Addressing the Threat of Vaccine Gaps
Vaccine gaps are a growing concern worldwide. They can lead to outbreaks of viral diseases that were previously considered long forgotten. Physicians, health care staff, and researchers have been battling to close these dangerous vaccine gaps for decades. In May 2015, The World Health Organization’s (WHO’s) World Health Assembly (WHA) agreed on a resolution to the 2012 Global Vaccine Action Plan that would encourage countries to take vaccine gaps seriously, increase transparency around the price of vaccines, and requests WHO to report on barriers to universal vaccination, among other things. With this in mind, we asked two Joint Commission International consultants to discuss their experiences with these dangerous gaps, as well as some causes and potential solutions.
1: In your opinion, what causes vaccine gaps?
Barbara Soule, RN, MPA, CIC, FSHEA: Vaccine gaps are based, in part, on access to health care, the education of patients and their communities, cultural values and beliefs, and financial challenges. Also, some vaccines may not be available in a country because of governmental regulations or supply chain issues.
Chinhak Chun, MD: The first obstacle is the cost of obtaining vaccines. The second is uneven logistics for delivering vaccines to the developing countries. Unfortunately, misconceptions about vaccines also play a significant role in the resistance to universal vaccination.
2: What do you think some of the best solutions to these gaps would be?
BS: Vaccines should be inexpensive and available to all persons. Improving methods of purchase and distribution are critical to solving the problem of vaccination gaps. Governments could also take leadership roles in ensuring that their populations have access to vaccines. Of course, education is critical and should address values in certain cultures that may interfere with taking vaccines. Physicians and other care providers should be updated on all vaccines on a continuous basis.
CC: The prices for vaccinations should be lowered. WHO could also act as purchaser and distributor for countries without the financial resources to obtain vaccinations.
3: What are some consequences you have seen arise due to vaccination gaps?
BS: Occasionally we see outbreaks when persons are not vaccinated and are exposed to viruses or some bacteria. Measles is the United States is an excellent example of the kind of outbreaks possible due to vaccine gaps. I’ve put together a timeline based on information from the Center Disease Control’s (CDC’s) website:
2008: The increase in measles cases was the result of spread in communities with groups of unvaccinated people. The U.S. experienced several outbreaks in 2008 including three large outbreaks.
2011: More than 30 countries in the WHO European Region reported an increase in measles, and France experienced a large outbreak. Most of the cases that were brought to the U.S. in 2011 came from France.
2013: The U.S. experienced 11 outbreaks in 2013, three of which had more than 20 cases, including one outbreak with 58 cases.
2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak.
2015: The United States experienced a large, multi-state measles outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious. However, it is important to note that no source was identified. Analysis by CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014.
CC: A number of things can happen as a result of vaccination gaps. The foremost consequence, obviously, would be a serious outbreak leading to the deaths of many people. Outbreaks of pneumococcal, haemophilus B, and influenza could lead to high death rates. Unvaccinated people are also susceptible to less deadly but still serious outbreaks, which would include chickenpox, measles, and typhoid fever.
4: What do you think WHO’s approved action plan means for the future of closing vaccine gaps?
BS: They are going to work toward understanding the gaps and then aim at reducing or eliminating them by making vaccines and education about vaccines available. It will be challenging to close these gaps. I suspect there will be incremental improvements, and with each improvement lives will be improved or saved. The WHO works in regions and each region will have to commit to working to improve vaccine use.
CC: It is difficult to predict what the outcomes of this initiative will be. WHO might consider transforming its modus operandi and instead negotiate with the big vaccine manufacturers for bulk-purchasing at a lower cost and then distributing vaccines for free or at cost to the needy regions. Also, it is up to each country to tap into its available resources and to ensure that the WHO’s initiative gains traction.
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This article is the first part of a two part series regarding decisions made at WHO’s WHA. To read the second part, please click here.