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 The power of immunization
 Commentary: New agenda for vaccines

A spotty scorecard

Safety boxes, such as this one being used following a vaccination in Mozambique, are cost-effective ways to ensure immunization safety. Such measures help eliminate reuse of unsterile needles and prevent unsafe disposal practices.

The experience with polio, while filling us with satisfaction, must also drive us to consolidate our accomplishments by turning the power of immunization on diseases that are still killing millions of children and impairing the abilities of countless others. We must aim for full coverage and complete effectiveness of immunization, not the spotty scorecard that proclaims success in scattered corners of the globe and neglect in many others.

  • There are still 30 million infants in the developing world who are not immunized before their first birthday.

  • More than 900,000 children under five still die each year from measles.

  • Neonatal tetanus kills 200,000 each year.

  • Annually, 370,000 under-fives die from whooping cough and 50,000 from tuberculosis.

  • Diphtheria has re-emerged in parts of the former Soviet Union.

  • Half of all pregnant women are not immunized against maternal tetanus, which kills 30,000 women every year.

The continuation of this suffering and loss of life contravenes the natural human instinct to help in times of disaster. Imagine the horror of the world if a major earthquake were to occur and people stood by and watched without assisting the survivors! Yet every day, the equivalent of a major earthquake killing over 30,000 young children occurs to a disturbingly muted response. They die quietly in some of the poorest villages on earth, far removed from the scrutiny and the conscience of the world. Being meek and weak in life makes these dying multitudes even more invisible in death.

All children everywhere must be able to enjoy the benefits of science and experience developed around vaccines. All children everywhere, without discrimination, have and must be able to enjoy equal rights. The Convention on the Rights of the Child, ratified by all but two countries, binds the world in a compact to realize these rights. Distance and remoteness must therefore neither blind our vision, blunt our feelings, nor stall our response to this numbing, recurrent tragedy. It is our collective responsibility to see that these deaths are prevented.

And they are preventable. We can and must now go the distance and finish what so desperately remains to be done by unleashing the full power of immunization against the six traditional child-killer diseases.

Measles is still a severe threat, especially in South Asia and sub-Saharan Africa, and efforts are needed to stop the downward slide in measles coverage that occurred in Africa during the 1990s.

Half of the infants born in developing countries are unprotected against tetanus and 200,000 die from the disease each year because their mothers have not been immunized with tetanus toxoid. And as infants die, so too do women: In parts of Africa, fewer than 40 per cent of women are immunized against tetanus. In rural pockets of China and India, 10 per cent or less may be protected.

Whooping cough (pertussis) still afflicts 20 million to 40 million people every year, primarily in developing countries, although a pertussis vaccine has been available for more than 70 years.

Efforts to reach the unreached must go hand in hand with the improvement of immunization safety. Reuse of unsterilized needles, poor hygiene at the time of vaccination and inadequate waste disposal are the main culprits. Failures in the cold chain to maintain vaccines at the proper temperature are also a problem. Personnel must be trained and systems introduced to prevent these dangerous practices.

The Safe Injection Global Network – which links international organizations, NGOs and private sector entities – is promoting the use of syringes that function only for a single dose. It is also investigating the possibility of introducing vaccines that don’t require needles for delivery, but can be given through other methods, including oral doses, jet ejectors, nasal sprays, skin creams and even genetically modified foods.

A clear priority now is to renew commitment at all levels to attain the immunization goals. The net must be cast wider to reach all those who have not been reached thus far – the poor, the displaced, people living in far-flung villages, children living on the streets, refugees and people living in areas of conflict. Extensive educational and outreach campaigns must be mounted in countries with high incidences of disease. Governments must renew their commitment and resolve problems caused by corruption, inadequate services and mismanagement.

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