Vaccines for all?

Inequalities in vaccine access hamper our global health.

March the 26th marks Vaccine Engagement Day- so on this day I reflect on where we are in terms of protecting our children across the world from some of our most deadly diseases. #VaccineConversations

My brother contracted measles as a toddler before he was able to access a vaccine. He was one of the unlucky people to develop complications from measles- in his case pneumonia. He spent months in intensive care and I cannot begin to imagine how frightening it was for him or my parents (I was not even born then). Fortunately he pulled through- not everyone is so lucky. It has been estimated that pre-vaccine, 2.6 million people globally died every year from measles- mostly children

I grew up hearing about my brother’s struggles with measles and he told me he still remembered his fever dreams - nightmares of him eating himself alive. Measles is a completely preventable condition now thanks to vaccination. Despite this, we are currently facing an unprecedented rise in cases in parts of the UK and across the globe with, for example, cases in Europe rising 30 fold. Immunization has been an incredible global health success story that saves millions of lives every year. Vaccines are now available for a host of life-threatening diseases preventing an estimated 3.5-5 million deaths per year from diseases like measles, tetanus, pertussis, influenza, respiratory syncytial virus and diptheria.

Worrying trends in vaccination rates of children across the world

Successful vaccine campaigns are a key component for health care, infection control and global health security. But efforts in getting vaccines out to all is stalling. The Covid-19 pandemic has had a huge impact- straining health systems and disrupting supply and access. Even without this massive health challenge, far too many children in the world are not being vaccinated. Many of the children who miss out on vaccines cannot access them because they come from countries or areas that are poor, marginalised and/or remote. It has been estimated that one in 5 children have no vaccines or are under-vaccinated (meaning less than a full vaccine course for any condition). Measles is an example of this with 1 in 5 children currently unprotected against disease. Measles is one of the most infectious diseases we have so this represents a grave threat. One person with measles can infect about 12 to 18 others but if about 95% of the population is vaccinated the virus stops circulating as it can’t find susceptible hosts. Its not just measles-a staggering 7 out of 8 girls are not vaccinated against the human papilloma virus (HPV) which protect against cervical cancer. The HPV immunisation programme has successfully almost eliminated cervical cancer in vaccinated women born since Sept 1, 1995.

Going the last mile…

There is clearly work to do to address vaccine inequity. A big issue is how accessible the vaccines are. The vaccines must be delivered in a place and at times when children and families can get to them. Staff and clinics must be resourced and equipped to have capacity to deliver vaccines. Flexibility in how, where and when we deliver vaccines is critical. The use of mobile vaccination clinics massively increased the rates of vaccination against COVID-19 in villages in Sierra Leone. Similarly, more flexible approaches to delivery and vaccine communication such as pop up centres in mosques enhanced COVID-19 vaccine uptake in ethnic minorities in Wales. Scotland, which has adopted a more flexible approach to delivery of the measles vaccine (with both mobile vaccination and parental flexible working), has seen excellent MMR uptake.

Vaccine costs- a barrier for some?

The cost of vaccines should not be a barrier that dissuades people from take-up however there are huge disparities in the costs of vaccines across the world. This was at its most stark with the COVID-19 pandemic. Vaccine donations from developed countries and support from COVAX helped deliver almost 1.9 billion doses of COVID-19 vaccines to 146 countries (mostly low- and lower-middle-income countries) by July 2023. However, the rate of vaccine rollout has not kept apace with viral evasion. A major issue has been stockpiling of vaccines by high-income countries. One solution would be to empower countries to have their own vaccine manufacture capacity and this has seen some success- for example with the WHO’s vaccine technology transfer hub at Afrigen Biologics and Vaccines in Cape Town. However, reluctance from manufacturers to share knowhow, patents blocking access to technology and restrictions and/or costs of some ingredients have constrained the overall production capacity.

Vaccine confidence has fallen.

Undoubtedly another major barrier to vaccine uptake is vaccine hesitancy. There can be many reasons for vaccine hesitancy but they are usually centred on a few core themes. Some people seek control and feel that we must take back control of our own bodies through alternative means. This may link to lifestyle choices whereby people shun mainstream medicine, opting for “natural” remedies. Similarly some fear “chemicals” and are concerned that vaccines will introduce toxic chemicals. People may be influenced by bad previous healthcare experiences or mistrust government agencies and pharmaceutical corporations. Some have misunderstandings about the risks of vaccination versus the risks of disease. Whatever the underlying fears, it takes empathy and patience to explore hesitancy. Sadly too some people spread misinformation and, even worse, some sow disinformation - often profiting from the misery they seed. Worryingly some disinformation actors come from medical backgrounds which has disproportionate impacts on vaccine trust. Social media plays a big role in amplifying such mis- and dis-information further. Its vital we support and empower people to both feel they can have their concerns listened to and considered and that they can access reliable vaccine information.

There is much positive action happening to tackle vaccine inequity and much we can do. We cannot afford to look away. It is completely unacceptable that so many of our children remain unvaccinated. I finish with a quote from the recent UNICEF publication “For Every Child, vaccination”

“Now is a time for determination. Now is a time for political will. Now is the time to protect the health of every child.”