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Immunizations are crucial to everyone’s health. They protect children from diseases and strengthen their immune system so it doesn’t have to work hard to protect them from exposure. The World Health Organization (WHO)’s World Immunization Week, from April 24 to April 30, aims to promote the use of vaccines to protect people of all ages against disease. This year, we’re sharing our PRA experts’ insights on the value of immunizations and the current challenges.

Key Highlights

For this year’s World Immunization Week, PRA experts from the Center for Vaccine Research discuss the value of immunizations and the current challenges facing immunization.

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Nick Tate
Nick Tate
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PRA experts from the Center for Vaccine Research—Darin Seehafer, Director of Therapeutic Expertise, and Lynlee Burton, Head, Center for Vaccine Research—and physicians completing the University of Siena’s Master’s in Virology Program—Keiko Pempho Msusa and Nginache Victoria Nampota—discuss the value of immunizations and the current challenges.

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How do immunizations support our healthcare systems, as well as our patients?

Darin:
By getting immunized, you can prevent diseases from occurring in the first place. This helps to relieve the burden on doctors, nurses, and hospital systems, by not having to treat large numbers of infectious diseases that could be potentially life-threatening.

Nginache:
Vaccines reduce the burden of diseases that would otherwise have a huge impact on the healthcare system. Particularly in settings like mine and Keiko’s in Malawi, where health systems are not strong, immunization plays a huge role in reducing the number of hospitalizations. For example, the Rotavirus vaccine, once it was employed in Malawi, reduced hospitalizations quite dramatically.

Keiko:
For countries like Malawi, a resource-poor setting, immunization is one of the only interventions that brings the majority of households in contact with the healthcare system five or more times during the first year of a child's life. Therefore, this offers a unique opportunity to reach the community with additional primary healthcare services.

This also contributes to health security by preventing diseases and supporting surveillance.

Darin:
Vaccines decrease childhood mortality rates around the world. As much as people may not realize it, diseases contracted in infancy or early childhood can be fatal. For example, in the past, it was common for families to have several children. Understanding that only three to five children would survive to adulthood because they would die from childhood diseases before the advent and wide use of vaccines.

For countries like Malawi, a resource-poor setting, immunization is one of the only interventions that brings the majority of households in contact with the healthcare system five or more times during the first year of a child's life. Therefore, this offers a unique opportunity to reach the community with additional primary healthcare services.

Keiko Pempho Msusa

WHO made the theme “year of nurse and midwife” for 2020. What roles do nurses and the midwives play in immunization and immunization awareness?

Keiko:
For low-income settings, like in Malawi, nurses are usually the first point of contact for patients. They're the ones who actually administer the vaccines to the children and adults as well. They play a critical role in immunization services for urban settings, but in rural settings, it's mostly health surveillance assistants who provide the immunization services.

Nginache:
Nurses are the backbone of the health care system, and that's the case in a lot of countries. It just goes to show how useful they are. They have many roles in the system such that some of their responsibilities are delegated to health surveillance assistants who provide vaccination in government primary health care centers. These are people who are trained to run the whole immunization system.

What is currently being done to generate awareness around the effectiveness of vaccines and what can we do more to raise that awareness?

Darin:
Through the WHO, UNICEF, and other not-for-profit organizations like the Red Cross and many government agencies, there is considerable efforts being made around the world.

Personally, I do not believe that getting the word out is the primary issue. I think the bigger issues with childhood immunizations today, for many parts of the world, include antivaccine movements, misinformation, and access.

Keiko:
For Malawi, we use community outreach programs. As stated earlier, we have health surveillance assistants, and they are considered front-line vaccinators. They are essential for the provision of vaccination in hard-to-reach areas, and they spread the word about the importance of vaccination to the patient. They’re also useful due to the shortage of human resources in the health sector in our country.

As for those with vaccine hesitancy, I feel like this requires a complex approach, basically to address all the social, religious, and psychological factors that are likely to differ within countries. For low income countries, there's a knowledge gap surrounding reasons for vaccine hesitancy and this requires a lot more focus, unlike industrialized countries where it's slightly influenced by confidence, risk calculation, complacency, or just convenience.

Nginache:
With globalization and urbanization, many more people have access to social media than in the past. So, criticism of vaccines has come into play. We need to start looking more closely at the messaging for vaccination in countries like ours.

I think the bigger issues with childhood immunizations today, for many parts of the world, include antivaccine movements, misinformation, and access.

Darin Seehafer, Director of Therapeutic Expertise

"What are some common misconceptions people have about immunization and why is it important to get vaccinated?

Lynlee:
I often find myself talking to people who are, for instance, new parents unfamiliar with vaccination information and they’re nervous about what to do. We try to put it all in perspective for them.

When you take your baby to a grocery store and plop them in shopping cart seat, they touch the cart and touch everything whizzing by them. You're exposing your child at that point to more viruses and germs and their little bodies are designed fight those off. The reason is because their mother passed on some of her protection to them while the child develops their own immune system.

The problem is, the other nasty viruses out there that our bodies can’t fight off alone. A vaccine protects your child from a disease that will kill them.

I often say that I like being in the vaccine industry because I'm not treating people and trying to make them better from a disease they have, I am saving them from being sick and dying. We prevent people from getting sick.

Darin:
In one presentation some years back, I saw a comic which illustrated a wall containing many bricks, and each brick was labeled measles, mumps, rubella etc. The imagery reflected that these potentially lifesaving vaccines are our societal walls against life-threatening diseases.

Now, imagine there are people on the other side of the wall, taking down the bricks. When you're not vaccinating, you're literally lowering that wall—not just for yourself and for your child, but for everyone.

Many vaccines work off a principle called herd protection. That means that the disease can't circulate if you cocoon those who are under-immunized, or those who cannot get immunized.

There are kids out there who cannot get certain vaccines because they have allergies or conditions. Some children, through no fault of their own, are left potentially exposed to these diseases. Those kids go to school and interact with other kids. If even one of them gets sick, and they’ve been under-vaccinated, it can lead to an outbreak.

That’s why you see these vaccines as mandatory. You're not just protecting yourself and your child, but you're also protecting other kids who aren't completely immunized or can't be immunized. There's an obligation in society to look out for the welfare of not just yourself, but for the rest of society, too.

Keiko:
There's a saying that vaccination has become a victim of its own success. It means people have become complacent as diseases that have killed millions of people are no longer there due to the success of vaccination itself. For example, Europe‘s low vaccination rates allowed measles to become endemic once again after earlier vaccination rates went down.

I think there's a misconception about disappeared diseases, and that could be one reason why there’s vaccine hesitancy. I had a conversation with one of my colleagues who seemed hesitant about the potential coronavirus vaccines. All I said to them was, “This is the world without one vaccine—just one coronavirus vaccine— and look at it now.” I was just trying to reiterate to them the importance of why we need vaccination.

I often find myself talking to people who are, for instance, new parents unfamiliar with vaccination information and they’re nervous about what to do. We try to put it all in perspective for them.

Lynlee Burton, Head, Center for Vaccine Research

Do you think given everything that's happening with the reporting around COVID and seeing it in communities, it might bring immunization awareness more towards the foreground?

Darin:
The flu kills tens of thousands of people each year, and at least between 10,000 and 30,000 people in the United States alone. People still find reasons not to get flu vaccinations. Even people in high-risk groups find reasons not to get it.

There will be the people who end up carrying the disease and infecting others and possibly dying from the disease. I don't know that there's an effective way to reach those people yet.

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