Recent headlines have been focused, quite rightly, on measles outbreaks in the United States. The disease is no longer endemic to our country, and if so many parents hadn’t been scared off vaccinating their children by a thoroughly debunked, fraudulent report, and myths making the rounds of social media, there would be no reason for outbreaks here or in other developed countries. But for this week, let’s think about the children in developing countries who can’t even gain access to life-saving vaccines.
World Immunization Week, April 24-30, celebrates the enormous gains made in immunizing children around the globe, mourns those who have died because of lack of access, and aims to bring attention to the many children who still need vaccination.
In many developing countries, which are often plagued by extreme poverty and/or conflict, measles is well known as a dangerous, often fatal disease. In 2015, the World Health Organization announced that more than 17 million lives had been saved since the beginning of the century through a worldwide measles vaccination campaign. Yet there were deep concerns that the effort wasn’t meeting its goals.
According to WHO’s release on this year’s observance:
In 2017, the number of children immunized – 116.2 million – was the highest ever reported. Since 2010, 113 countries have introduced new vaccines, and more than 20 million additional children have been vaccinated.
But despite gains, all of the targets for disease elimination—including measles, rubella, and maternal and neonatal tetanus—are behind schedule, and over the last two years the world has seen multiple outbreaks of measles, diphtheria and various other vaccine-preventable diseases. Most of the children missing out are those living in the poorest, marginalized and conflict-affected communities.
The 2019 observance of World Immunization Week will emphasize vaccine heroes who have helped improve vaccine access and awareness around the world. In fact, Texas has a leading hero: Dr. Peter Hotez, who has stood up to educate people about the importance of vaccination even in the face of abuse and threats against him.
Hotez is a double hero. Head of the Texas Children's Hospital Center for Vaccine Development, and dean of the National School of Tropical Medicine, Baylor College of Medicine, he works on developing vaccines for diseases that afflict hundreds of thousands of people in developing countries, such as human hookworm and schistosomiasis.
Writing for The Immunization Partnership in 2014, Hotez recalled seeing the results of lack of immunization years earlier:
Starting in the 1990s I began to make visits to Central America and elsewhere in Latin America in order to further my tropical disease interests. I will always remember reaching Guatemala City after a short flight, getting off the plane, and making clinical rounds at Hospital Roosevelt – their big public general hospital. It was though I had gone back in time 100 years seeing children with measles, pertussis, and neonatal tetanus, i.e., diseases that had disappeared long ago from the US. The major difference between American children and Guatemalan children was that we vaccinated our children whereas the Guatemalans did not have access to vaccines.
Hotez, father of a young woman who has autism, recently published the book “Vaccines Did Not Cause Rachel’s Autism.”
As Hotez’s work illustrates, measles is only one of the diseases that calls for global immunization work. A 2017 fact sheet by WHO, the most recent available, shows the following information about prevention of dangerous diseases:
Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 191 countries by the end of 2017. Global coverage with 3 doses of Hib vaccine is estimated at 72 percent. There is great variation between regions. In the WHO Region of the Americas, coverage is estimated at 91 percent, while it is only 28 percent in the WHO Western Pacific Region. The WHO South-East Asia Region raised coverage from 80 percent in 2016 to 86 percent in 2017.
Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 187 countries by the end of 2017. Global coverage with 3 doses of hepatitis B vaccine is estimated at 84percent and is as high as 93 percent in the Western Pacific. In addition, 105 countries introduced one dose of hepatitis B vaccine to newborns within the first 24 hours of life, and the global coverage is 43 percent.
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, and can cause cervical cancer, other types of cancer, and genital warts in both men and women. HPV vaccine was introduced in 80 countries by the end of 2017, excluding four countries with introduction in some parts of the country.
Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2017, 85 percent of children had received one dose of measles vaccine by their second birthday, and 167 countries had included a second dose as part of routine immunization and 67 percent of children received two doses of measles vaccine according to national immunization schedules.
Meningitis A is an infection that can cause severe brain damage and is often deadly. By the end of 2017 – 7 years after its introduction – more than 280 million people in African countries affected by the disease had been vaccinated with MenAfriVac, a revolutionary vaccine developed by WHO and PATH. In 2012, MenAfriVac became the first vaccine to gain approval for travel outside the cold chain – for as long as four days without refrigeration and at temperatures of up to 40°C. Ghana and Sudan were the first two countries to include the MenAfriVac in their routine immunization schedule in 2016, followed by Burkina Faso, Central African Republic, Chad, Mali and Niger in 2017.
Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 122 countries by the end of 2017.
Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 135 countries by the end of 2017, including five in some parts of the country, and global coverage was estimated at 44 percent.
Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2017, 85 percent of infants around the world received three doses of polio vaccine. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan, Pakistan and Nigeria. Polio-free countries have been infected by imported virus, and all countries – especially those experiencing conflict and instability – remain at risk until polio is fully eradicated.
Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 91 countries by the end of 2017, including six in some parts of the country, and global coverage was estimated at 28 percent.
Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes, and ears. Rubella vaccine was introduced nationwide in 162 countries by the end of 2017, and global coverage was estimated at 52 percent.
Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or in the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. The vaccine to prevent maternal and neonatal tetanus had been introduced in 106 countries by the end of 2017. An estimated 85 percent of newborns were protected through immunization. Maternal and neonatal tetanus persist as public health problems in 14 countries, mainly in Africa and Asia.
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2017, yellow fever vaccine had been introduced in routine infant immunization programs in 36 of the 42 countries and territories at risk for yellow fever in Africa and the Americas. In these 42 countries and territories, coverage is estimated at 43 percent.
This worldwide campaign by WHO and the dedicated team members who work under difficult and occasionally dangerous conditions to save lives, reminds us all of the tremendous importance of using vaccination to combat diseases that we have unfortunately come to think of as not being a threat. They are, in many corners of the world, and if growing numbers of people fail to recognize the importance of vaccines, those disease could become very real threats in places where they haven’t been for years – including here at home.