Where we must vaccinate
KARACHI/GANDHIDHAM-GUJARAT – With measles outbreaks currently spreading across Europe and the Midwestern United States, and meningitis infecting US college students, health experts are doing something they never thought they’d have to do in early 2017: reminding people in developed countries that vaccines save lives.
Perhaps vaccines are a victim of their own success: they work so well in protecting people against certain illnesses that many in the West have forgotten how devastating preventable diseases can be. With the recent outbreaks in the US and Europe, parents are being reminded that foregoing vaccinations for their children is a deadly gambit.
Sadly, in many other parts of the world, particularly South Asia, parents need no reminding that immunisation saves lives. What they need is access to vaccines.
Preventable disease outbreaks, rare as they are in Western countries, are all too frequent occurrences in a region that is home to the world’s largest number of unvaccinated children. In the early 1980s, one of us almost lost our baby son to bacterial meningitis, because no vaccine was available in Pakistan at the time. The boy made a full recovery, but only because of an early diagnosis and care at a premier hospital, which is out of reach for many parents in Pakistan. The boy’s siblings were later vaccinated, too, but only after stocks of the vaccine were secured in the US and hand-carried back to Pakistan.
Fortunately, going to such lengths is largely unnecessary today. On average, 90% of children in South Asia now receive vaccines for preventable illnesses such as tetanus, influenza, diphtheria, and pertussis, and the number of infants protected against Hepatitis B has increased by nearly 60% in the last decade. Moreover, six countries in the region were declared polio-free in 2014, following extensive vaccination campaigns. Only those living in marginalised and remote areas remain unvaccinated for polio, typically owing to local hesitancy and refusals.
Collectively, these remarkable figures amount to a public health miracle. But too many children are still suffering needlessly. The just-concluded World Immunisation Week (April 24-30) should spur us to redouble our efforts to vaccinate the millions of children in South Asia who remain unprotected from preventable illnesses.
Globally, more than 11 children under the age of five die every minute, many of them in South Asia, from preventable diseases. Despite the region’s progress, one in four children remain unprotected against diseases like measles and hepatitis, and the figures are even higher for major killers such as pneumonia and meningitis. As a result, the mortality rate for children in South Asia today is almost twice as high as it was in the US 50 years ago.
We have the tools to address these shortcomings and ensure that no child dies unnecessarily from an illness that vaccination could have prevented. To succeed, however, several obstacles must be overcome.
First, we must resolve systemic weaknesses in the region’s underdeveloped health systems, by improving training for health workers, ensuring proper storage and transportation of vaccines, and developing effective ways to deliver them. These improvements, together with more effective information sharing in the medical profession, are critical for better planning and accountability as well.
Second, we must actively confront the growing anti-vaccine lobby, which threatens to undo the gains made in recent years. These groups spread falsehoods about vaccine safety that can lead parents to leave their children unprotected. Foregoing vaccinations not only puts the health of individual children at risk; it also raises the likelihood of outbreaks that jeopardise the health of entire communities.
Finally, we must continue to encourage countries in the region to increase vaccine coverage rates, in particular with newer vaccines proven to protect against pneumonia and diarrhea, the two leading infectious killers of children.
Positive steps are already being taken to realise these goals. In Pakistan, for example, officials in Punjab province, hoping to protect one million children from a common form of diarrhea, recently introduced the rotavirus vaccine. Next door, India has vaccinated close to four million children since launching an initiative to expand the rotavirus vaccine’s coverage in ten states, and plans to reach 13 million children by the last quarter of 2017.
There is still much to do in both countries. In India, 13 million children annually are not reached with the rotavirus initiative; in Pakistan, five million children annually are not vaccinated. But, with help from Gavi, the Vaccine Alliance, more vaccines are being brought to the world’s poorest communities through funding, training, and delivery. Health officials everywhere can learn from and replicate the gains made in these two countries.
We are at a pivotal moment in the global vaccination drive. As pediatric professionals who have dedicated our lives to protecting children from preventable diseases, we believe it is within the world’s capacity to end this needless suffering. Vaccines are a proven tool for improving children’s health and development. Ensuring that children have access to them is an achievable public health goal behind which parents and pediatricians everywhere should unite.
(Zulfiqar A. Bhutta is Founding Director of Aga Khan University’s Centre of Excellence in Women and Child Health in Karachi, Pakistan, Co-Director of SickKids Centre for Global Child Health, in Toronto, Canada, and President of the International Pediatric Association. Naveen Thacker is President of the Asia Pacific Pediatric Association and Coordinator of the International Pediatric Association, based in Gandhidham-Gujarat, India.) Courtesy : Project Syndicate, 2017. Exclusive to the Sunday Times.
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