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ACCRA (Reuters) - When Odei Antwi-Agyei had the chance of introducing vaccines to prevent Ghana's children dying of diarrhea, or vaccines to stop them dying of pneumonia, he did what no African immunization chief has done before. He said he'd do both at the same time.
The logistics of such a plan are enormous even in a relatively small country of 24 million people.
Just keeping the stockpiles of vaccines cool is tough in a tropical nation where average daytime temperatures are 30 degrees Celsius and rural electricity supplies are not reliable.
Then there are the training programs for tens of thousands of healthcare workers, the bottom-up public awareness campaigns taken to outreach centers in rural villages, and the upgrading and reissuing of millions of child health record cards.
But as the manager of Ghana's Expanded Programme on Immunisation faced with stubbornly high child mortality rates, Antwi-Agyei says he had no time for defeatism.
"We looked at our mortality and saw that some of our highest causes of death are from vaccine preventable diseases. Pneumonia and diarrhea are killing our children," he told Reuters.
"This calls for business unusual. Business as usual is not enough. We have to do things differently."
In 2008, the last year for which full data are available, more than 54,000 Ghanian children died before they had reached their fifth birthday. Public health officials say 20 percent of those deaths were from pneumonia and diarrhea.
So this year, starting this week, Ghana will vaccinate the first babies in a new campaign against rotavirus - a cause of severe diarrhea - and pneumococcal disease, which causes pneumonia, meningitis and sepsis.
The vaccines - oral rotavirus shots made by GlaxoSmithKline (GSK), and Merck, and pneumococcal shots made by GSK and Pfizer, are in large part funded by the Global Alliance for Vaccines and Immunisation (GAVI), a donor-backed group that funds bulk-buy vaccination programs for poorer nations that cannot afford to pay developed-economy prices.
Emma Agbesi paid the highest price of all with her child. The 25-year-old's second son - a "beautiful, fat, fair baby" as she describes him - died two years ago after failing to fight off the pneumonia that took over his lungs.
Isaac was five months old when he became very sick. "He had a fever and he couldn't breathe properly. There was a lot of noise when he was breathing, and it was very short and fast," she remembers.
With Isaac's temperature rising and his lungs struggling, staff at the local health clinic told the mother to take him to the hospital - a 45 minute taxi drive away over the rough roads and red earth of the mango-growing district where she lives.
Doctors there did their best, but it was too late, Agbesi said. "When he died, it was so painful. The pain is very bad. He was a beautiful boy."
At the Princess Marie Louise Children's hospital in Accra, doctors say such heartbreaking tales are common.
"Last month in our emergency room, 75 percent of the deaths were from diarrheal diseases and respiratory infections like pneumonia," said Eric Sifah, medical superintendent at the 74-bed hospital. "In one month we could have 30 deaths from diarrhea and at least one a day from pneumonia."
Little doubt, then, about why Antwi-Agyei was not prepared to choose one vaccine before the other.
Seth Berkley, GAVI's chief executive, who is visiting Ghana for the launch of the new vaccines, is impressed and a little concerned about Anti-Agyei's decision.
"The introduction of just one vaccine alone would imply an immense workload of financial planning, medical training and upgrading a complex logistical system," he said. "With a double launch, Ghana's health officials are feeling twice the heat."
But, he notes, Ghanaian health officials' ambitions are also based on some cool, calm calculations.
Rotavirus, a disease that causes gastroenteritis — an inflammation of the stomach and intestines - can lead to severe dehydration and death in children most vulnerable to infection, those between six months and two years old.
Treating rotavirus diarrhea among Ghana's children costs an estimated $3.2 million a year, but a recent study found that giving rotavirus shots to children under five would be highly cost-effective, saving the country $1.7 million in treatment costs and 1,554 children's lives every year.
While the immediate benefits of vaccinating children against these killers are clear in terms of saving lives and reducing disease, Ghana is also looking at long-term pay-back. Evidence suggests the value of vaccines goes beyond just health benefits.
Healthier children are far more likely to attend school regularly, and studies show they also learn more effectively.
They are also more likely to be economically productive. Experts say a one year increase in life expectancy increases labour productivity by around 4 percent.
Orin Levine, director of the International Vaccine Access Center (IVAC) at the Johns Hopkins School of Public Health in United States, has no doubt diarrhea and pneumonia are the most important diseases for Ghana to tackle to bring down child deaths and says it will see huge social and economic returns.
"We estimate that if they scale up the coverage of pneumonia and diarrhea vaccines over this decade, they'll prevent more than 14,000 child deaths and 1.4 million cases of meningitis, pneumonia and diarrhea," he told Reuters.
And those prevented deaths, as well as prevented costly cases of disease, will have economic benefits which IVAC expects to be almost $320 million in total by 2020.
"Ghana's best resource for the future is its people. So having them healthier, better educated and more productive, is the surest way for Ghana to develop and make itself more successful," Levine said.
Viewed on an individual level, a GAVI-led study has found that reduced death rates brought about from full immunization can lead to an increase of between 12.4 and 18 percent in future annual income for adults.
For mothers like Abigail Kokote, that will make all the difference. She works in the market near her home village of Ayikuma in the Dodowe district near Accra and knows that when her children are sick she can't go to work, making it even more difficult for her to afford the medicines they need.
Her new baby, Jonathan, is 10 weeks old and has just become on the first infants in the country to be fully immunized against pneumococcal and rotavirus as well as having the routine pentavalent, polio and yellow fever shots already included in Ghana's child vaccination program.
"Now I know he will grow up to be big and strong. He will be healthy and he will learn well at school. Maybe he will become a politician, even a future leader," she laughs.
The similar aspirations of Sophia Ashiabi, a 21-year-old mother cradling her baby at the vaccination and weigh-in outreach unit in Ayikuma, reflect the findings of a 2011 study by researchers at the U.S. Harvard School of Public Health who found that vaccinated children have better cognitive development and significantly higher language and IQ test scores.
"Children who have had vaccinations don't have to miss school like ones who are sick very often," Ashiabi said.
Her one-week old son is yet to be named, but she says she'd like to call him Kweku - which means "Wednesday", the day he was born - and she will bring him back to the clinic in a few months when he's old enough to be immunized.
"Vaccination will give him strength and open his mind," Ashiabi said. "He will be bright in school and grow up to be a very important person."
Reporting by Kate Kelland; editing by Elizabeth Piper