Why Do Vaccine Schedules Differ
The chickenpox example
Chickenpox is an example of a vaccine that some countries adopt into their routine childhood vaccination schedules, while others do not. The question that follows is why there is a difference in opinion for introducing widespread uptake of a vaccine or not. Japan was one of the first countries to adopt universal chickenpox vaccination.46
Australia, Canada, Germany, Qatar, Republic of Korea, Saudi Arabia, Taiwan, Uruguay, U.S., Italy and Spain followed afterwards and adopted universal chickenpox vaccination. When extreme cases of chickenpox have occurred there have been calls for the vaccine to become available for free through the National Health Service in the UK. However, most European countries do not vaccinate against chickenpox, except for at risk groups. The main reason for not adopting universal vaccination is the high cost. Additional supporting justifications are that it is usually a mild disease and the benefit of fewer cases of shingles as explained here.
What Are The Benefits Of Eradicating Diseases
The immediate benefit of eradicating a disease is obvious preventing suffering and saving peoples lives.
But eradicating a disease can also have significant economic benefits. Disease eradication takes years to achieve and requires a lot of financial investment: smallpox eradication had an estimated cost of $300 million over a 10-year period polio eradication efforts to date amounted to $4.5 billion.14 But, as the chart here illustrates, while the initial costs of disease eradication efforts are high, in the long-term these costs pay-off. Simply controlling a disease can be more expensive because of the continued burden a disease poses on a healthcare system and the lost productivity of a sick population.
How much we should spend on eradicating a disease? There will always be other good causes we can spend money on. These include non-health causes, health causes with greater burden, eradication of different diseases, and even research into more cost effective treatments instead of eradication. The scenario or intervention which brings the highest benefit needs to be assessed for each disease separately.
As a classical paper by Walter R. Dowdles classical paper on disease eradication states: Elimination and eradication are the ultimate goals of public health. The only question is whether these goals are to be achieved in the present or some future generation.15
Eradicating vs controlling a disease: schematic comparison of the costs
What Are Vaccines Made Of
Each vaccine will be made up of slightly different ingredients depending on the disease it is targeting. The active ingredient in a vaccine is a very small amount of the killed, greatly weakened or broken-down parts of the bacteria or virus you are vaccinating against. Vaccines also contain small amounts of preservatives and stabilisers, such as sorbitol and citric acid. These can already be found in the body or in food usually in much larger quantities than the amount used in a vaccine. However, the most abundant ingredient in a vaccine is water.
Some vaccines also contain aluminium usually in the form of aluminium hydroxide. Aluminium is found naturally in nearly all food and drinking water and is used in vaccines to strengthen and prolong the immune response they generate.10 The amount of aluminium in vaccines is extremely small and a recent study found that, in an infants first year of life, the total amount of aluminium in both vaccines and food is less than the weekly safe intake level.11
Immunisation is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year – World Health Organization
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Diseases The Us Eliminated Thanks To Vaccines
An article in Business Insider outlines six diseases eliminated in the U.S. due to vaccines.
The six diseases:
1. Smallpox: The U.S. announced smallpox eradicated in 1972. Less than a decade later, it became the first and only disease eliminated worldwide.
2. Polio: A polio vaccine was unveiled in 1955, and the disease was declared eliminated by 1979.
3. Diphtheria: People first received the vaccine in the 1920s, and the CDC reported less than five cases in the U.S. over the past decade.
4. Mumps: Only a few hundred people in the U.S. contract the disease every year, thanks to a vaccine introduced in 1967.
5. Measles: The CDC recently warned the U.S. could lose its elimination status if the country’s current outbreak continues through the fall.
6. Rubella: Vaccines were first introduced in the 1960s, and the World Health Organization rubella eliminated from the Americas in 2015.
The Microbiologists Checklist For Disease Eradication
To determine if a disease can be eradicated, consider the science, the political climate and the economics involved. Focusing on the scientific criteria, scientists and public health officials can study the eradication campaigns for smallpox and rinderpest. Both of these diseases had particular characteristics that facilitated their eradication.
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How Do Mandatory Vaccination Policies Vary By Region
We found that assessing policies across WHO regions European, Americas, Western Pacific, African, and Eastern Mediterranean was a useful way to break down our analysis of policies worldwide.
In the chart you see a breakdown of the number of countries with a given policy mandate. You can view this by region by using the Change region toggle on the interactive chart.
Europe has a mixture of mandatory and recommended policies. But most European countries 16 out of 28 do not have mandatory vaccination. European countries were among the first to introduce mandatory vaccination for smallpox in the early 19th century, which also led to early push-back. The early introduction and early push-back, along with present-day approaches to foster mutual trust and responsibility between citizens and the health authorities, may be part of the reason why vaccination is often recommended rather than mandated in many European countries.50 Countries of the former-USSR or under the influence of the Eastern Bloc previously had mandatory vaccination, and many kept this policy in the post-USSR era.
Most countries in the Americas 29 out of 35 have mandatory vaccinations. In the USA, vaccination is regulated by individual states though it is mandatory for school entry in all of them. In Canada, only three provinces have legislated mandatory vaccination policies that apply to children enrolling in school.
Diseases Nearly Eliminated By Vaccines
Human health has improved dramatically since the introduction of vaccines. Before widespread vaccination, diseases like polio, smallpox, rubella, and measles crippled and killed millions of people each year. Now that vaccines for children are common, some of these diseases are virtually non-existent. The World Health Assembly declared smallpox eradicatedeliminated worldwidein 1980, and the Global Polio Eradication Initiative has managed to drastically decrease polio cases.
Lest we forget why vaccines are important, heres a look at 14 diseases that once ravaged families and communities.
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Relationship Between Eradication And Comprehensive Health Services Development
There has been longstanding, sometimes acrimonious debate between advocates for eradication and advocates for development of comprehensive health services . PHC advocates assert that eradication efforts divert severely limited funds and efforts from comprehensive development . Eradication advocates point out the permanent benefits of absence of disease and assert that their efforts strengthen the overall PHC infrastructure, as well as asserting that eradication efforts capture the imagination and attract resources that would otherwise not be available . There is evidence that both are correct, at least to some extent.
Taylor et al pointed out that polio would not be a high priority in many developing countries in the absence of the eradication movement and that economic benefits from eradication will accrue mainly to the industrialized countries, which are now polio-free, rather than to the polio-endemic poorer countries, which are having to spend limited health resources on polio eradication. In response, Sutter & Cochi pointed out that polio does pose a major problem in developing countries and that substantial external assistance is being provided to the poorer countries to ease the burden on domestic resources.
Is The Disease Easily Diagnosable Or Recognizable
Disease symptoms are one way to quickly diagnose the presence of a disease at the individual or community level. The smallpox eradication campaign benefited from the characteristic sores and rashes caused by VARV infection. These distinct symptoms allowed health officials across the world to easily and effectively diagnose patients and track disease epidemiology in their communities. As another example, poliomyelitis, caused by poliovirus , produces characteristic, rapid-onset paralysis in a subset of patients that has been used as a marker for active community transmission.
The more sophisticated the methods of disease diagnosis, the less likely that disease will be eradicated. Malaria, a disease that has been targeted for elimination, historically required skilled medical professionals able to interpret patient blood smears to identify infected individuals. The lack of trained parasitologists in endemic areas proved to be one of the reasons why the 1950s campaign to eradicate malaria failed.
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Financing The Development Of New Vaccines
Table 3 indicates some of the organisms that are currently the target of vaccine research recent and continuing technical advances should make it technically possible to develop effective vaccines against most of these pathogens. However, whether all these vaccines will prove cost effective or be used widely enough to provide a sufficient financial return to the manufacturer is uncertain, as illustrated by the recent case of a serogroup B meningococcal vaccine developed using an innovative technical approach but whose deployment in the UK is being queried on the grounds of cost effectiveness .
Smallpox: 200 Years Between Vaccine And The Disease Eradication
The last recorded case of smallpox occurred in 1977 in Somalia. The disease was officially declared eradicated by the World Health Organization in 1980.
From the invention of vaccine against smallpox by Edward Jenner in 1796, it took almost two centuries to eradicate the disease.
It was only with the establishment of the World Health Organization in the aftermath of World War II that international quality standards for the production of smallpox vaccines were introduced and the fight against smallpox moved from national to an international agenda. In 1966, the WHO launched the Intensified Smallpox Eradication Program. By then smallpox cases and deaths in Europe and North America had been driven down substantially but large parts of Asia and Africa still struggled under smallpoxs disease burden.
Shown in the chart are the number of reported smallpox cases from 1920 until the last case in 1977. Even though smallpox had high visibility and should therefore have been relatively easy to document, the lack of an international organization dedicated to global health means the number of cases was likely much greater.
The world map illustrates the year the variola virus was no longer endemic in a country.16
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How Effective Is Vaccination
Vaccination is extremely effective with most childhood vaccines effective in 85% to 95% of children who receive them.1 It is considered one of our greatest global health achievements and is estimated to save 23 million lives a year.2 Thanks to vaccines, life-threatening diseases that used to be common in young children in the UK, such as diphtheria, whooping cough and polio, are now relatively rare. Looking at the history of vaccine-preventable disease, there is a huge drop in the number of cases of a disease following the introduction of a vaccine against it. If smallpox had not been eradicated, it would cause 5 million deaths worldwide a year!3 Through vaccination, some diseases have even been eradicated completely, for example smallpox.
Eradication: Definitions Determine Success
Eradiction can be hard to conceptualize. Infectious disease anthropologist Thomas Aiden Cockburn defined disease eradication as the extinction of the pathogen that causes disease. By this definition, smallpox and rinderpest are not eradicated. Samples of both viruses still exist in the world: the United States and Russia have stocks of VARV securely stored, while samples of RPV remain in many facilities around the globe. Extinction would require the destruction of these stocks, a complex topic involving geopolitics and cultural norms, as well as microbiology.
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How Do I Know Vaccines Are Safe
Before a vaccine can be given to the population it must go through rigorous testing. Like all medicines, vaccines go through many clinical trials, where they are administered and monitored in groups of volunteers. In the UK, the results of trials are then assessed by the Medicines and Healthcare products Regulatory Agency . Once licensed, the vaccine must then be further approved by the MHRA before it is added to the routine vaccination programme. Even once a vaccine becomes part of the vaccination programme, it is continually monitored for safety and effectiveness by the MHRA. Any suspected side effects are reported by medical providers or patients to the MHRA using the yellow card scheme. No medicine can ever be completely risk free or 100% effective. However, strong licensing processes and safety tests ensure that the health benefits of medicines being given through the NHS greatly outweigh any risks. As vaccines are given to healthy people, these regulatory measures are even stricter, meaning that the level of acceptable risk for vaccines is much lower than it would be for other medicines.9
People Do Not Know How Well We Actually Do In Global Vaccination
Today vaccines protect millions of people around the world from infectious diseases. In this fight we are much, much further ahead than most people realize.
The first chart shows the evidence for this misperception. In this chart we plotted the survey responses that people gave when they were asked How many of the worlds 1-year old children today have been vaccinated against some disease?. The correct answer was 85.8% this is the share of 1-year olds that received the third dose of the combination vaccine that protects against Diphtheria, Tetanus, and Pertussis .
But in all countries in which people were surveyed people were much too pessimistic about the global coverage. Americans think that only 35% of the worlds children are vaccinated, the true coverage is 50 percentage points higher.22
In Japan people were even more pessimistic and thought that only 18% were vaccinated. As it is often the case in questions on global development we again see that people in poorer countries have a more accurate view of the world: in Kenya and Senegal people thought that vaccines reach around two thirds of all children in the world, but even these highest estimates are 20 percentage points too low.
We hugely underestimate global vaccination coverage23
Peoples view on vaccination coverage is outdated by more than three decades
We have created a chart that shows the absolute number of one-year-olds who have received the vaccinations.
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Not Every Child Who Should Be Vaccinated Is Vaccinated
Global vaccine coverage
This chart shows the global vaccination coverage of one-year-olds with some of the most important vaccines recommended by the WHO. For many essential vaccines coverage is now much higher than 80%. However, the rates of vaccination are still not sufficient.
If you click the play button you see that the coverage for most vaccines has increased substantially over time.
The vaccine against diphtheria, tetanus and pertussis, is often used as the key metric for global vaccination coverage because it is a good indicator for access to routine immunization services. In 2018, coverage of the third dose of DTP was 86%. This means that out of 135 million under-one-year-olds more than 19 million did not receive full immunization. The coverage of the first dose of DTP was 90% indicating that 13.5 million children were not vaccinated in 2018.
In 2018, only 35% of children globally received the rotavirus vaccine, which protects children from diarrheal diseases one of the leading causes of child mortality. Similarly, pneumococcal vaccine that protects children from pneumonia the leading cause of child mortality only reached 47% of one-year-olds.1
Related chart the number of children vaccinated. This chart shows how many one-year-olds were vaccinated globally.
Prosperity and vaccination coverage
Why do not all children in the world receive vaccinations?
Global Decline In Vaccine
The WHO estimates that 2 to 3 million deaths are prevented every year through immunization against diphtheria, tetanus, whooping cough, and measles.12
Nonetheless, the WHO also estimates that VPDs are still responsible for 1.5 million deaths each year.
In the chart we see the global number of deaths of children younger than 5 years per year from 1990 to 2017. The number of deaths which are wholly or partially preventable by vaccines are shown in color.13 The chart shows that the reductions in child deaths over this 25-year period were primarily achieved by a reduction of the number of deaths from vaccine-preventable diseases: The decline in causes which are not vaccine preventable has been modest, while the number of child deaths caused by diseases for which vaccines are available declined from 5.1 million deaths in 1990 to 1.8 million deaths 27 years later.
Two vaccines are responsible for saving millions each year: DTP against diphtheria, tetanus, and pertussis and MMR against measles, mumps, and rubella.14 Before the measles vaccine was introduced in 1963, measles caused a large number of deaths globally, estimated at 2.6 million each year. Because about 86% of the world population is immunized today, the number of people killed by measles have been cut dramatically to an estimated 95,000 deaths in 2017. Tetanus and pertussis were also previously much bigger killers, with pertussis affecting especially children younger than 5 years and tetanus striking newborns .
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