Thomas M. File, Jr. M.D. MSc FIDSA
President, Infectious Diseases Society of America
From measles to the next unknown pandemic, medical immunisations remain an essential component to the sustainable control of infectious diseases. First, however, they must be available and accepted.
The vaccine development era of last century ushered in the ambitious global public health era of this century. This led to the eradication of smallpox and the near eradication of polio. It enabled the elimination of measles in countries across the globe, and greatly reduced the global impacts of deadly infections such as pertussis and childhood meningitis.
Even as violence and political instability have undermined efforts to gain control of the ongoing Democratic Republic of Congo Ebola outbreak, a newly developed vaccine has protected health workers, families and communities and averted even more damage.
With the inspiration of these examples, the nearly four-decade quest for a vaccine against HIV has continued. Other, proven prevention measures have also spurred strides toward ending the pandemic’s global impact.
That’s because we know what vaccines can do. Every year, vaccines are estimated to prevent from 2 million to 3 million deaths globally. The accelerated rollout of measles vaccines between 2000 and 2017 alone led to an 80% worldwide drop in measles deaths. Still, the full value of this formidable weapon against preventable illnesses and deaths remains unrealised.
Misinformation and access barriers cost lives
In spite of the proven value of vaccines, 1,200 measles infections were recorded last year in the United States – the highest number since 1992 – despite a declaration in 2000 that local transmission of the virus had been eliminated.
Failures to overcome vaccine hesitancy, inspired by misinformation campaigns, as well as obstacles to routine health care access has enabled the spread of preventable disease.
While the great majority of illnesses in the United States were among people who had not been vaccinated, that was only part of the story.
It is important to note the outbreaks all originated with travellers who imported the disease from countries where measles remains endemic – and where vaccine access is limited. Due to obstacles, including long distances to clinics, health system supply gaps and health worker shortfalls, a 2019 WHO/CDC report found that global coverage with the first dose of measles vaccine stalled at 85%. This is significantly shy of the 95% necessary to prevent outbreaks.
Goals and resources can save lives
A new global immunisation strategy by the World Health Organization (WHO), to accelerate and expand vaccine coverage, is important and timely.
An early draft of the strategy calls for countries to develop improved methods and means to educate vaccine-hesitant families and communities – on vaccine safety and effectiveness. In the U.S., the VACCINES Act, under consideration by Congress, would support those efforts on the domestic front, and also strengthen surveillance and responses to outbreaks of vaccine-preventable diseases.
The WHO draft strategy also calls for supporting immunisation capacities during outbreaks, as well as other emergencies including conflicts. WHO also should set global goals with deadlines for coverage of universally important vaccines, including those for measles, mumps and rubella (MMR) and for diphtheria, tetanus, and pertussis (DtaP). Those goals and deadlines can drive investment priorities, propel progress, and build accountability.
Infectious diseases don’t observe borders
Implementing these strategies will require strengthened health systems in many countries lacking resources to provide the routine health care needed to detect, prevent and respond to health threats where they originate. Continued and sustained U.S. leadership and support of global health security partnerships will be crucial to accomplishing that goal overseas, and essential to protecting health at home.
