GRASSROOTS: VIEWPOINT - May 2000
Advocating immunization: how health professionals can make a difference
Scott Wittet and Robert Aston offer some practical suggestions
CHILDHOOD vaccines save three million young lives per year. The World Bank has concluded that immunization is one of the most cost-effective health interventions available today and that improved health helps to reduce poverty and boosts national development. Yet the realities of current immunization programmes often fall short of their potential. If you and your staff are involved in promoting immunization in any way, there are steps that you can take to help overcome the common problems. You can advocate for stronger and better immunization programmes. You can advocate for the introduction of new and under-used vaccines against major threats to public health, such as hepatitis B and yellow fever. And you can inform yourself fully about vaccine safety so that you can help parents who may be worried by media "scares". Here are some suggestions:
Learn all you can about overall immunization safety
Become familiar with the evidence that immunization is a very safe and cost-effective way to protect children against suffering, disease, and premature death. If you do not have the time to investigate the literature yourself, take advantage of the short summaries and briefing documents that are available for healthcare workers on the web sites of reputable organizations in public health, such as the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and others. If web access is difficult, write to the organizations public information offices to request paper copies of documents.
For general information for health professionals on the benefits of immunization:
- The "Resource Center" of the Bill and Melinda Gates Childrens Vaccine Program, PATH, 4 Nickerson St, Seattle, Washington 98109 USA: http://childrensvaccine.org/html/immunization-resources.htm
- The World Health Organization, 1211 Geneva 27, Switzerland:
"Six Common Misperceptions about Vaccination"
"Immunization Safety Priority Project"
- The South Australian Health Commission, via the Australian Government Publishing Service, GPO Box 84, Canberra ACT 2601:
"Immunization: Myths and Realities"
- The Centers for Disease Control and Prevention, National Immunization Program, Information Center, 1600 Clifton Road, NE , Mailstop E34, Atlanta, GA 30333, USA (or call +1 404 639-8226):
"Six Common Misperceptions about Vaccination - And How to Respond to Them"
"What Would Happen If We Stopped Vaccinations?"
Learn about your local immunization programme
Try to determine how "healthy" it really is. Are children being fully immunized and are they receiving the vaccines at the right age? Are the injections safe? Has the risk of accidental needle-sticks been minimized? Is the cold chain adequate? Is there adequate surveillance of vaccine uptake, adverse events, and disease incidence? Are public relations and health education efforts effective? Is there a working system to counter anti-vaccine rumours and misinformation? If not, alert those in charge of the programme and urge them to make some changes.
Reputable sources on injection safety and the implementation of safety surveillance include:
- The Safe Injection Global Network (secretariat based at WHO, address as above):
- The Institute for Vaccine Safety at Johns Hopkins University, Baltimore, Maryland, USA:
- Relevant papers in a special issue of the Bulletin of the World Health Organization devoted to immunization safety:
Know your local disease burden
If you think that hepatitis B or Haemophilus influenzae type b (Hib) disease are problems in your area, find out what is known about the disease burden. Contact your health authorities, the WHO representative, and the local UNICEF office. Determine if there are research projects in which you could participate or that can share relevant data. Investigate what is known about the burden of these diseases in neighbouring countries.
- For WHO statistics on disease burden by region see the 1999 World Health Report
Crucial contact: healthcare workers have a duty to give informed advice to parents
Fight ignorance and misinformation
As the success of immunization programmes reduces the immediate threat of disease in some countries, it is increasingly common to find individuals and groups who criticize immunization and claim that it is harmful. For example, anti-immunization groups have recently revived claims of a link between the combined vaccine against measles, mumps and rubella (MMR) and autism. There is to date no evidence of a causal relationship between the vaccine and autism, but many parents have been worried by what they have heard. They have a right to accurate and informed advice from their healthcare workers.
- For help in responding to parents concerns, see the CDCs website for a briefing on this topic, with links to other resources:
In general, be sceptical about rumours and sensational media reports claiming dangers from modern vaccines; they may be based on misinterpretation of the evidence. As the feature on rotavirus vaccines on pages 3 to 6 of this issue shows, vaccine safety concerns that are genuine are promptly publicized.
Remember that vaccines are far safer than the diseases they prevent. Severe adverse effects of vaccines are very rare. The diseases themselves are much more likely to harm children. Remind colleagues and patients about the horrors of those diseases. Counter allegations of vaccine-damaged children with reports of disease-damaged children.
Dont sit on the fence
Health professionals do not help parents if they simply hand out brochures or articles and expect people not trained in medicine to make sense of confusing, and sometimes contradictory, data. Healthcare providers are trained to form balanced, evidence-based judgments and to share their recommendations with patients. Doctors or nurses who do not assist patients with healthcare decisions may be shirking their responsibilities. If you believe in the value of immunization, say so.
Discuss, publish, teach, advocate
Write articles for the local newspaper. Make yourself available as a guest on radio and television programs. If vaccine-preventable diseases are in the news, use the opportunity to call for increased political commitment to immunization. Discuss your concerns with government officials. Introduce yourself to programme managers at UNICEF and non-governmental organizations such as Save The Children or Médecins Sans Frontières. Become active in national paediatric and medical associations and encourage them to formally recommend use of new vaccines against diseases that are major public health problems.
Sustain the momentum
Emphasize that vaccination is necessary even when disease levels diminish in your community. Global travel is now so common that infections can be spread between continents in a day. Not until a disease has been eradicated worldwide can immunization against it be discontinued safely. Only smallpox has been eradicated so far, and that was achieved through continuing, and thorough, immunization.
Global immunization is the greatest public health success in history. In little more than a decade, a massive effort raised coverage rates from 5 per cent of children worldwide in the late 1970s to a reported 80 per cent in 1990. But as new health issues were given priority, some of the energy and excitement about immunization dwindled. Fortunately, that trend is now being reversed.
You can be part of the process. It may seem that immunization issues are being addressed at the national and international levels. But change often comes from the community, and public demand for stronger immunization programs can influence public policy. That demand can be encouraged by individuals, single voices, persistently making themselves heard, then joining with others to create a chorus that cannot be ignored.
Scott Wittet is Communications Director, Bill and Melinda Gates Childrens Vaccine Program.
Dr. Robert Aston is Consultant in Communicable Disease Control and Immunisation, Wigan and Bolton Health Authority, and Member, UK Joint Committee on Vaccination and Immunisation
Note: This is a shortened and adapted version of an article first published at www.ChildrensVaccine.org
Immunization Focus May 2000 - Contents