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Health: Power of the Needle


Since its brutal civil war ended a decade ago, Mozambique has made enormous economic progress. It now boasts rising foreign investment and economic growth that has averaged 7.5% for the past 11 years. Some of the African nation's new prosperity can be seen in the medical clinic at Manhica, where well-dressed women wait to vaccinate their plump children.

But in another ward not far away the sight is horrific. There, 15 malnourished babies with bulging eyes and protruding stomachs lie on beds covered with frayed green blankets donated by a U.S. charity. Gaunt parents sit at their sides. A doctor checks the chart of one child showing she is losing weight--a sign she probably has AIDS. During the rainy season that begins in November, doctors say, up to 100 malaria victims a day will crowd the free clinic; most will have to sleep on the floor.

The health crisis among the poor is a big reason why, despite its gains, Mozambique remains one of the most miserable lands on earth. One in five children dies before age 5. Average life expectancy is 39 years. Big killers include preventable or treatable diseases like malaria, measles, and cholera. Some 20% of adults have hepatitis B; 13% have the HIV virus. With per capita income of $210 a year, even with foreign aid Mozambique spends just $10 per person each year for health care.

Turning the crisis around will take many years. But there is reason for hope. A coalition called the Global Alliance for Vaccines & Immunization (GAVI) is funding an aggressive program to immunize Mozambique's children against a host of diseases for which cheap vaccines already exist. If successful, GAVI, which works with 53 countries and is backed by $750 million from the Bill & Melinda Gates Foundation, could serve as a new model for managing aid to fight diseases such as AIDS.

The strategy: Instead of a gaggle of foreign donors wastefully running their own immunization efforts as in the past, GAVI wants recipient countries to take the initiative and manage their own program. The World Bank, UNICEF, the U.S. Agency for International Development, and the World Health Organization belong to the alliance. GAVI pays for vaccines, then monitors progress. It vows to cut funds for countries that don't do enough to meet targets. In Mozambique, GAVI's aid has been especially helpful in bringing in hepatitis-B vaccine, which costs $15 per treatment. "We could have prevented many children from contracting hepatitis, but we couldn't afford to import it," says Prime Minister Pascoal M. Mocumbi. "GAVI is making a very important contribution."

Mozambique's commitment to upgrading health care is a big reason GAVI rolled out its program there. In the late 1990s, the government developed a comprehensive antipoverty strategy. Using World Bank funds, it is training thousands of nurses and technicians, and has repaired 1,000 health clinics damaged by civil war and floods. It is building 50 new clinics a year and buying cold-storage units needed to keep vaccines from spoiling.

Health officials hope the investment made for the immunization program will make it easier for Mozambique to attack diseases such as malaria and AIDS if and when vaccines are developed. In most of Africa, the chief obstacle to fighting AIDS isn't the price of medicines. It's the lack of modern clinics and trained staff. "If we had an AIDS vaccine today and the money we needed to buy it, we'd be hard-pressed to do anything with it because of the bad infrastructure," says Dr. Gordon Perkins, manager of diagnostic research and development in tropical disease for the Gates Foundation.

GAVI also has a strategy to speed development of drugs for diseases that afflict poor nations. If pharmaceutical companies produce effective vaccines, GAVI's Vaccine Fund promises to buy sufficient quantities to make the effort profitable. So far, GlaxoSmithKline PLC (GSK) has joined the hunt for a new malaria vaccine. If this approach to foreign aid works, it could mark the beginning of dramatic progress in the war against diseases crippling the developing world. By Jonathan Katzenellenbogen in Manhica, Mozambique, and Pete Engardio in New York


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