#vaccineswork
For health workers, the death of a child always strikes hard, but this tragedy is felt deepest when it's due to a disease that is readily preventable with a safe, effective vaccine.
Professor Berthold Koletzko, a paediatrician from one of Munich’s largest hospitals, has seen firsthand the alarming consequences of children missing out on vaccination. This has led to their exposure to illnesses that, in Europe, he’d once thought confined to a distant past: diseases like measles or tetanus - which previously he’d only seen while overseas in his youth.
“What we are seeing is that more parents are no longer aware of the dangers of these diseases. When I grew up many of us knew children who were damaged because of them. We, in the hospitals, still see their impact, but for newer generations of parents, it can feel much more remote.”
According to preliminary WHO data, measles increased by around 300% globally in the first three months of 2019, compared to the same time last year, with sizeable rises in all regions of the world.
The reasons for children not getting their vaccines are diverse. The majority are the consequence of a fundamental lack of access to vaccination services, with Sub-Saharan Africa – which has the lowest coverage - accounting for the largest part of the increase, and the greatest burden of cases.
However in places with historically high immunization rates, complacency – whether from parents, health providers, politicians or governments - can also play a role, and comes at an extremely high cost.
Gafo, Polio vaccine champion
“My son may not have the normal life we prayed for, but he will always be an exceptional boy. What happened to my son has increased awareness of polio and many mothers are having their children vaccinated, saving these children from lifelong paralysis.”
A public health success story
Today’s measles outbreaks suggest pervasive backsliding after decades of hard-won progress.
85% of the world’s children – increasing from around 20% back in 1980 – now receive essential, lifesaving vaccines, protecting them and their communities against not only measles but also diphtheria, tetanus, pertussis (whooping cough), hepatitis B and polio.
This level of protection comes through a strong global push to increase vaccine access and affordability, with support in recent decades from new partnerships like Gavi, the Vaccine Alliance - focusing on expanding vaccine availability in the poorest countries - and the Measles & Rubella Initiative.
From these efforts, the resulting health gains stand tall.
number of reported cases since 1980
Back in 1963, measles alone caused approximately 2.6 million deaths every year. Today it has been reduced to 110,000 – that’s a 95% reduction.
Data on reported cases was provided by Member States and data on coverage estimates was provided by WHO-UNICEF (data as of July 2018)
Data on reported cases was provided by Member States and data on coverage estimates was provided by WHO-UNICEF (data as of July 2018)
Back in 1963, measles alone caused approximately 2.6 million deaths every year. Today it has been reduced to 110,000 – that’s a 95% reduction.
measles
4’211’431
173’330
pertussis
1’982’355
143’963
tetanus
114’251
12’476
diphtheria
97’511
8’819
polio
52’795
96
21%
85%
of infants born were
vaccinated with DTP3
(diphtheria tetanus
pertussis)
vaccinated with DTP3
(diphtheria tetanus
pertussis)
1980
2017
1980
2017
And there has been a similar impact on many other once-feared diseases. Only 30 years ago for instance, wild poliovirus was widespread across 125 countries, causing millions to endure lifelong paralysis. Last year there were wild poliovirus infections in just two countries – Afghanistan and Pakistan – with only 33 confirmed cases reported worldwide.
Maternal and neonatal tetanus, an often fatal disease, has been eliminated in all but 13 countries because of vaccination of women before or during pregnancy. And promising results from nations that have introduced the human papillomavirus vaccine early, suggests that cervical cancer is set to decline.
Meanwhile, new vaccines are on the horizon to protect against some of our most dangerous known pathogens. The rVSV-ZEBOV Ebola vaccine has already played a critical role in controlling the spread of the current outbreak in the Democratic Republic of the Congo, while RTS,S, the world’s first ever malaria vaccine is being piloted in routine immunization programmes starting this month in three African countries.
#VACCINESWORK
Support Vaccines Support VaccinesToo many gaps in the chain of protection
Yet, recent outbreaks of vaccine-preventable diseases illuminate persistent holes in our defences.
For several years, global immunization rates have stalled. While 85% coverage means roughly 116 million children get their vaccines every year, it also means approximately 20 million miss out.
There remain eight countries in which fewer than half of children are vaccinated. And there are just 10 countries - Afghanistan, Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan and South Africa – which account for the majority (around 60%) of the unimmunized.
“Most of the unvaccinated live in places where there is serious poverty, conflict, and low vaccine access,” explains Dr Kate O’Brien, WHO’s Vaccine and Immunization Director. As humanitarian crises become more common and protracted, with record numbers displaced and on the move, these challenges intensify.
And even in a country with high overall coverage, stark disparities can exist within its borders.
“If a disease returns into a community,” explains O’Brien, “these gaps in vaccination can mean there’s enough opportunity for it to take hold, keep going, and spread fast.”
2016
2017
2018
And risks are looming large. Based on the latest data, measles case reports doubled globally from 2017 to 2018, with all regions of the world experiencing large, often protracted outbreaks of the disease.
Measles is in itself very serious. Even in high income countries, the disease results in hospitalization in up to a quarter of cases – but experts warn it can also be ‘a litmus test’ of things to come.
Measles outbreaks
2016
2017
2018*
- Americas Cases: 12 775 16'689
- Europe Cases: 4'363 24'356 83'540
- Africa Cases: 36'269 72'603 55'445
-
Eastern
Mediterranean Cases: 6'275 36'427 57'054 - South-East Asia Cases: 27,530 28'474 82'929
- Western Pacific Cases: 57,879 10'695 30'388
*Based on preliminary data as of April 2019
Identifying the missing links
Across countries of all income-levels, inequalities in access are the fundamental barrier to vaccination, with the poorest children consistently the least likely to get their vaccines fully and on time. But in some countries where access is high, there are also parents who delay or refuse vaccines for their children because they are uncertain or undecided about immunization.
Often reduced to a sole narrative about ‘anti-vaccination’ campaigns, vaccine hesitancy is a complex phenomenon – with many and varied causes.
Ilamnisa 3.5 years
“Polio drops give me power. I also get to have nail polish on my finger after taking drops”
Ayuba Gufwan Polio survivor
“My desire is to make sure that every single child in Africa gets immunized and grows up to be healthy and strong.”
Tajarya Najam Ghulam
“Every time vaccinators come to our door, I tell my niece that she and her doll must rush downstairs to get vaccinated.”
Gafo, Polio vaccine champion
“What happened to my son has increased awareness of polio and many mothers are having their children vaccinated.”
Lovely Barua, vaccinator in Cox’s Bazar
“I go to them. I try and gather girls from the area in one location to vaccinate them there and give them privacy.”
Ana Maita, Mothers Advocate
“My father-in-law got polio. He is still alive today and living proof of what it means to not protect your child from preventable diseases.”
Dr Jelke Fros Virologist
“We are trying to alter the genome of viruses in such a way that host cells better recognize these viruses and stimulate immune responses.”
Mufti Laeeq Religious scholar
“People come to us seeking a response on what Islam says on the use of vaccines.”
Shaheen Grandmother
“I always bring my grandson to the door when community vaccinators come or I take him to the local health centre.”
Irfanullah Health worker
“Sometimes it requires trekking for 30-40 minutes just to reach a single house. Extreme cold, snow and rain makes it even harder.“
Having questions or concerns about vaccination can be linked to factors such as a lack of trust in the health system and conventional medicine, or anxieties fueled by specific events: issues that require significant commitment and investment to address.
During the West African Ebola outbreak in Sierra Leone for instance, essential vaccination coverage plummeted as parents feared taking their children to health clinics. Today, it's back to previous high levels, but this required extensive efforts from health authorities to rebuild confidence, to bring parents and their children back to their health services.
Parents can also be hesitant because they lack accurate information on the safety of vaccines, or the severity of the diseases they protect against. For example, even in Europe, Canada and the United States, about 1 in 4 children with measles will be hospitalized, while 1 in 15 will suffer from potentially life-threatening complications such as pneumonia or encephalitis, a dangerous swelling of the brain.
“Parents are increasingly exposed to much confusing and conflicting information on vaccines,” explains Koletzko. The danger is that where there is this uncertainty, it can be fuelled by misinformation campaigns, particularly online, with people increasingly polarized into taking ‘sides’.
Online, such misinformation can travel fast, far and across borders, with unsubstantiated claims, harassment of vaccine advocates, and harmful unscientific content virally reproduced across digital platforms.
Dr. Christa Kuderna
Every day, Dr Christa Kuderna sees more than 80 children coming into the children’s ward of one of the biggest public hospitals in Vienna.
With all this said, there is much that can be done to make vaccination easily accessible and convenient, while ensuring that the public is well-informed and ‘vaccine literate’.
Evidence shows that globally, very few parents are overtly opposed to vaccination. “The reality is that, where the opportunity exists, most parents choose to get their children vaccinated on time,” explains Lisa Menning, an expert in vaccine demand issues at WHO. “A few are unsure or reluctant; a very tiny minority simply refuse.”
When those who are uncertain or prevaricate become the focus, we see that there are opportunities to understand and address their concerns. “It is vitally important to listen to parents’ questions and concerns, and respond to them with care and compassion,” she adds.
Tackling the spread of vaccine misinformation is also important. Several online platforms have taken welcome initial steps to clamp down on fake vaccine-related news – but it is not the end point. There is critical work needed over the long-term to build a population’s health literacy and resilience to rumours and misinformation, and to build trust in health services.
This requires comprehensive strategies: rather than putting out fires, we should work to promote the benefits of vaccines through a person’s life, and involve all health professionals in this pursuit. “Every check-up,” says O’Brien, “should be an opportunity to check in on vaccination.”
This encompasses health workers of all sorts: from midwives who have a large share of initial contacts with new parents, to pharmacists, general practitioners and nurses. To be a trusted and credible source of information, ”they must have the tools and time available to engage adequately with parents on this critical issue,” says Menning.
It will also, she adds, mean building immunization systems and indeed primary care services that merit parents’ trust – that are affordable, accessible, and have people at their heart.
Health worker training module: managing pain during vaccine administration pptx, 3.16MbHealth worker training module: conversations with hesitant caregivers pptx, 910kb
A right for all children and a shared responsibility
Ultimately, tackling under-vaccination – both through access and acceptance - requires a whole-of-society commitment to vaccination as a right for all children, and a social contract.
As recent outbreaks have demonstrated, no country and no individual can afford to be complacent about vaccines. Putting out fires - responding to outbreak after outbreak - is expensive, ineffective and costs lives. The only sustainable response is prevention, by ensuring that everyone is vaccinated at the right time with the right vaccines through the course of their lives.
Vaccines not only save lives; they help children learn and grow, they mean more days in school, they avert many debilitating risks from childhood diseases, and they reduce healthcare costs, protecting families and communities from sliding into poverty.
“There is,” said Dr Tedros and Henrietta Fore, heads of WHO and UNICEF in a recent joint editorial for CNN, “absolutely no ‘debate’ to be had on the benefits versus risks from diseases.” Huge progress has been made, but much more needs to be done to ensure vaccines can continue to protect people into the future.
This, they say, “will take long-term efforts, political commitment and continuous investment – in vaccine access, in service quality, and trust - to ensure we are, and remain, protected together.”
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