International Observer

Editor's note: The thoughtful article by Dr. Andrus and his colleagues in describing the utility of the Pan American Health Organization's (PAHO's) ProVac model¹ reminds us of the startling childhood and adult disease statistics. Whether it is the 440,000 gastroenteritis annual deaths in children younger than age 5 or the 32,000 annual deaths from papillomavirus—with more than 80% in poor and developing countries—these numbers are staggering. Examples such as the experience in Mexico that was described by Santos et al.² show the ProVac model can work very well.

The authors suggest that three essential factors need to be addressed if agencies and governments are to attain a sustainable impact: decisions should be nationally based; evidence used to support the decisions must be broad-based; and infrastructure must be in place to support a nationally based process. The ProVac program objectives are rather aggressive, with just a five-year horizon to achieve a series of ambitious goals. At the same time, PAHO is honest: the organization recognizes it has little choice but to move in this direction. PAHO can serve as a model for the rest of the developing world. Lessons learned in the ProVac experience will serve many others well as they attempt a similar, if not more aggressive approach.