million infants on four or five separate occasions each year. They saved 3 million lives in 1992, and further extension of the service could have saved another 1.7 million.

The cost of fully immunizing a child in low-income countries ranges from $6 to more than $20, with an average of about $15. Today, it requires five visits to a clinic, but the development of vaccines that cover all major diseases in just one visit, if successful, could cut costs by as much as 70 percent. Total annual costs are $2.2 to $2.4 billion for the Expanded Programme on Immunization, less than 2 percent of the public health expenditure of developing countries.

The payoffs are difficult to tally, since they largely take the form of avoided health care costs and expanded productive potential of people. The measles vaccine alone cut death rates from about 2.5 million a year in 1980 to less than 900,000 in 1990, and nonfatal measles episodes from about 75 million a year to 25 million. The...