A watershed

With the beginning of the 1990s has come new hope that the age of neglect may be giving way to the age of concern.

The evidence for this new hope, amid all the seismic shifts in the political and economic landscape of recent years, is a series of quieter changes which have not made the nightly news but which have affected the daily lives of many millions of people.

The first of these changes is the entirely new priority that has been given to the task of immunizing the world's children. For a decade, national health services, UNICEF, the World Health Organization (WHO) and many thousands of individuals and organizations have struggled towards the goal of 80% immunization coverage in the developing world. In 1990, that goal was reached. The result is the saving of over 3 million children's lives each year, and the protection of many millions more from malnutrition, disease, and disability.

The significance of this achievement goes beyond these extraordinary statistics. Eighty per cent immunization means that approximately 100 million children are being reached by a modern medical technique on four or five separate occasions during their first year of life. As a logistical achievement, it is unprecedented; and it shows beyond any doubt that the outreach capacity now exists to put the basic benefits of scientific progress at the disposal of the vast majority of the world's poor. Secondly, it demonstrates that progress can now be made towards basic social goals even by the poorest of developing countries. Over the last five years, immunization coverage has been lifted dramatically in many nations with per capita incomes of less than $500 a year.

Other advances in knowledge and technique are now lining up outside the door that immunization has unlocked. And the potential remains enormous. Thirty-five thousand children under five die in the developing world every day. Almost 60% of those deaths, and much of the world's illness and malnutrition, are caused by just three diseases - pneumonia, diarrhoea and measles - all of which can now be prevented or treated by means which are tried and tested, available and affordable.

Similarly, the vitamin A deficiency which threatens up to 10 million of the world's children with death, serious illness, and loss of eyesight, could now be brought under control at a cost which is negligible in relation to the benefits it would bring.

Or to take another example, the iodine deficiencies that lower the mental and physical abilities of up to a billion people and are the world's single biggest cause of mental retardation could also now be eliminated at a total cost of approximately $100 million - less than the cost of two modern fighter planes.

Even those aspects of poverty which have traditionally been considered the most expensive and the most logistically stubborn - the lack of adequate nutrition, safe water supply, and basic education - are also now becoming susceptible to a combination of new technologies, falling costs, and community-based strategies. The cost of providing clean water in Africa, for example, has been halved since the mid-1980s and now stands at an average figure of about $20 per person per year. Similarly, countries such as Bangladesh and Colombia have demonstrated that a basic, relevant education can be provided at a cost of approximately $20 per child per year. Equally large scale trials in Africa and in India have shown that the incidence of child malnutrition can also now be halved at a cost of less than $10 per child per year.