Vaccines in Developing CountriesHow much can the world really rely on vaccines as a cure to disease? For many impoverished communities, the jury is still out; many recent studies show that vaccines in developing countries are more ineffective than those in developed, high-income nations.

However, developing countries are at greater risk for all infectious diseases than developed countries. The World Health Organization (WHO) documented that the “total number of healthy life years lost per capita was 15-times higher in developing countries than in developed countries.” In addition to this imbalance, vaccines in developing countries also threaten these nations with ineffective treatment. Due to the many factors that impact disease, it is difficult to pinpoint specific causes behind vaccine acceptance or denial. However, the health effects of poverty contribute to the reasons why vaccines in developing countries are often ineffective.

How Poverty Increases Sickness

Poverty is a health epidemic. In 2008, PBS aired an original docu-series called “Unnatural Causes” that outlined the ways diseases disproportionately affect poor and marginalized groups. The show posed one overarching, famous question: “Is inequality making us sick?” In the assessment of vaccine effectiveness in rich versus poor countries, the creators of “Unnatural Causes” say the answer is yes.

A functioning immune system is largely responsible for an individual’s ability to make antibodies, the infection-fighting proteins developed via vaccines. Impoverished people often do not have high-functioning immune systems. This means that they cannot produce antibodies as well as their developed-nation counterparts.

Multiple factors contribute to the prevalence of ineffective immune systems in developing countries. The overpopulation and crowding common in low socioeconomic areas increase the risk of disease exposure. Pre-existing health conditions, resulting from vitamin deficiency and little clean water or sanitation, increase individual susceptibility to sickness. Further, unreliable health care places systemic, structural constraints on impoverished communities. In this way, poverty and disease continually reinforce each others’ negative effects.

Comparison Studies: Developed Nations vs. Developing Nations

Water-borne diseases, malaria, tuberculosis and HIV/AIDS continually afflict developing countries. They may be responsible for damaging people’s natural immunity, thus decreasing the likelihood of vaccine acceptance. Indeed, one study found that these diseases “may damage lymph node structures that are crucial to developing immunity after a vaccine.”

This study from the University of Minnesota compared Americans to Ugandans. Researchers discovered all the Ugandans had “significantly higher levels of inflammation in their bodies and a depleted supply of protective T cells.” In addition, the Ugandan’s lymph nodes (which help filter infections and respond to vaccines) were inflamed and scarred. None of the American participants had these issues. After administering a yellow fever vaccine to the Ugandan test subjects, researchers discovered a positive correlation. The more damaged their lymph nodes, the less likely it was for antibodies to form.

Another series of studies in Dhaka, Bangladesh discovered that a poor response to vaccines in developing countries could be correlated to the small intestinal bacteria endemic to low-income countries. Petri’s team surmised that “inflammation [in the intestine] could prevent vaccines from lingering in the gut and could keep the immune system from reacting to them.” The team also identified a similar issue with rotavirus vaccine response. In contrast, 98% of children in the developed world do not have complications after vaccination.

The Future of Vaccines

According to the World Bank, “nearly half of the world lives on less than $5.50 a day.” In addition, only 59 of the 195 countries in the world possess a Human Development Index (HDI) at or above 0.8, making them developed countries. This means that ineffective vaccination responses affect the majority of the world’s nations. Thus, the world needs a systemic change in public health to fix this issue. Studies in Bangladesh and Africa “are testing whether sanitation interventions such as installing hand-washing stations in rural homes” can relieve the gut inflammation thought to be causing poor responses to vaccination.

However, even though vaccines in developing countries are sometimes ineffective, routine vaccination for infants and children may help. Young children are less likely to have the long-term health effects responsible for ineffective responses to vaccines, with the exception of illnesses inherited from a mother’s womb. WHO estimates that approximately 70% of the 9 million deaths from children under five “could be prevented or treated with access to simple, affordable interventions,” including vaccines.

Vaccinating Children in Developing Countries

Still, the complicated relationship to vaccines in the developing world is palpable. One study in India found that there is only a 55% rotavirus vaccine efficacy rate in young children. However, India’s plan to make the rotavirus vaccination routine may “save 27,000 of the 78,000 young lives that infections claim every year.”

Thus, expanding coverage of vaccines in developing countries has proven successful in many cases. Various programs work to extend this success. Since 1990, WHO’s Expanded Programme on Immunization has helped decrease mortality rates among infants and children via vaccination. The Global Vaccine Alliance has also “vaccinated more than half a billion additional children since its founding in 2000,” often in developing countries. While routine vaccination is not a panacea, it helps prevent disease before long-term health issues develop.

Improving World Health

Obviously, this is a hefty challenge. Changing human response to vaccines will take years of improving sanitation and living conditions. In addition, developed countries often receive vaccines first and in larger quantities due to having more money. In the meantime, scientists and doctors are experimenting with speedier methods to the vaccine problem. Take mesalazine, a drug that treats the bowel inflammation preventing antibody response to vaccines. This drug could possibly treat unreliable oral vaccines for stomach illnesses. Recognizing the issue of vaccines in developing countries is the first steps in improving global health.

Grace Ganz
Photo: Flickr

Vaccines in Developing Countries
It is estimated that immunization practices save two to three million lives each year. The development of vaccines and mass immunization practices have helped eradicate deadly diseases such as smallpox, while drastically reducing the number of people infected by influenza, hepatitis A and B, rubella, measles, chickenpox, polio, tetanus, mumps and other preventable illnesses. Vaccines also help prevent outbreaks and epidemics by increasing the number of people immune to various diseases within populations. Despite these benefits, global vaccine coverage is inadequate. Developing countries, in particular, often lack access to life-saving vaccines. Here are six facts about vaccines in developing countries.

6 Facts About Vaccines in Developing Countries

  1. An estimated one-quarter of all deaths in low-income countries are attributable to communicable diseases. More than 1.5 million people die annually from diseases that are preventable through vaccination. In 1990, 2.5 million children in developing countries under five died from vaccine-preventable diseases such as rotavirus, measles and pneumococcal disease. No deaths were attributable to these diseases in industrialized nations. Efforts to expand access to vaccines in developing countries reduced the child mortality rate to 750,000 in 2013. Despite this improvement, 19.7 million children under the age of one still lacked access to basic life-saving vaccines as of 2019.
  2. High manufacturing costs for vaccines hinder accessibility in many developing countries. Poverty-stricken nations often rely on vaccines to be imported from developed nations. Inefficient public health infrastructure and a lack of resources for transporting vaccines pose an obstacle to widespread immunization access.
  3. Developing countries continue to lack access to vaccines. Vaccine coverage has remained unchanged throughout the past few years in many developing countries, despite global advances in immunization knowledge and technology. Humanitarian crises caused by conflict and natural disasters threaten to perpetuate this stagnation in vaccine access.
  4. Several preventable diseases are making comebacks. In recent years, an increase in vaccine hesitancy among populations in developing countries has resulted in reductions in already poor immunization rates. The result has been outbreaks and resurgences of vaccine-preventable illnesses such as measles, diphtheria and even polio.
  5. Vaccinations also have significant economic benefits. Expanding access to vaccines in developing countries is a strategic economic investment because the financial and human costs of death and disease outweigh the burden of implementing immunization programs. Between 2001 and 2020, the economic benefit of vaccinations in developing countries was nearly $2.3 trillion.
  6. The World Health Organization has proposed the Immunization Agenda 2030 to address vaccine access. This program plans to address the shortcomings and challenges of immunization globally, including the recent outbreaks of infectious diseases such as Ebola and COVID-19. The Immunization Agenda 2030 envisions “a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being.” Amidst the current COVID-19 global pandemic, its mission to improve access to life-saving vaccines in developing countries is more important than ever.

These six facts about vaccines in developing countries highlight the work that still needs to be done. Moving forward, it is essential that the World Health Organization and other humanitarian organizations make increasing access to vaccines a priority.

– Alana Castle
Photo: Flickr

Vaccines in Developing Countries “Thanks to vaccines, more children are now living to see their fifth birthday than at any point in history.” Dr. Seth Berkley, CEO of Gavi, said.

While this is an inspiring fact, the truth is that immunization rates in some developing countries are becoming stagnant.

The Plateau of Immunization Rates

The immunization rates of the vaccine for diphtheria, tetanus and pertussis (DTP) usually reflect the quality of the overall immunization coverage within a nation. In the last three years, the immunization rate for the third dose of DTP in Chad has remained at 55 percent. The immunization rate for DTP in Somalia has been about the same since 2009. Guinea, whose DTP immunization rates used to be around 70-80 percent 10 years ago, now has had a rate of 63 percent for the last four years.

This data is somewhat shocking, considering a global effort to prioritize vaccines began in 2000. The same year, Gavi, a global Vaccine Alliance, was created with the help of a $750 million donation from the Bill & Melinda Gates Foundation. Since 2011, Gavi has surpassed its own goals of decreasing child mortality, averting future deaths and increasing child immunization in the more than 60 countries that are Gavi-supported. In just five years, Gavi was able to provide vaccines to 34 million more children than what was anticipated, and the group began administering vaccines for pneumococcal and rotavirus one year ahead of schedule.

Maintaining the Vaccine Schedule

Nonetheless, groups like Gavi struggle to keep immunization active in developing countries after the child is no longer an infant. For example, the vaccine for human papillomavirus (HPV) is typically administered in two doses within 1-2 years for children above the age of nine. HPV can cause cancer, especially in those with weak immune systems, so it is important to time the vaccine administration effectively in order to be nearly 100 percent protected. Since there is no health plan that puts emphasis on older children, HPV becomes more of a threat in countries that do not enforce the strict vaccine schedule.

The World Health Organization has a plan to fix this. The Global Vaccine Action Plan (GVAP) is set to address health program expansion to include services beyond infancy by 2020. Ministers of Health from 194 countries agreed to support the GVAP, which includes nation-specific health program monitoring and strengthened leadership.

Negative Attitudes About Vaccines

Despite intervention from non-governmental groups, the plateau of immunization rates still exists. This may be due to negative attitudes towards vaccines in developing countries. The attitudes stem from the idea that vaccines are harmful or that the health workers are ingenuine. Citizens of three Nigeran states believed that the administration of the polio vaccine would spread AIDS in 2003, and in India, people believed that vaccines were a Western plot to instigate an undercover method of family planning to threaten Muslims. Researchers cite that a way to eliminate this anxiety is to take into account sociocultural behavior when implementing vaccine programs and to strengthen communication and advocacy in order to increase participation.

While negative attitudes towards vaccines contribute to plateauing immunization rates, the expensive price of vaccines may also be a contributing factor. In 2001, six vaccines from the World Health Organization cost less than $1. Now, 12 vaccines from the WHO cost up to $45.59. This can obtaining a vaccine for someone living in Madagascar extremely difficult – the monthly salary in Madagascar is $33.

Immunizations Eradicate Disease

By increasing immunization rates, diseases can begin to disappear. In the U.S., immunization rates in 2000 were at 91 percent for the measles, mumps and rubella vaccine, and the Center for Disease Control declared measles to be officially eradicated. Since then, diagnoses of measles have increased slightly among populations that are unvaccinated.

Despite these few diagnoses, the majority of the U.S. will never come in contact with measles. Dr. Jean Campaiola, hospital psychiatrist, describes this result as “herd immunity.” Herd immunity occurs when a certain percentage of the population receives the vaccine for a particular disease. For some diseases like measles, the percentage is at least 90-95, but for polio, the percentage is 80-85. This means that 20 percent of people could deny receiving the polio vaccine and still be protected from the disease because the remaining 80 percent were vaccinated.

“If this occurs rarely in a population, it’s not a big deal, but if it becomes more common, then previously eradicated diseases could make their way back into the general population,” says Dr. Campaiola. She said fears that the anti-vaccine attitude in the U.S. could cause previously eradicated diseases to re-emerge.

By administering more vaccines in developing countries, an entire community can be protected by herd immunity. Those most vulnerable to diseases (infants and the elderly) can be immune to certain diseases if more people around them receive vaccines.

In third world countries, governments spend $29 for each person’s health. In the U.S., the government spends $4,499. There is a clear need for vaccines in developing countries around the world, including a larger-scale project to improve coverage. Gavi’s next step in revolutionizing immunization is a five-year program to introduce sustainable health programs in low-income countries and to increase equitable use of vaccines. The U.S. has the power to spread the good message of vaccines, and someday, we can eradicate most major diseases all around the world.

– Katherine Desrosiers
Photo: Wikimedia

important and impactful vaccinationsVaccines are small doses of a disease or virus that prepare the body’s immune system for any future encounters with that disease. After exposure to the disease through vaccination, the body builds up resistance to that specific disease. The development of these important and impactful vaccinations has led to the eradication or near eradication of several diseases that brought death and disability to thousands.

Polio Vaccine

Polio is a disease caused by the poliovirus that can degrade an individual’s spinal cord and musculature. In extreme cases, polio leads to muscle paralysis and death if the paralysis invades muscles used for breathing. In 1952, Jonas Salk developed the first effective polio vaccine. After the development of the vaccine, mass immunization campaigns took place throughout the United States.

Governments then distributed polio vaccines throughout the world. By 1989, polio was eradicated in the Americas, and as of 2017 only Afghanistan, Pakistan and Nigeria had recorded cases of polio. Overall, the polio vaccination campaign is considered one of the most important and impactful global health campaigns in human history.

Smallpox Vaccine

Smallpox is an infectious disease most commonly known by the distinct progressive skin rash it causes that spreads across the body. The disease also gives individuals a fever and severely weakens the body. Approximately three out of 10 individuals that have smallpox die. Smallpox is believed to have dated back to the Egyptian era and caused many deaths throughout global civilization.

A vaccination for smallpox was formally discovered and published in 1798 by Edward Jenner. Throughout the 19th century, smaller scale vaccination campaigns attempted to eliminate the disease’s prevalence. It was not until 1967 that the World Health Organization coordinated a massive vaccination campaign to eradicate the disease globally. In 1977, the last epidemic of smallpox occurred in Somalia.

In 1980, the World Health Assembly officially declared the world rid of the disease thanks to the distribution of these important and impactful vaccinations. Today, the Centers for Disease Control and the World Health Organization describe smallpox eradication as the biggest achievement in public health history.

Yellow Fever Vaccine

Yellow fever is a mosquito-borne disease that affects countries in equatorial climates. Yellow fever causes serious bleeding of the internal organs and in many cases results in death. The illness derives its name from the jaundice symptoms, or yellow discoloration of the skin, that usually result from infection. In 1937, while conducting research at the Rockefeller Foundation in Ecuador, microbiologist Max Theiler developed an effective vaccination strain.

Later, the global health community distributed the vaccine to the countries most affected by the illness. In 1952, Theiler received a Nobel Prize for his efforts in disease eradication. Today, yellow fever outbreaks are common, but these important and impactful vaccinations continue to save millions of lives.

Furthermore, countries with disease prevalence are taking massive steps to eliminate yellow fever. For instance, as of January 2018, the Nigerian government has set a goal to vaccinate 25 million individuals in hopes of meeting a global effort to end all yellow fever epidemics by 2026.

Vaccinations are one way that foreign aid and global health work hand in hand to genuinely help humanity. While there are more diseases that need to be researched and certainly more vaccinations to distribute, it is important to take stock of historical public health achievements and incorporate their successes into future efforts.

– Daniel Levy

Photo: Wikimedia Commons

Pneumonia VaccineAccording to Dr. Seth Berkley, CEO of Gavi, within the last 10 years, the pneumonia vaccine has saved the lives of more than 500,000 children in developing countries. More than 109 million children have been given the PCV (pneumococcal conjugate vaccine) with Gavi’s support.

Although the numbers have now reached 41 percent from 2015’s 35 percent of receiver rates, millions of children are still not receiving the pneumonia vaccine. This is an issue because the disease is both treatable and preventable, but remains the leading cause of death in children throughout the world.

The pneumococcal vaccination protects the body against different types of the pneumococcal bacteria itself. The pneumonia disease is most common in children, and therefore the CDC recommends that all children be vaccinated. Although there are many different types of pneumococcal bacteria, there are only two types of the vaccination itself. The first vaccination to fight pneumonia is called Prevnar 13. This vaccination protects against 13 different types of the pneumococcal bacteria. The second type, Pneumovax 23, protects against 23 different types of the bacteria. Although this vaccine can save lives and prevent the disease, children in developing countries are nine times more likely to get the disease than people in developed countries.

Normally, children in developing countries receive vaccinations 10 years after children in wealthy countries do, but with the Advance Market Commitment, funded by Italy, Canada, Russia, Norway and the Bill and Melinda Gates Foundation, they were able to get the PCV vaccine as soon as a year after it was developed. The market legally binds commitment purchases of the vaccinations through preset terms. This concept has been around for a long time, but the Advanced Market Commitment’s tactics seem to be very effective. Gavi has reached 58 countries throughout Africa and Asia with their immunization programs. The continued push to immunize all children in developing countries will greatly affect these nations’ outcomes in the future.

– Chloe Turner

Photo: Flickr