Childhood survival rates improve, but growing pains remain

In KwaZulu-Natal, one of South Africa’s most heavily HIV-burdened provinces, 37 percent of expectant mothers are living with HIV. But for the province’s HIV-positive mothers like Zanele, who gave birth to her baby Sabelo last year, treatment for prevention of mother-to-child transmission (PMTCT) is preventing many newborns from contracting the virus. All four of Zanele’s children are HIV-free, in fact, because she received antiretroviral (ARV) treatments through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Exceptional PMTCT gains have been made in recent years. 2.4 million HIV-positive pregnant women have received ARV treatments worldwide. These treatments averted 850,000 new infections among children between 2005 and 2012. In 2012, an unprecedented 62 percent of pregnant women living with HIV in the highest-burden countries received PMTCT services.

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Even better, the successful PMTCT effort is just a part of an unparalleled reduction in child deaths from many diseases globally, including malaria, pneumonia, diarrhea, measles, polio and neglected tropical diseases. Six million fewer young children will die this year than in 1990, when an unimaginable 12.6 million children worldwide —more than 34,000 a day — died before reaching their fifth birthday. Such exceptional gains in child survival over the last 25 years would not have been possible without the U.S. government, the largest single donor to global health.

America’s legacy in child survival efforts is strong, thanks to the unfaltering, bipartisan support of recent presidential administrations and Congress. This support has enabled the crucial work of federal agencies and initiatives like the U.S. Agency for International Development (USAID), the Centers for Disease Control (CDC), the Millennium Challenge Corporation (MCC), the President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI), and multilateral institutions like the GAVI Alliance, the World Health Organization (WHO) and UNICEF.

The Global Fund, to which the U.S. government is the largest contributor, is also deeply committed to child survival efforts. As of 2012, the Global Fund has channeled approximately $6.6 billion toward improvements in maternal and child health, with an additional $3.3 billion scheduled to be disbursed toward these efforts in the next few years. In addition to providing PMTCT treatments to mothers like Zanele, Global Fund-supported programs have delivered 6.9 million basic care and support services to orphans and other vulnerable children, distributed 360 million insecticide-treated nets, and treated 330 million cases of malaria — a disease to which children under age 5 are especially susceptible.

The Global Fund also has a longstanding partnership with UNICEF; a partnership that was reinforced recently through an April 2014 agreement to integrate investments in lifesaving commodities for higher public health impact. The Global Fund and UNICEF agreed to jointly identify countries where investments in commodities to prevent and treat HIV, tuberculosis and malaria could be better coordinated with those designed to improve overall maternal, newborn and child health. To start, such commodities could include iron and folic acid, tetanus vaccinations, syphilis screening and treatment for pregnant women, antibiotics to treat pneumonia, and oral rehydration salts and zinc to treat diarrheal disease in children.

There is much more work to be done to end preventable child deaths around the world. We have yet to reach the United Nations’ Millennium Development Goal (MDG) 4, which aims to reduce the under-5 mortality rate by two-thirds between 1990 and 2015. Children in sub-Saharan Africa are on average 15 times more likely to die before the age of 5 than children in developed regions. Malaria killed an estimated 482,000 children under age 5 in 2012 — one child almost every minute.

At the same time, we have unprecedented opportunities in front of us to end unnecessary child deaths. Experts can foresee a time when no child will be born with the HIV virus. The map on malaria is shrinking. And as we near the 2015 deadline for the MDGs, the U.S. government and global health community remain deeply committed to making sure the world’s children see many more birthdays.

On June 25, U.S. government leaders will join with NGOs, the private sector, faith-based organizations and foundations on Capitol Hill to reflect on what has been achieved in the last quarter century and, more importantly, recommit to accelerated progress in child survival in the years to come.  Please join me in applauding the U.S. government, the Global Fund and many more partners in their efforts to blow the candles out on under-5 mortality and end preventable child deaths once and for all.

Derrick is the president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, an advocacy organization dedicated to sustaining and expanding U.S. support for the Global Fund. A global health thought leader with nearly two decades of policy and international development experience, Derrick previously served as a senior program officer at the Bill & Melinda Gates Foundation.