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Immunization: How It Started, How It's Going – What We've Achieved Through 50 Years Of Vaccination Programs
By Shyam Bishen, Head, Centre for Health and Healthcare, World Economic Forum
Immunization is one of the most effective health interventions we can make.
Every year vaccination programmes save millions of lives. They have helped eradicate diseases like smallpox – a deadly virus that has killed hundreds of millions of people. They were key to turning the tide of infections during the COVID-19 pandemic. And day-to-day, they are protecting vulnerable babies and children from diseases like measles, meningitis and tuberculosis.
The benefits extend beyond individual health as well. By preventing the spread of infectious diseases, vaccines reduce the burden on healthcare systems, lower healthcare costs, and enhance productivity by averting illness-related absenteeism. Furthermore, immunization contributes to socioeconomic development by preserving human capital and promoting economic stability, particularly in resource-limited settings where disease outbreaks can have devastating consequences.
It's been 50 years since the launch of the World Health Organization's (WHO) Expanded Programme on Immunization (EPI) – a drive to provide universal access to life-saving vaccines for children worldwide – and this year's World Immunization Week will recognize the collective efforts behind it.
A lot has changed since the EPI was launched in 1974. Today, every country has a national immunization programme and many diseases have become far less common and deadly than they once were. But, in recent years, progress on immunization has slipped. Millions of children are missing out on life-saving vaccinations because of growing conflicts, economic downturns and vaccine hesitancy.
So now is an opportune time to review what we have achieved in the past 50 years, and what more we can do to ensure that people do not die from vaccine-preventable diseases.
Eradicating smallpox – and polio, almost
The WHO describes the eradication of smallpox as a "monumental triumph in the history of immunization" – and with good reason. The decline in smallpox deaths in the 20th century alone is extraordinary. Between 1900 and its eradication in 1980, the disease is estimated to have killed more than 300 million people.
A vaccine against the highly infectious variola virus that causes the disease was first discovered in 1796. In the following decades, several countries introduced mandatory vaccination policies. Although, at the turn of the century, the disease was still endemic in many countries, by the time the WHO's Intensified Smallpox Eradication Program was launched in 1966 it had been all but eliminated in Europe, North America and Australia. Coordinated programmes helped extinguish infections entirely by 1980.
We are now on the verge of eradicating polio, having first developed a vaccine against it in 1955. As a result of mass vaccination programmes in countries including India and Pakistan, cases of wild polio have decreased by 99% since 1988 when the World Health Assembly adopted a resolution to end the disease.
New vaccines for HPV, malaria and meningitis
The EPI was initially focused on six childhood diseases. This list has now expanded to include 13 universally recommended vaccines and an additional 17 depending on context.
The list of vaccine-preventable diseases continues to grow and malaria is a recent notable addition to it. After successful trials in Ghana, Malawi and Kenya in 2019, the first malaria vaccine was recommended for use by the WHO in 2021. There are now two approved malaria vaccines the WHO recommends using to prevent malaria in endemic areas.
Millions of children have been reached through vaccination programmes and deaths from the disease in young children have been cut by 13%. With malaria remaining one of the leading causes of child mortality, reaching more people with these life-saving vaccines is a top priority.
Another crucial vaccine breakthrough has been the development of a vaccine for the human papillomavirus (HPV). It is responsible for the majority of cervical cancers, which are the fourth most common cancers in women. The vaccines also protect against other cancers including vaginal and anal.
Around 125 countries have introduced HPV vaccines since they were first licensed in 2006, and there are efforts to encourage other countries to introduce them into their routine immunization programmes.
This year, Nigeria became the first country in the world to roll out a new vaccine for meningitis, which protects people against five strains of the meningococcus bacteria. It is one of 26 countries in Africa where meningitis is hyper-endemic, and last year, the number of meningitis cases in Africa jumped by half.
Ending outbreaks earlier
Away from childhood immunization programmes, mass and targeted immunization interventions have also been crucial to curbing infections and deaths from several other diseases.
Ebola outbreaks, for example, can now be more quickly and effectively controlled by vaccinating those most at risk through "ring vaccination" strategies. The disease is relatively rare and unpredictable but also has a high death toll associated with it. A global stockpile of ebola vaccines has been established to help improve the response in the face of an outbreak.
The COVID-19 pandemic is another example of where rapid development of vaccines allowed the outbreak to be downgraded from one of global concern by limiting the spread and severity of the illness.
What we need to do now
Through human ingenuity we can now prevent – and possibly end altogether – some of the world's most deadly diseases. However, a challenge remains in ensuring these life-saving interventions are universally accessible.
Initiatives like the World Economic Forum's Regionalized Vaccine Manufacturing Collaborative are vital to expanding vaccine production across the globe and preventing vaccine disparity across regions. By combining forces governments, pharmaceutical companies and investors can help prevent future pandemics and accelerate vaccine innovation.
These collaborations are also crucial to supporting the development and targeted funding needed to develop vaccines for the diseases we don't yet have covered.
And, despite the overwhelming evidence supporting the safety and efficacy of vaccines, misinformation and misconceptions persist, leading to vaccine hesitancy and reluctance. Addressing these misconceptions requires comprehensive public health campaigns that prioritize education, transparency, and trust-building. Healthcare providers, policymakers, and community leaders play crucial roles in dispelling myths, providing accurate information, and fostering vaccine confidence among the population.
JoCo Survey Shows Immigrants Face Barriers To Find Vaccine Access
A Johnson County community assessment shows immigrant populations are the least vaccinated in the county.
Marginalized populations in Johnson County lack access to free COVID-19 vaccinations, according to a recent countywide survey.
The survey found that immigrants living in Johnson County experience several barriers to vaccination, including a lack of health insurance, a lack of overall vaccination information, and language and communication barriers.
Karrey Shannon, a community health nurse at Johnson County Public Health, said limited access to health care is largely due to immigrants working in lower-wage jobs that often do not provide health care benefits for employees.
The survey, called the Whole Worker Health Equity Survey, Report, and Needs Assessment released on April 17, revealed the county was made aware of the lasting economic and social impacts COVID-19 had on the immigrant population. The survey was conducted by Johnson County Public Health and the organization Escucha Mi Voz in fall 2023.
The health equity survey shows many economic factors that affect vaccine access for immigrants, such as lack of affordable housing. According to the survey, 53 percent of surveyed immigrants pay more than $800 in monthly housing.
Additionally, 53 percent of respondents said they did not have health insurance. Of these, 83 percent of Hispanic and Latino respondents said they did not have health insurance, compared to 11 percent of Black African respondents.
Mazahir Salih, a volunteer at the Immigrant Welcome Network and Iowa City's Mayor Pro Tem, said vaccine misinformation, a lack of free vaccines, and a lack of health care information provided in multiple languages largely affect the immigrant population.
Salih said most vaccine misinformation is found on social media and often targets immigrants. According to the National Library of Medicine, immigrants are more likely to seek vaccine information on social media platforms where they have access to information in their native language.
Financial and communication obstacles cause immigrants to have more economic disadvantages and are often related to unaffordable housing and low education.
Shannon said she hopes the survey results will bring awareness of vaccine hesitancy to local governments and lead to supportive actions toward the immigrant population. She said the Johnson County Public Health Department has worked to meet the health needs of immigrants by having free vaccine pop-up booths in local areas.
Salih said the county should be doing a lot more to provide health care education and access among the immigrant and refugee community. She said many immigrants arrive with little to no knowledge of vaccines and often do not believe in the importance of them.
"They come from their country with certain beliefs, and there is no education here for them in their language," Salih said. "And there is no outreach that has been done by the health department or anyone else to go and talk to them."
Salih said community outreach is influential among immigrants and finding messengers within immigrant communities can help lessen the language barrier between immigrants and health care workers.
RELATED: JoCo Public Health selected for grant program to address vaccine inequities
Johnson County Board of Supervisors Chair Rod Sullivan said the board acknowledges the difficulty of having health care access when there are little to no resources provided for immigrants.
Sullivan said the board will continue to promote and support vaccination programs in the county and continue working with public health to provide more access to minorities.
Shannon said it is important to keep updated on all vaccinations, and her goal is to save lives through health care.
"Vaccines, at their base, are set essential preventive care," Shannon said. "And the single most effective way that we have to prolonging people's lives or keeping disease rates low is being able to offer those to people who may not otherwise be able to seek out preventive care."
Navigating Vaccine Coverage For Seniors With Medicare Changes
What You Need to KnowGetting the right vaccinations can help your older clients stay healthy and active longer.
As individuals age, their need for protective measures against certain infectious diseases, including shingles and respiratory syncytial virus , major cause of pneumonia, becomes increasingly important.
George, a 70-year-old retired social worker, sent us a question about this topic.
The QuestionUnder the Inflation Reduction Act, are vaccines like the shingles vaccine now covered by Medicare at no cost? If so, how can I get them?
The AnswerYes, the Inflation Reduction Act helped Medicare beneficiaries by providing coverage of eligible vaccines with no out-of-pocket costs for the beneficiaries. The list of covered vaccines includes the vaccines against shingles, RSV and pneumonia.
This legislative change marks an important shift toward enhancing preventive health measures for seniors, promoting a proactive approach to health care.
Which Plan Covers WhatThrough Original Medicare, Part B provides shots for seasonal flu, pneumonia and COVID-19; as well as hepatitis B vaccines for high-risk individuals, plus tetanus shots for beneficiaries who are injured.
Medicare Part D prescription drug plans cover the shingles, Tdap, RSV, hepatitis and meningococcal vaccines.
For those with Medicare Advantage plans that encompass prescription drug coverage, the same protections apply.
More to ConsiderCovered vaccines: The Inflation Reduction Act offers certain recommended preventive vaccines free of charge for those beneficiaries enrolled in a Medicare Part D plan.
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