Vaccination affects us all, and in World Immunization Week 2015 (April 24 – 30), the World Health Organization (WHO) is calling on everyone, from policy-makers and health professionals to community-based initiatives and the private sector, to raise awareness about the importance of immunization and mobilize their collective resources and creativity to close the immunization gap. By keeping deadly and mutilating communicable diseases in check, vaccines are — and will remain essential to maintaining and expanding health gains. Vaccines are an important tool in tackling future outbreaks and epidemics.
This year, the theme of World Immunization week is “Close the immunization gap”: the gap between the 1 in 5 children who still do not receive basic life-saving vaccines, as well as to the gaps in progress towards the targets set by the Global Vaccine Action Plan (GVAP). The GVAP envisions a world where everyone lives life free from vaccine preventable diseases – whoever they are, wherever they live – by 2020.
The GVAP aims to:
- strengthen routine immunization to meet vaccination coverage targets;
- accelerate control of vaccine-preventable diseases with polio eradication as the first milestone;
- introduce new and improved vaccines; and
- spur research and development for the next generation of vaccines and technologies.
According to the most recent WHO estimate, 1.5 million children die every year of diseases that could be readily prevented by vaccines that already exist. In 2013, nearly 22 million infants missed out on the essential diphtheria-tetanus-pertussis vaccine (DTP3), many of them living in the world’s poorest and most vulnerable communities.
There are three steps to closing the immunization gap:
1. Integrate immunization with other health services
2. Strengthen health systems to improve vaccine delivery to reach every last child
3. Ensure vaccines are both accessible and affordable to all
While the global theme this year focuses on closing the immunization gap and reaching equity in immunization levels as outlined in the GVAP, the Western Pacific Region goes a step further to commit that this endeavor of protecting the communities through vaccination is everyone’s job.
Vaccination is very essential to our lives, especially as a baby. In our first year or so of life, we are very susceptible to infections and diseases. As expressed in this article, current vaccination rates have been falling due to unimmunized children and blame the media for being a big factor in spreading myths about vaccines to parents. Our body that young does not have the ability to form polysaccharides to protect us from foreign invaders. By vaccinating your child, the vaccine is able to place a toxoid protein on the polysaccharide of a B cell for example, takes it in, and breaks down the components. A peptide of the toxoid gets expressed on the MHC class II molecule allowing it to bind to the TCR of the T helper cell. This helps trick the immune system into forming anti-polysaccharide antibodies, neutralized antibodies. These then in return cover the pathogen and protect the baby from that invader from doing any future harm.
Global vaccination efforts will only see success if herd immunity can be established in low-income, under-vaccinated countries. The cultivation of herd immunity has several obstacles, including the excessive cost of vaccines and the high non-vaccinated population density.
The cost of vaccines has sky-rocketed over the past decade; an article discussing this issue states that, in countries supported by the GAVI Vaccine Alliance, the vaccination cost in 2013 was $39 per child. While this price may seem minuscule to many in the United States, it is an extraordinary expense to these countries that have such high rates of poverty and large populations.
As stated in an article published in the American Journal of Public Health, the countries with the highest prevalence of preventable diseases are some of the poorest countries on Earth. Childhood clinical pneumonia is an example of a preventable disease which is endemic in many poverty-stricken areas of the world. According to the World Health Organization, the incidences of vaccine-preventable pneumonia are highest in south and central Africa and parts of south Asia. These developing countries also happen to be some of the most populated. The populations listed in the CIA’s World Factbook indicate that these low-income countries with endemic pneumonia comprise over one-third of the world’s total population. As these regions are densely populated, crowding is a large contributor to the spread of pneumonia and other vaccine-preventable diseases. Due to high costs and demand in these areas, many children never receive vaccination; therefore, herd immunity against vaccine-preventable diseases is practically non-existent in these countries. Herd immunity is the mechanism which protects many unvaccinated children in developed countries where vaccines are readily available and routinely utilized. This process occurs when a significant portion of a community has been vaccinated; therefore, any unvaccinated children are protected from disease since they are primarily surrounded by those that have undergone vaccination. The key factor in ensuring the success of global vaccination efforts is the establishment of herd immunity in these poverty-stricken and densely populated countries.
In 2000, measles was considered to be wiped out within the US, but recently it is making a comeback due to decreased numbers of vaccinated children. This example alone is powerful in conveying the importance of providing vaccinations to children everywhere, especially in the world’s poorest and most vulnerable communities. However, in addition to the current aims the GVAP should also initiate educational programs that encourage those who already can afford to immunize their children to do so. Otherwise, even with the improved technology and decreased costs the herd immunity that encourages protection from infectious diseases such as measles or polio will never truly be reached and in turn eradication of these diseases will never truly occur. Only if both aims to decrease vaccination costs and increase vaccination education among the entire public are reached can the ultimate goal of disease eradication be accomplished. Otherwise, the GVAP’s efforts may be wasted.
GVAP’s mission to immunize every child is very noble that faces a lot of obstacles that may be insurmountable. One of this global mission’s biggest obstacle involves overcoming unfavorable cultural beliefs. In some of these undeveloped countries there’s a deep distrust of modern medicine and deep faith in traditional healers; this was evident during the Ebola outbreak in West Africa which was traced back to traditional healer in Sierra Leone who spread the disease because people believed she had the power to cure it. The main solution to this problem is education, GVAP needs to spend some of its resources to dismantle the myths that people believe about immunizations and teach people that the risks of not being vaccinated outweigh the risks of getting the necessary vaccines. The GVAP should also spend some of its resources on developing alternatives to the traditional syringe to reduce vaccination costs and increase efficiency.
Although the video and article focused on the immunization gap in poor countries, I think that the importance of vaccination needs to be reiterated to developing nations. Recently there has been a surge of old diseases like whooping cough and measles due to the misinformation spread and people deciding to no longer vaccinate their children. I think many people misunderstand the importance of herd immunity due to a lack of education and fear mongering. Along with researching methods for creating more cost effective vaccines, research needs to be done like in this article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659827/) on how to present the data on vaccines to the general public that is easy to understand and outlines how the benefits outweigh the potential risks of vaccinations. Making laws that mandate vaccination would also help but due to the many loopholes that can be used to get around that I think the most successful longterm plan would be removing more of the mystery and fear that surrounds vaccination.
I think this article, along with its supplementary video, make for a wonderful representation of how important and necessary vaccinations are. In particular, the video highlighted how early vaccinations can start, from the birth of a newborn child with the giving of a drop of vaccination serum! However, as many have noted, there are several issues, both cultural and financial, that stand in the way of making vaccines widespread and available to all. Although cultural barriers may be considered the toughest to cross and change, new information about the benefits of vaccines and importance of eliminating life threatening diseases we have cures for may speak loudest to families who have already suffered through the loss of a family member, and potentially with the help of those families, a new ad campaign can be done to help inform other frightened families that vaccines are a lifeline for disease prevention, not an avenue for problematic development or unnecessary as many already believe. Not only that, but as the GVAP highlighted, society should be trying to, “Integrate immunization with other health services”, potentially such as regular check ups or screenings for disease. In this way, doctors could professionally explain what vaccines are and their importance to families in a personal one on one environment, that could then lead to that family’s new acceptance of vaccination. In turn, this open family could now explain these benefits to those around them and help spread a greater understanding of vaccines in general based on the critical information shared to them by the doctors they themselves know and trust. Thus, a greater emphasis on healthcare providers having vaccination lessons and providing for vaccinations during other healthcare services should be made to coincide with the efforts of making vaccines a part of normal healthcare! This thought process then leads one to ask, even if families are open to vaccination because of better marketing and more active vaccine campaigns, there are still underprivileged populations that may never be able to afford the price vaccines have risen to. Although this may be true, the GVAP again highlight they wish to, “Ensure vaccines are both accessible and affordable to all”. This means that it is already understood that sadly vaccines have become a semi-luxury to those populations that cannot afford them and that a primary focus of vaccination developers should be to create new vaccines that aren’t extremely costly to make! Not only that, but to potentially create a way in which vaccines can be administered easier, allowing for large vaccinations to occur at once for a population in need that could be funded for by a specific program paid for by others that support vaccination. Such donations are actually viable, being that many in our society already understand how crucial vaccines are and would support programs that make the realization of, “Closing the Immunization Gap”, an actual reality!
I fully support and admire the aims of GVAP because it truly is tragic when children die from vaccine-preventable diseases (VPD). Vaccines are powerful in combating a variety of diseases all over the world. Protections of the children of third world countries are always a concern but something that I’ve noticed in the first world is an anti-vaccine trend. Media posts with false and misleading information about vaccines have been force fed to people via the many ways to access the internet. I personally have experienced statements from coworkers about their mistrust in the medical system and their intentions of denying vaccines to their children. They justified their claim by stating vaccines will cause autism. This movement is concerning because not only is this untrue but the ideology behind it can potentially cause damage to another human being and society. The hurdles for achieving the goal of GVAP may include but are not limited to peoples doubt in effectiveness and safety of vaccines, the promotion of homeopathic medicine, certain conspiracies, the idea of the intrusion of civil liberties and the thought that a deity does not support its usage. I hope that the ill informed will receive the necessary knowledge to increase awareness of the necessity of vaccines and immunity to ensure that the goals of this article are met by 2020.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693340/
http://www.sciencedirect.com/science/article/pii/S0031393912000042