By RICHARD SKOLNIK
This is adapted with permission from Jones and Bartlett Learning from: Childhood Vaccines – A Best Buy in Global Health, available at this link.
The Evolution of Global Childhood Vaccine Programs
Stopping the COVID-19 pandemic will require widespread vaccination globally, including among children. It is important, therefore, to understand the evolution of global childhood vaccine programs.
The first major program for childhood vaccines globally was the Expanded Program on Immunization, (EPI), established in 1974. UNICEF played a major role in this program, with substantial international support. The EPI program aimed to enhance coverage of vaccines to protect against six childhood diseases: diphtheria, pertussis, and tetanus (DPT); polio; tuberculosis (TB); and measles.
In 2000, the Global Alliance for Vaccines and Immunization – now Gavi, the Vaccine Alliance – was formed as an international public-private partnership. For eligible low- and lower middle-income countries, Gavi aims to enhance coverage of childhood vaccines, expand access to new vaccines, and improve the effectiveness and efficiency of global efforts in this area.
Childhood Vaccines Today and their Benefits
Since Gavi’s formation, a number of WHO-recommended vaccines, besides the six basic ones noted above, have been added to the global vaccine program. These address: hepatitis B; rotavirus; Haemophilus influenza type b; human papilloma virus; rubella; and pneumococcal infections.
Many people have no understanding of the enormous benefits conferred by childhood vaccines. They have never known a child to die from measles or seen anyone in an iron lung when polio kept them from breathing properly. Yet, thanks to vaccines, the number of polio cases in the world declined from 350,000 in 1988 to 134 in 2019, as the world engaged in a global program to eradicate this disease. Measles caused an estimated 2.6 million deaths each year before the introduction of the measles vaccine in 1963. In 2018, the number of measles deaths annually had been reduced to about 140,000 – although this is still 140,000 too many.
Besides being safe and effective, the vaccines used in the global programs for child health return benefits far in excess of their costs. The cost of fully immunizing a child with WHO-recommended vaccines is now about US$28 in Gavi-supported countries. Studies suggest these vaccines can return benefits up to $54 dollars for every dollar invested. It is because they yield such high benefits compared to costs, that childhood vaccines are referred to as one of the “best buys in global health.”
There has been hesitancy about vaccines since the first vaccine was developed. The nature of this hesitancy, however, has changed. Today, many who are hesitant have little understanding of what the world was like before the development of childhood vaccines. In addition, many of those who are hesitant are part of or inspired by a well-organized movement against vaccines, which is promoted on social media. This movement started in earnest following a 1998 journal article that linked vaccines and autism, which was later retracted and whose author lost his British medical license.
The world has learned much about dealing with vaccine hesitancy and remarkable success was achieved in Nigeria and India, among other places, in the global polio program, despite enormous hesitation by minority populations. The learning from these experiences needs to be put to further use today. We also need to better understand how to deal more effectively with hesitancy in high-income countries and what that means for the rest of the world.
There has been great progress in the last two decades in expanding vaccine coverage against childhood illnesses. Childhood vaccines are a great investment and have enormous benefits. COVID-19, however, dealt a terrible blow to health services and vaccine coverage in many countries. The global health community and individual countries now need to do all they can to regain their momentum on childhood vaccines. In addition, they must face difficult challenges in getting approval for, acquiring, and then using COVID-19 vaccines on children. There are few matters that can be more important and few investments that can pay a higher return than getting childhood vaccines back on track and ending the COVID-19 pandemic.
Editor’s Note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health. Skolnik has written this article in his personal capacity.