Monday, May 23, 2011

Mix Vaccine With Contaminated Water and Swallow

I've ceased to expect much from the English Guardian on the subject of development now that their development section is "in partnership with the Bill and Melinda Gates Foundation". But a recent blog post from the section takes pretty much the opposite stance to that of the Gates Politbureau when it comes to the question of basic water, sanitation and hygiene over vaccination.

The Gates publicity machine tends to gush about vaccines, about how they are the future of health and development, about how they are investing $10 billion in them, advocating for a 'decade of vaccines', etc. This flies in the face of public health experience over many decades. For Gates, public health means giving people some drugs and letting them swallow them with contaminated water.

But according to the Guardian article, the World Health Organization estimates that 10% of global disease could be prevented through the provision of safe water, sanitation and hygiene facilities. That estimate sounds rather low, especially for infant and childhood diseases. But at least it is recongized that conditions such as cholera and guinea worm can not be eradicated without providing people with the basics.

Gates, on the other hand, wishes to sink much of his Foundation's money into a vaccine for cholera and polio, with only dribs and drabs going to WASH. And it's not just the Foundation's money that is involved here. It seems that when the Foundation makes a pronouncement about anything, regardless of its serious lack of understanding of the issues, global policy does likewise.

The massive cholera epidemic currently raging in Haiti is a result of a lack of water, sanitation and hygiene services in the country. This lack is not purely a result of some recent disasters, either. The country has been left dangerously underdeveloped as a result of numerous factors, many of them political. Even if a vaccine was available, people would be unlikely to have received it in Haiti and they would likely have been infected with many of the other water borne diseases that are as debilitating and deadly as cholera.

The author of the Guardian article, Yael Velleman, is a policy analyst at WaterAid. The article also calls for closer cooperation between government departments responsible for health, on the one hand, and water, sanitation and hygiene, on the other. This means that donors and those working in development need to connect these two development themes and recognize that they are interdependent.

So, yes to vaccines and other medical technologies. But without better living conditions, they will make little or no difference to people's lives. WASH must come first because without it vaccines will be useless. If you don't believe me, carry out this quick thought experiment: mix vaccine with water drawn from the nearest source of contaminated water and swallow.

These are excellent and sobering insights from WaterAid and Yael Velleman, in particular. There is more on the above issues on their website, including some clarification of the Gates Foundation's stance on immunization and how inimical it is to development (my words, not hers!). The issue is covered in pictures in another Guardian article.


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