“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