Measles vaccinations alone prevented 57 million deaths since the year 2000. But this success does not just depend on developing effective vaccines; they need to be accessible to everyone. Credit: Shutterstock.

By Daniela Ramirez Schrempp
Sep 4 2024 (IPS)

Measles infections are surging right now, with epidemiologists reporting that the number of large or disruptive outbreaks has tripled over the past three years. It is one of the most infectious diseases that we know. The virus spreads through respiratory droplets; when an infected person coughs or sneezes, it can linger in the air for up to two hours and infect 10 others who are not immune.

Most of the estimated 136,000 people who died from measles infections in 2022 were children under the age of five. Every single death is a tragedy, but it hurts even more when those deaths could have been prevented with a safe and effective vaccine.

As a pediatrician, I am proud to be involved with vaccines because of their public health impact. Vaccination has accounted for 40% of the observed decline in global infant mortality; it is one of the most remarkable achievements in modern medicine.

Globally, just under three-quarters of all children under the age of two received both doses of a measles vaccine when at least 95% is needed to prevent outbreaks. Even worse, an estimated 14.5 million children haven’t received any doses of any vaccines

Measles vaccinations alone prevented 57 million deaths since the year 2000. But this success does not just depend on developing effective vaccines; they need to be accessible to everyone.

Having grown up in Colombia, at a time and place where vaccines were not as prevalent or accessible, and having attended medical school there, I unfortunately saw children sick and dying from diseases that vaccines could prevent. I even had some of these diseases in childhood. And so, every time my kids get vaccinated, I celebrate (although they don’t).

Not all parents have this background though, and I understand how decisions that impact the health of your child can be intimidating without it.

My work in vaccine safety also provides an understanding of the research behind these shots. Every vaccine goes through rigorous testing in clinical trials, continuous monitoring for adverse effects, and adherence to strict regulatory standards. There is also strict safety surveillance and data monitoring conducted not only by drug developers but also by national health authorities in each country.

For vaccines, we closely monitor for safety and reactogenicity — the property of a vaccine to produce common, short-term side effects that are typically mild, self-limited, and usually indicate an immune response, such as pain at the injection site, fever, or fatigue.

We ask participants in clinical trials to report daily if they experienced any of these symptoms, how long they lasted, and how severe they were. This information helps inform future vaccine recipients about what they can expect. If the reactogenicity is too high and unacceptable, it may be a reason to discontinue the clinical trial and reassess what needs to be changed to continue the development of that vaccine.

In terms of safety, all adverse events that happen to any participant during a trial are carefully evaluated and analyzed to identify which of these events could be associated with the vaccine. We ask participants to report all signs and symptoms they may have experienced during the trial, whether they think they are related to the vaccine or not.

Usually, a trial includes participants who receive the actual vaccine and others who receive a placebo. That means that the study is “blinded” and neither the participants nor the trial staff and researchers know who is receiving the vaccine or the placebo until the data is evaluated. This helps us better determine if adverse events are related to the vaccine.

Globally, just under three-quarters of all children under the age of two received both doses of a measles vaccine when at least 95% is needed to prevent outbreaks. Even worse, an estimated 14.5 million children haven’t received any doses of any vaccines.

There are many unfortunate reasons why, including impoverished communities not having access to adequate healthcare and displaced populations driven from their homes. It isn’t only caused by people who are skeptical of the value of vaccines; however, these individuals had the choice to protect their children and their communities and they chose not to.

The stakes are clear, and it is not just about measles. Wild polio virus infections have decreased 99% since 1988, from 350,000 cases to 6 in 2021.

The disease still lingers though, as vaccination rates, at an average of 83%, are good but not great with too many geographic disparities for a disease that is exceptionally contagious and can cause irreversible paralysis.

Pertussis, or whooping cough, is another contagious infection with a significant mortality rate among infants, yet it is not being tracked as diligently. The last year WHO has complete data is 2018, when more than 151,000 infections were catalogued. In 2023 an estimated 84% of infants around the world received the recommended three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine, but low-income countries trailed wealthier countries in immunizing their children.

If you take care of a child’s health and wellbeing, you’re taking care of the future of an entire community. And if that child is able to grow and learn without the threat of disease, the future of both the child and the community improves considerably. This is our goal.

Every parent’s decision to vaccinate their child plays a role, along with every program and initiative that makes the decision accessible and effective. Achieving herd immunity is paramount, where diseases cannot take hold in a community because most everyone has been immunized. Only high vaccination rates make this future possible.

Daniela Ramirez Schrempp, MD, is the Pharmacovigilance Medical Leader at the Bill & Melinda Gates Medical Research Institute.

A young boy in Pakistan receives an oral polio vaccine (OPV). Over the last 30 years huge progress has been made against polio and it is now only endemic in 2 countries, Afghanistan and Pakistan, with only 33 cases confirmed cases last year. Credit: Ashfaq Yusufzai/IPS

By Tharanga Yakupitiyage
UNITED NATIONS, May 1 2019 (IPS)

Since the introduction of vaccines, diseases such as measles and polio were quickly becoming a thing of the past. However, the world’s progress on immunisation is now being threatened.

According to the World Health Organisation (WHO), 85 percent of the world’s children received basic vaccines, including the measles and diptheria-tetanus-pertussis (DTP) vaccines, which can protect them from infectious diseases that cause serious illness and even death.

In fact, measles immunisation resulted in an 80 percent drop in measles-related deaths between 2000 and 2017 worldwide.

Still, access to vaccines remain elusive for many out-of-reach communities.

In 2017, an estimated 20 million infants did not receive the DTP vaccine, 60 percent of whom live in just 10 countries, including Afghanistan, the Democratic Republic of the Congo, Iraq, and Nigeria.

A rising anti-vaccination movement is also threatening to dismantle progress.

In the United States, there are now more than 700 cases of measles across 22 states making it the highest figures the country has seen since 2000.

The phenomenon has prompted some states to not only make immunisation mandatory, but also to ban unvaccinated children from public spaces.

To mark World Immunisation Week, held during the last week of April, IPS spoke to WHO’s Coordinator of the Expanded Programme on Immunisation Dr. Ann Lindstrand on the challenges of immunisation and the way forward. Excerpts of the interview follow:

World Health Organisation’s Coordinator of the Expanded Programme on Immunisation Dr. Ann Lindstrand.

Inter Press Service (IPS): How is the overall global picture regarding immunisation, and why does immunisation matter? 

AL: Immunisation matters because it is one of the most effective health interventions that we have, and it has saved millions of lives. I don’t think there is any other health intervention that works that well, with such high coverage, worldwide.

Just looking back at what we have gained from immunisation—back in 1963 when we didn’t have any vaccine for measles, there were about 2.6 million deaths every year due to measles. Now, that figure has reduced by 95 percent. The last figures we have are from 2017 with an estimated 110,000 deaths—so there has been a tremendous health gain.

Same with polio—30 years ago, we had widespread polio crippling people but now its only endemic in two countries Afghanistan and Pakistan with only 33 cases confirmed cases last year.

Now the newer vaccines like HPV [human papillomavirus] will help us reduce numbers of cervical cancers and new vaccines on the horizon like the Ebola vaccine which is used in outbreaks in Africa right now has really played a critical role in stopping the spread of the current outbreak in the DRC.

Just this month, the first ever malaria vaccine is being piloted in routine immunisation programs in three countries.

We still need to reach more. We still need to reach the last 15 percent and we need to close equity gaps to reach those furthest away.

IPS: WHO and others have pointed to the anti-vaccination movement as one of the biggest health threats in the world. How concerning is the move away from vaccinations, and what does this mean for people around the world? Is this a new challenge for WHO? 

AL: It is an area of concern, yes.

But it is not the global picture. We do not have the data to say that hesitancy has increased but we have seen that with social media and the internet, misinformation is spread more widely and easily.

That’s something we are really worried about. In some areas, there is a resurgence of disease because of unacceptably low coverage rates or that people are refusing vaccines.

We need to see this in a historic perspective. Anti-vaccine messages have been around for just as long as vaccines have been around—these things come and they go.

But it worries us and we need to be right there to tackle to spread of vaccine misinformation. It is really important to put out the right messages.

I work as a paediatrician and I have talked to a lot of parents who have had these concerns and it takes a lot of effort.

At the heart of it, it is really the health worker who is sitting there with the [parent] who have concerns or have heard something on the internet or media, and they need to be able to respond to their questions and to listen and respect the concerns of parents.

And that those health workers actually have the capacity and time to respond, both with the social ability to listen to the parents’ real concerns and also provide the scientific evidence.

There is a lot of work in training healthcare workers which is ongoing and we need to keep doing that. We need to equip healthcare workers with the right methods, words, scientific evidence to reassure parents.

The bigger picture for us to improve health is for children everywhere to get vaccinated on time and every time. We need to increase access so that vaccine services are made convenient and welcoming so people want to go there, that we are good at putting out credible information from the beginning including what are the facts, what is the evidence.

IPS: Some U.S. states are enacting mandatory immunisation laws or even barring those who have not received vaccines from certain public spaces. Do you agree with these steps, or does more need to be done? 

AL: The only disease where WHO actually recommends mandatory proof of vaccination applies to yellow fever and for international travellers in certain countries.

Beyond that, it is up to every country to make decisions based on existing disease epidemiology, their laws and regulations, and if it is the best way to go.

Many countries have achieved high immunisation coverage without mandatory immunisation.

It is a complex area—how do you sanction parents? How far do you go to enforce laws when they are in place?

That is a conversation that every country needs to have before even considering any of the mandatory vaccinations.

I think it is important to encourage countries to invest in and protect their individuals and communities from vaccine-preventable diseases and then remove barriers—have few access barriers when it comes to cost and convenience.

Make it simple and easy. Make the choice of vaccines the social norm.

IPS: In light of World Immunisation Week, what is your message for people around the world regarding the importance of immunisation?  

AL: Immunisation is a fantastic health intervention. It is a right for all children, and it is also a shared responsibility.

As we have seen with the recent outbreaks, no country and no individual can afford to be complacent about vaccines. It is important that we look at not just putting out fires or responding to outbreaks after they have happened—that’s expensive, ineffective and it costs lives.

What is more important is to have sustainable prevention, thinking and ensuring that everyone everywhere is vaccinated at the right time with the right vaccines and throughout their life course.

It also important to see that vaccines is not just for saving lives, it helps children to learn, grow, keep them in school instead of sick, avert disabilities and long-term consequences. It reduces the health care costs for a country, and protects families and communities from sliding into poverty.

There is no debate to have on the benefit or the risk between vaccines and the vaccine-preventable diseases.

We need to continue to protect people also in the future, and we really need to invest in trust in vaccines and in our healthcare system.

Excerpt:

A baby cries in his mother’s lap while being inoculated against measles by Vaccinator Joseph Kamara, at Tagweh Town Community Clinic in Bomi County, Liberia. Credit: UNICEF

By Roger Hamilton-Martin
DAKAR, May 4 2015 (IPS)

As Sierra Leone, Guinea and Liberia work to end Ebola, critical healthcare services damaged by the epidemic are beginning to be revitalised.

Supported by United Nations Children’s Fund (UNICEF), the three countries worst-hit by the disease have begun a campaign to immunise three million children against preventable illnesses like measles and polio.“UNICEF trained a former Ebola sensitisation team to go door-to-door explaining to parents that the vaccinations for measles were safe, essential, and not related to Ebola in any way." -- Tim Irwin

The launch of the campaign coincided with World Immunization Week, which ran Apr. 24 to 30. In Guinea, the World Bank has provided funding, whilst in Sierra Leone, funding has come from the Canadian International Development Agency, the European Union and the United States Office of Foreign Disaster Assistance.

Speaking to IPS about the relevance of the campaign, UNICEF West Africa spokesperson Tim Irwin said, “The focus is still very much on getting to zero cases of Ebola, but the reduction in the number of cases has allowed for the resumption of some interventions.

“Immunisations have restarted and UNICEF and partners have supported the governments in the reopening of schools.”

At the end of March, the World Health Organisation said “in light of the decline in Ebola cases, it is urgent to focus efforts on restarting and intensifying immunization activities.”

Currently, the risk of vaccine-preventable disease outbreaks outweighs the risk of increased Ebola virus transmission.

In Liberia, a campaign to provide measles and polio vaccinations to over 700,000 children under five years old is planned for May 8-14. There, measles vaccination rates were adversely affected due to the impact of Ebola on the country’s healthcare infrastructure.

Little more than half of children aged under one year received measles vaccines in 2014. Before the epidemic in 2013, measles coverage was 89 percent, while in 2014 it fell to 58 percent.

Meanwhile, Ebola had a significant impact on Sierra Leone’s vaccination regime, with routine vaccinations decreasing by 17 percent during the epidemic. Since the start of 2015, 21 laboratory confirmed cases of measles have been reported. In May, an immunisation drive for 1.5 million children under five will cover measles and polio.

In Guinea, where a measles outbreak was declared in early 2014 – prior to Ebola – the number of confirmed measles cases increased almost fourfold, from 59 between January and December 2013 to 215 for the same period in 2014, according to WHO. There are currently some 1265 suspected cases of measles in Guinea.

Irwin told IPS that in Guinea, one significant challenge is communicating the safety and importance of vaccines to sections of the population which remain sceptical, and in some cases concerned that vaccinations could be connected with Ebola.

“The second phase of measles vaccination campaign was launched in Forest Region which is still recovering from the psychological trauma of the Ebola outbreak,” Irwin said.

“While there hasn’t been a case that region for months, the UNICEF team and partners took the initiative to conduct a social mobilisation campaign ahead of the vaccinations to ensure that the turnout would be as high as possible.”

Health professionals remain vigilant for cases of Ebola, and are required to wear gloves when vaccinating – a practice not routinely required for administering injectable vaccinations in normal conditions.

As part of the community-sensitisation campaign in Guinea, UNICEF has been conducting door-to-door visits to discuss vaccinations with parents.

“UNICEF trained a former Ebola sensitisation team to go door-to-door explaining to parents that the vaccinations for measles were safe, essential, and not related to Ebola in any way,” said Irwin.

UNICEF health specialist Dr. Rene Ehounou Ekpini told IPS that Ebola had highlighted serious problems in Guinea’s health system. “Firstly, it’s a problem of poor distribution, with most health workers in the capital. At the second level, it’s an infrastructure issue.

“It’s important to restore confidence in the health system,” he said.

Edited by Kitty Stapp

“In situations where there is a higher mortality and morbidity, people very often still see on a day to day basis the impact of vaccination.” Jos Vandelaer, UNICEF. Credit: Adil Siddiqi/IPS

By Lyndal Rowlands
UNITED NATIONS, Feb 5 2015 (IPS)

Measles remains one of the leading causes of death for young children worldwide, even though a safe vaccine is available.

Most of the 145,700 people who died from measles in 2013 were children under the age of five, according to the World Health Organization (WHO)."These kids face a double whammy, in that if they don’t get immunised and they fall sick their chance of getting treatment is also lower than an average kid.” -- Jos Vandelaer of UNICEF

However, immunisation has also saved many children from death and serious illness. The WHO estimates that 15.6 million deaths were prevented between 2000 and 2013, because of increased access to the measles vaccination.

Jos Vandelaer, prinicipal advisor on immunisations for UNICEF, the United Nations children’s agency, told IPS that the children most at risk of missing out on vaccinations are among the world’s most vulnerable and disadvantaged, including children from minority backgrounds and displaced or refugee children in temporary accommodation.

“These are the very same kids who also don’t have access to health care, to clean water, to hygiene, to school, and so on,” he said.

“So these kids face a double whammy, in that if they don’t get immunised and they fall sick their chance of getting treatment is also lower than an average kid.”

In light of the recent outbreak of measles in the United States, Vandelaer spoke to IPS about some of the differences in communicating the importance of vaccination in developed and developing countries.

“In situations where there is a higher mortality and morbidity, people very often still see on a day to day basis the impact of vaccination. If you still have a lot of measles around, people will understand that vaccinating the child will protect the child,” Vandelaer  explained.

“That is probably less visible in situations where you have higher coverage and the diseases are less prevalent. People start to see less of the benefit of immunisation, because they don’t see the disease anymore,” he said.

“What we start seeing, as has also been in the press here in the United States, or in some European countries, these are often the people who are higher educated who are having objections against immunisations, it is not a matter of not being informed, but it is a matter of being misinformed,” he said.

Vaccines protect the group not just individuals

Vandelaer also spoke about the importance of herd immunity.

Within any society there are always a small number of people who cannot be immunised, including the very young and children with compromised immune systems from cancer or other illnesses. These children rely on what is called herd immunity to protect them from vaccine-preventable illnesses.

As Vandelaer explained, “If you get above a certain threshold with immunisation, you protect a large number of kids, and if you do that and you manage to be above that threshold, you have enough children protected to make life for the virus difficult enough to find the few kids who are not protected.

“A virus will hop from one person to the next, but if a person is protected the virus can’t go any further. If you have enough of these people who are protected and the virus is hopping around and it hops onto a protected person, it can’t go any further,” he said

“When there are very few un-immunised children they are actually protected by the children around them. That is why it is important to vaccinate, not just to protect individuals, but also to protect the group.”

Elder explained that governments voice their concerns about the high prices of vaccines at the World Health Assembly every year.

Governments of the world’s poorest countries can access vaccines through the GAVI Vaccine Alliance, of which UNICEF is a member. These governments are required only to make a small copayment, and GAVI covers the rest of the cost, through donated funds.

However many of the world’s poorest people now live in middle-income countries, and their governments usually purchase vaccines directly from manufacturers, in a market shrouded in secrecy.

While compiling their latest report, MSF Access contacted governments and vaccine producing companies to ask for information about how much vaccines cost.

Elder said that none of the vaccine producing multinational corporations MSF Access contacted provided any data on how much they charged for vaccines and that they actually “[took] great lengths to conceal whatever price information possible”.

The companies did all tell MSF Access that they used a tiered pricing structure, so theoretically this should mean poorer countries pay less than richer countries to access vaccines.

Elder explained that one of the reasons MSF Access believes that vaccine prices should be made publicly available is because the data they did receive from governments did not necessarily reflect the tiered pricing structure that the vaccine manufacturers claim to use.

“When you actually look at the [limited] data, and look at the prices governments are paying vis-à-vis their economic level there isn’t this classic line,” Elder explained.

Another issue effecting vaccine supply is having a healthy market, preferably without monopoly or duopoly situations. MSF Access report that there is currently only one manufacturer (Serum Institute of India) who produce 80 percent of the supply of the measles vaccine and who are also the only WHO prequalified manufacturer of the MR vaccine (the combined measles and rubella vaccine).

This has actually resulted in a price increase for the MR vaccination, which the WHO now recommends as part of the basic vaccination package, and places a worryingly heavy reliance on a single manufacturer.

While UNICEF and the United States government both publish what they pay for vaccines, they are rare exceptions. Elder says that greater transparency is needed across the board so that taxpayers from the donor countries who support GAVI and middle income countries who buy their vaccines directly, know how much vaccines are costing their governments.

Edited by Kitty Stapp