Posts

vaccine accessibility
Vaccines are second only to clean water in reducing the rate of infectious disease. Vaccines prevent about 6 million deaths every year, and those that have been in use for decades show a 99 percent decrease in the rates of people contracting those diseases. Unfortunately, vaccines are not affordable for many people living in poverty throughout the world, making them much more vulnerable to infectious disease. Several factors contribute to the current lack of vaccine accessibility in many parts of the developing world. However, there are also significant improvements that are being made in decreasing the financial gap between those who receive vaccinations and those who do not, helping make vaccines more accessible to everyone.

The Current Situation

The price of the vaccine doesn’t always reflect the cost: People in developing countries are not only paying for the cost of manufacturing the vaccine, but also for expensive shipping costs, refrigeration, tariffs on imports, and taxes on medical supplies. These additional costs are often much more than the cost of the actual vaccine, and they make what would otherwise be an affordable vaccine inaccessible to a lot of people.

Clinic visits cost money too: In addition to buying the vaccine with all of its fees piled on top, people also have to pay to visit a clinic to receive these vaccines. The hours of health clinics are often inconvenient as well, forcing people to forgo wages from work in order to see a doctor.

Many vaccines require multiple rounds: A lot of vaccines, such as RTSS for malaria, MMR for measles and the HPV vaccine require multiple rounds of vaccination in order to be effective. This simply compounds all of the other barriers to vaccine accessibility; those receiving the vaccine have to pay for treatment again as well as take time off of work to visit a clinic.

Doctors are few and far between: In many parts of the developing world, there are very few doctors, and these doctors are limited in the number of patients they can treat each day. Therefore, even if one can afford to pay for the vaccine and can make it to a clinic, there is no guarantee that they will be able to be seen by a doctor.

Improvements to Vaccine Accessibility

Local health centers’ capacities are being strengthened: Gavi, a non-governmental organization dedicated to providing vaccines to the developing world, is working to strengthen the capacity of existing health centers to deliver immunizations. Gavi is working to increase the proportion of people who are receiving a full cycle of vaccines rather than “dropping out” after the first dose by providing sustainable funding to health clinics across the developing world.

Foreign aid decreases the price of vaccines: Providing foreign aid specifically for vaccines decreases the cost to those receiving treatment, and in turn, spares families from having to pay far more for treatment if someone contracted an infectious disease. Foreign aid for vaccinations has the highest return on investment of any type of aid besides education.

People are going beyond wanting to vaccinate to actually vaccinating: The Poverty Action Lab at MIT is implementing research on how to motivate people from desiring to vaccinate to doing it. This research is increasing the numbers of people receiving preventative immunizations in the developing world and reducing the rates of disease.

Infrastructures to keep vaccines cold for cheaper: The governments of Ethiopia and Gambia have created cold chain infrastructures in order to reduce the cost of transporting vaccines that need to be refrigerated. These infrastructures are far from perfect, as some cold storage facilities in Ethiopia have not been kept as cold as they need to be in order to protect the vaccines.

However, progress is still being made in reducing the cost of vaccines and allowing them to be more accessible to those living in poverty. Gavi is working to implement more cold chain infrastructures in other countries in Sub-Saharan Africa.

Moving Forward

There is clearly still a long way to go in ensuring vaccine accessibility to everyone who needs it, but a lot of progress has been made in breaking down the current barriers to accessibility. Vaccines are much cheaper than the cost of treatment for those who have the diseases vaccines aim to prevent, and investing in vaccinations relieves the world’s poor of the additional burden of treatment costs. Vaccines are one of the greatest assets in our toolbox to fight poverty, and great strides are being made in the effort to make accessibility a reality.

Macklyn Hutchison
Photo: Flickr

Vaccinations in Egypt
Vaccinations have been proven to be the most powerful and most cost-effective health intervention that can be provided to a population. Vaccinations have been proven to reduce disease, disabilities and deaths, especially in children under the age of five. The majority of unvaccinated children reside in low to middle-income countries where health systems are compromised, such as Egypt. Vaccinations in Egypt have proven incredibly successful, but the country still has a ways to go.

There are three main organizations that supply vaccinations to low-income countries. These are UNICEF, the Pan American Health Organization and the Gavi, the Vaccine Alliance. These organizations understand the impact vaccinations have on the eradication of disease.

Vaccinations in Egypt Have a Track Record of Success

Vaccinations have had a large impact on the health of children in Egypt. The vaccinations in Egypt that have been the most successful are poliomyelitis and neonatal tetanus. These vaccinations are responsible for nearly eradicating these diseases. The last case of polio was recorded in 2004, and by 2005, only 25 cases of neonatal tetanus were recorded.

Egypt established the National Immunization Program in the 1950s, and the first vaccinations introduced to the population were tuberculosis and diphtheria. Pertussis and tetanus vaccinations in Egypt became available in the 1960s. In 1977, the measles vaccination was introduced, followed by the measles, mumps, and rubella (MMR) combination in 1999.

However, better access to vaccinations in Egypt is critical. Measles and rubella were the most common diseases prior to vaccination programs in 1977, and even though it has been estimated that as of 1999, 95 percent of children were vaccinated with MMR, there were still major outbreaks of measles and rubella in Egypt between 2005 and 2007. Measles was considered endemic until 2008, when measles cases were estimated at less than one per every 100,000 people.

International Efforts to Increase Access to Vaccines in Egypt

Egypt has developed a strategy to increase access to vaccinations for the general population. The main organizations that coordinated and funded this plan are the Ministry of Health and Population, UNICEF and the World Health Organization. The plan is to increase access to vaccinations in Egypt in these ways:

  • Target 36 million children between the ages of two and 19
  • Maintain coverage of the vaccinations already supplied
  • Strengthen and increase school immunization programs
  • Obtain stronger disease surveillance
  • Improve social mobilization
  • Establish the Interagency Coordinating Committee

Egypt has put forth great effort to provide vaccinations to all of its children. However, there is still a substantial need for more vaccinations in Egypt.

There are nonprofit organizations that are working to improve this situation for Egypt and other countries in need. The Access to Medicine Foundation is motivating the pharmaceutical industry to aid low to middle-income countries such as Egypt. In 2008, the Access to Medicine Foundation published the first Access to Vaccines Index. This index acknowledges the pharmaceutical companies that are responding to the need for vaccination in low-income countries and highlights each company’s progress. There are many positive actions that are improving access to vaccinations in Egypt and other low-income countries. However, the need is still present and crucial.

– Kristen Hibbett
Photo: Flickr

mmr vaccine
Measles, mumps and rubella are all viral diseases that can interrupt the development of children and adolescents. Accessing reliable information about the MMR vaccine is the most cost-effective method to increasing its uptake.

The MMR vaccine is recommended in childhood. The three-in-one vaccine is necessary for most children to enter school and can be given as early as 11-15 months, and children should get two doses. In addition, adults born after 1956 or 18 years or older should also receive one dose of the vaccination unless they have already had all three diseases.

The MMR vaccine can be given at the same time as other vaccines. Young children (under 12 years) can get a combination of vaccines known as the MMRV (measles, mumps, rubella and chicken pox).

Upon receiving the vaccination, there are some risks involved, but most people who receive the vaccine do not develop any problems.

Mild issues can occur 6-14 days after receiving the vaccine and can include any of the following: fevers, mild rashes, and swelling of cheek/neck glands. Moderate issues can range from: seizures, stiffness/ pain in joints, temporary low platelet count that leads to a bleeding disorder (1 in every 30,000 doses). Some severe and very rare problems are: serious allergic reaction (1 in every million doses), deafness, permanent brain damage, and long-term seizures/comas. There is no evidence that the vaccine causes childhood autism.

All of these listed risks are small however, in comparison with the risks of contracting measles: severe illness, hospitalization and death. The vaccine itself has brought huge leaps in early childhood disease prevention, providing vaccination to over 500 million people worldwide in over 100 countries. Before the vaccine, mumps was the most common cause of viral meningitis in children and rubella caused terrible damage to unborn babies.

Now, both mumps and rubella are virtually non-existent in children.

The Measles Outbreak

With concern to the current measles outbreak of 2014, two doses are recommended because 2-5 percent of vaccinated people do not respond to their first dose. More than 99 percent of people develop immunity after
the second dose.

Out of the 593 confirmed cases of measles, very few were from people who had been vaccinated twice.

The virus itself can stay in the air for two hours after a person with measles symptoms have left the area and is spread by respiratory droplets. The people infected are contagious four days before and after receiving the rash.

International Outbreak

In the third world countries of the world, measles outbreaks have been spreading more freely, with thousands of cases. In the Philippines, there were 50,000 registered cases and 77 deaths. In Vietnam, there are at least
8,700 cases with 112 deaths in children. In Pakistan, over 30,000 people have caught measles and 290 people have died, with the number increasing daily for children alone. The effect of measles has been spreading due to a lack of proper vaccination, more vulnerable immune systems and misinformation (MMR vaccine may produce autism).

In Africa, the number of measles-related deaths have decreased by 91 percent due to a surge in immunization. However, cases have still been growing, a number well into the thousands.

The potential benefits of the vaccine outweigh the risks. Parents should understand that the MMR vaccine is the best way to protect their children from these diseases, especially if traveling to an affected area, or the family resides in an affected area.

Ashley Riley

Sources: About, About 2, CDC, CDC 2
Photo: Medimoon

More Midwives Needed in NepalNepal’s maternal mortality rate (MMR), or the ratio of maternal deaths per 100,000 live births for reasons related to pregnancy or birth, has declined in Nepal over the last fifteen years. It is estimated that between 1996 and 2005, Nepal reduced its MMR from 539 deaths to 281. It was estimated in 2010 to be around 170.

These declines, similar to those seen in countries such as Bangladesh, Malaysia, and Thailand, are cause for hope. However, health care experts say the gains in Nepal are unsustainable if the country does not address its need for more health care professionals, especially midwives, to prevent women from dying in childbirth.

Declines in maternal mortality rate are attributable to a number of factors other than improved health care access or services. Nepal’s paradox is that even though the MMR is decreasing, access to skilled birth care is still very low. In general, improved health care positively correlates with reduced MMR, but sub-Saharan Africa and Asia have not demonstrated a strong correlation so far due to lack of skilled birth care.

Experts in maternal health do not have the data necessary to determine the exact causes of the decline, but there are multiple factors involved. The top reasons are the social empowerment of women, reduced fertility, and government health care programs. Nepalese women are now having fewer children on average, and have more access to contraception and family planning tools. Women’s life expectancies and literacy rates have increased as MMR has declined. Women are now also offered financial incentives to seek medical care during pregnancy and have more access to affordable, life-saving health care such as blood transfusions.

Nepal is on track to meet its Millennium Development Goal of reducing MMR by 75 percent, to 134 deaths per 100,000 live births. When it reaches that point, the country will require the help of more midwives and health care workers trained in birthing to further reduce maternal mortality. A 2012 UN study found that a midwife in attendance during birth can reduce up to 90 percent of maternal deaths.

– Kat Henrichs

Source: IRIN
Photo: Midwife Ramilla