Transforming global health for children

Pneumonia is the biggest reason why children die globally, and the pneumococcal conjugate vaccine can prevent that. For children in the poorest countries that are most at risk, however, the vaccine may be inaccessible or simply too expensive.

child in hospital

Image: Hans Kaufman

Professor Fiona Russell, paediatrician, epidemiologist and translational researcher in the Department of Paediatrics and at the Murdoch Children’s Research Institute, is dedicated to transforming global child health with her work on the use of the pneumococcal conjugate vaccine in the poorest countries in the region.

“It’s very challenging in poorer countries to measure impact – whether it’s through a lack of recording of cases, missing data or medical records. A lot of countries want to introduce it, they haven’t got a documented disease burden, they haven’t done the health economics, and it requires a large investment to introduce a new vaccine even if it’s cost-effective.”

Seven years ago, the World Health Organisation (WHO) asked Professor Russell to go to Laos, a country with one of the highest burdens of child mortality in the region. The Lao government was interested in an assessment on the introduction of the vaccine so it could show its value in reducing child mortality in the future.

Fiona’s team established a surveillance study in a single hospital to demonstrate how effective the vaccine was in reducing pneumonia that requires oxygen. Low oxygen levels are the main complication of pneumonia that leads to mortality. Her team developed a novel method of analysis and found the vaccine reduced hypoxic pneumonia by 35 per cent.

“Oxygen is expensive and 30 per cent of the population in Laos live on a $1 a day and oxygen might cost $10 or more a day. These costs are enormous for people to treat their children and it’s not uncommon for parents to have to make a decision to either take their child home to die, or borrow money and create a debt, plunging the household into further poverty.”’s not uncommon for parents to have to make a decision to either take their child home to die, or borrow money and create a debt, plunging the household into further poverty

Professor Russell’s team have since conducted similar studies in Mongolia and Papua New Guinea, utilising these direct, simple and low-cost methods to show the health impact of the pneumococcal conjugate vaccine, published in The Lancet Western Pacific in September.

Her research has also extended into measuring indirect effects associated with the vaccine. International research priorities for the pneumococcal conjugate vaccine include establishing whether three doses, the standard schedule for most countries, are needed. The success of a reduced two-dose schedule, however, is reliant on herd protection being generated.

“We are developing methods to measure herd immunity to guide countries on when they could remove a dose from the schedule. Hopefully we can come up with a metric and demonstrate, for example, if 50 per cent coverage is achieved, then an indirect effect is likely.”

Fiona is also working on a clinical trial in Fiji to reduce maternal infant infections. Women in labour are randomised to receive a single dose of a broad-spectrum antibiotic to look at its impact on bacteria likely to cause meningitis and other severe, invasive infections. “In the absence of vaccinations, we are looking at the impact on the mother and baby with an oral antibiotic that is cheap and cost-effective and might transform infant mortality.”

- By Tanya Bradford

Professor Russell is Deputy Chair of the Australian Regional Immunisation Alliance and will take a leading role in providing support to maintain immunisation services and technical input into COVID-19 vaccine implementation in the Pacific. She also leads the public health and epidemiology component of a WHO review on pneumonia treatment and management in low and middle-income countries.