AAP endorses report on improving global immunization systems

Future of global immunization

The 194 member states of the World Health Assembly, representing 99% of the world’s countries, recently endorsed the Global Vaccine Action Plan (GVAP) to realize this era as the Decade of Vaccines. The action plan is designed to provide more equitable access to vaccines for all people, regardless of who they are or where they live, and to prevent millions of deaths by 2020.

The NVAC’s global immunization report describes why the Decade of Vaccines and the action plan are urgently needed and deserve support: “Vaccine-preventable diseases still account for a quarter of the deaths in children under five. Vaccines against common causes of pneumonia and diarrheal diseases, the leading causes of death in children, are still not widely accessed by developing countries. Children in the lowest wealth quintiles are still the least likely to receive immunizations.”

Many of the focus areas and recommendations in NVAC’s report are aligned with the GVAP’s strategic objectives. The report illustrates that the United States has provided strong leadership and support of global immunization efforts and urges government leaders to continue this support for the well-being and safety of its citizens and to continue humanitarian leadership. As long as diseases like polio and measles are circulating anywhere in the world, all countries are at risk for dire economic and public health consequences of resurgence.

Though measles was eliminated in the United States in 2000, sporadic measles importations from other countries have resulted in costly outbreak investigations and control measures — 63 outbreaks of measles resulting in 911 cases from 2001-’11.

Dr. Orenstein

Public health response to these importations involves state and local public health staff time, vaccine administration, laboratory testing, and other outbreak control efforts. These are costly and strain already sparse budgets. For instance, the cost of responding to two 2011 outbreaks in Utah were estimated to have exceeded $300,000.

Failure to eradicate polio in the three countries that have never interrupted transmission of polio (Afghanistan, Pakistan and Nigeria) has resulted in children being crippled by preventable disease in those countries as well as reinfection of seven other countries. Though we are at the nadir of polio cases, continued failure to eradicate polio could result in as many as 200,000 new cases every year within 10 years. Moreover, three of the nine new or underutilized vaccines being implemented as part of the GVAP — Haemophilus influenzae type b, pneumococcal and rotavirus — are expected to prevent 102 million cases of disease, save 3.7 million lives and save $63 billion from 2011-’20.

The NVAC recommendations outlined in the report fall under six primary focus areas:

1. tackling time-limited opportunities (e.g. completing polio eradication, advancing measles mortality reduction, etc.);

2. strengthening immunization systems;

3. improving vaccine safety monitoring and surveillance;

4. increasing research and development capacity;

5. strengthening vaccine decision-making capacity; and

6. supporting U.S. leadership efforts in working with partners (e.g. facilitating long-term assignment of professional staff).

Support from pediatricians

The Academy encourages its members and other pediatric societies to become familiar with the report and look for ways to advocate for the principles therein (see resources). In addition to ensuring that their own patients, traveling or not, are fully immunized, U.S. pediatricians can support global immunization efforts in several ways.

• Advocate with pediatric societies in other countries, particularly developing countries, to incorporate critical vaccines into childhood immunization schedules; improve immunization delivery and access; and educate parents, providers and government officials about the importance of immunization.

• Educate U.S. leaders about the benefits of supporting global immunization, prevention of disease, disability and death both in other countries and the United States.

• Partner with groups working in immunization, including Rotary on polio, Lions on measles and UNICEF.

• Reach out to immigrant populations in your area to ensure they are appropriately immunized.