Implications of Recent Developments in Vaccines for Child Health - Literature review Example

Name Implications of recent developments in vaccines for child health Course Date Implications of recent developments in vaccines for child health Introduction Vaccines form an integral part of the entire health system where it has four elements that include; viz, vaccine delivery, advocacy and communications, disease surveillance, logistics, in addition to vaccine supply and quality. Previously, immunization systems were composed of vertical programmes where there had limited functions with the rest of the health system but gradually immunization systems have become more integrated and currently immunization share functions as well as resources with the entire health system. According to Cochi (2011) globally, vaccination of children is one of the leading health interventions in reduction of infant and child morbidity and death. Within the previous two decades, vaccinating children has prevented about 20 million deaths globally and at present vaccination prevents more than 2.5 million child deaths yearly. However, approximately two million children succumb yearly from diseases that can be prevented through vaccination and this represents about 25% of all children mortalities below 5 years. Children mortalities as a result of rotavirus diarrhea, pneumonia and invasive pneumococcal disease top the list of priorities, in addition to decreasing childhood deaths resulting from measles following a decade of notable improvement on this front. New vaccines being developed presently can prevent million of childhood deaths. The next decade provide an incredible opportunity to transform global health and has the potential of improving child survival rates significantly and at the same time expand the effect of vaccines across the lifespan (Cochi 2011). This paper will focus on analyzing the implications of recent developments in vaccines for child health. Significance of vaccines on child health The introduction of vaccines in prevention of fatal childhood diseases has been a great success. Vaccines have been protecting children worldwide against common and life-threatening diseases and thus immunization using the development vaccines is a long standard healthcare service. The vaccines safeguards the child health and protect children against various childhood diseases such as TB (BCG), diphtheria, tetanus and whooping cough (DPT), polio, measles, hepatitis b (HepB), as well as measles, among others. Dramatic decrease in children deaths has been recorded for the most nine vaccine-preventable illnesses (Global Vaccine Action Plan 2012). According to Dunn (2008) recent development of vaccines offers the potential of helping many countries to reach their Millennium Development Goal 4 (MDG4) targets and this is the reason why children immunization is being prioritized globally. New opportunities are progressively being established by developing new and improved vaccines against many diseases of global significance (WHO 2008). Childhood vaccination not only greatly improves child health, but also significantly lowers child mortality. Studies indicate that childhood vaccination protects children against the targeted diseases and also provides wide range of health benefits and this makes childhood vaccination an important public health measure. In addition, since children vaccination improves children’s health, it in the long run results to improved productivity in children even in schools and later on such children have higher worker productivity as adults. Therefore, childhood vaccination is a health system component that not only improves children’s health but also promotes economic success as well as poverty reduction (Dietz et al. 2009). At present, vaccines are now perceived as effective and cost-effective way of improving children’s health. Globally, children are consistently immunized against major disease and thus immunization has turned out to be a fundamental element of global public health efforts. Decrease in diphtheria, measles, and whooping cough has prevented more than million deaths in developing countries. The new developed vaccines even protect children from pneumonia (PCV) and diarrhea (rotavirus vaccines), which are some of the leading child killers (Institute of Medicine, National Academy of Sciences 2007). Orenstein (2010) further explains that it is very essential to have infants administered with diphtheria-tetanus-whooping cough (DTaP) vaccines aptly. Whooping cough is still present and the disease can have very bad effects on infants, particularly to infants below six months. Therefore, infants should be protected through vaccination on schedule. Of equal importance are Haemophilus influenzae type B (Hib), along with pneumococcal conjugate vaccine (PCV) which are very vital for infants because they also prevent children against the most common causes of bacterial meningitis. Influenza vaccine is another vital vaccine for children, in particular children aged between six months to five years. Morbidity from influenza in children below five years is very common and thus the importance of influenza vaccine (Orenstein 2010). Several programmes have been established to boost and strengthen children vaccination against diseases. Such programmes include The Expanded Programme on Immunizations (EPI). The EPI which is a programme that was set up to offer life-saving vaccines to children globally has considerably reduced childhood morbidity and deaths and now reaches more than 85 percent of children globally. The number of recommended vaccines has grown dramatically and the GAVI has been helping developing countries to have a higher accessibility to new vaccines which has prevented more than 5.5 million deaths of children (Alliance for Health Policy and Systems Research, 2009). In order to handle the whole child in fighting childhood diseases, WHO and UNICEF established the Global Immunization Vision and Strategy to broaden the reach of EPI and prevent more childhood disease. Similarly, the Global Vaccine Action Plan (GVAP) was established to facilitate access of vaccines universally. GVAP focuses of establishing strong vaccine systems in order to expand health systems and closely coordinate with other primary healthcare delivery programmes to attain vaccination objectives. This endorses a strong vaccination system as a fundamental element of an efficient health system and also enables development of suitable interventions for integration in order to make best use of synergistic impacts (Dietz et al. 2009). However, EPI still faces some challenges like where in 2012 some countries the coverage of EPI is still low where about 2 million children, in particular children from developing countries did not receive three fundamental vaccinations within their first year. Again, diseases that can be prevented by vaccines which include pneumonia and diarrhea still contribute to considerable number of deaths in children below five years. Integrated and inclusive service delivery can generate demand, reinforce routine vaccination services, as well as improve vaccination coverage and hence improve the overall health of children (Duffy 2010). Disease control benefits of vaccines 1. Eradication Unless there is existence of an environmental reservoir, when vaccines eradicate a pathogen, such pathogens cannot re-emerge, unless if humans re-introduce the pathogens by accident or malevolently which results to vaccinations being discontinued. Whereas disease eradication is an ideal target for vaccination, at present the only childhood disease that has been eradicated globally is smallpox which has allowed children vaccination of smallpox to be discontinued. Vaccines have the potential of eradicating other childhood disease as long as the diseases do not have extra-human reservoir, the vaccines are effective and specific diagnostic tests are there. Disease eradication entails high levels of immunity globally over long time duration with ample and effective surveillance. Eradication of polio has been a global challenge but high coverage with oral polio vaccine has eradicated type 2 poliovirus worldwide and transmission of type 1 and 3 polioviruses are still in existence but limited within few countries. In addition, problems such as paralytic disease that is caused by oral polio vaccine, as well as vaccine-virus excretion within immunodeficient people have not yet been solved yet they are problems that some children experience when administered with polio vaccine. Global usage of monovalent type 1 and type 3 OPV in addition to inactivated polio vaccine (IPV) might ultimately be necessary (Ramsay, Yarwood, Campbell & White 2012). 2. Elimination A study carried out by Ramsay, Yarwood, Campbell & White (2012) found out that in 4 to 6 WHO regions, considerable efforts and progress have been made to eliminate measles where transmission of measles no longer takes place indigenously and importation of measles never results to sustained spread of the virus. This is because it is possible to eliminate diseases locally without global eradication of the disease causative microorganism. The key to these regions succeeding in eliminating measles is where more than 95 percent population immunity via a two-dose vaccination treatment. A combination of measles, mumps and rubella vaccine (MMR) can also eliminate and in the long run eradicate both rubella and mumps (Ramsay, Yarwood, Campbell & White 2012). Increasing levels of measles vaccine administration within Africa where vaccine coverage was just 67 percent within 2004 is fundamental for eradicating measles. Measles has already been eliminated in America while measles, mumps as well as rubella have been eliminated within Finland and this indicates that these diseases can be eliminated globally. Vaccines might also enable elimination of Haemophilus influenzae type b (Hib) through effectively implemented immunization national programmes (Ramsay, Yarwood, Campbell & White 2012). Nonetheless, disease elimination does not totally do away with the danger of the disease being re-introduced. For instance, Botswana has been polio-free from 1991 but the type 1 poliovirus was reintroduced in 2004 through importation from Nigeria. Similarly, measles was reintroduced in Indiana within 2005 by a traveler from Romania. For diseases such as tetanus that have environmental reservoir, it is not possible to eradicate them though global disease elimination of such diseases is a feasible goal if vaccination of human beings is maintained at high levels (Farrington 2008). 3. Control of mortality, morbidity and complications for the individual children Pre-exposure vaccination of children using numerous vaccine antigens is the basis of successful immunization programmes against several childhood diseases. This is because protection of successful vaccines occurs when administered prior to exposure. For example, vaccination against invasive Hib disease proved to be effective where more than 90 percent efficacy of the vaccine was established within European, American and African children. Likewise, in UK infants who were vaccinated with 3 doses of the same vaccine did not develop Hib disease and recently clinical studies have validated the high efficacy of vaccinating infant against Hib within in Germany and Sweden (Farrington 2008). Challenges facing vaccination However, in spite of developments in vaccines, children vaccination remains far from universal because children in developing countries are still susceptible to vaccine-preventable disease. For instance, global children’s vaccine coverage for DPT was at 70% in 1990s while in Africa the coverage was only at 53%. This implies that a big number of children do not still access the vaccines, especially children from the developing countries and from marginalized communities. For instance, in 2011, out of 11 million children aged 1 covered under routine vaccination within some of ESA countries, about 1.7 million did not receive vaccine protection. In this example, most of these children were from remote regions or from urban slums (WHO 2013). Moreover, children living in marginalized communities also do not receive vaccines against the fatal disease due to the communities being affected by conflicts or the families of the children refusing to have them receive vaccines due to ignorance. Africa where most countries are still developing has been polio-free for years; however in May 2013 a 2 year old child was confirmed as having polio virus and hence that record no longer holds. The horn of Africa currently faces a major polio crisis whereby polio cases are not only being reported within Somalia but also within Kenya, Ethiopia and also South Sudan. In spite of immediate response from the countries’ governments and support from WHO, UNICEF and similar bodies, the polio outbreak in these countries is spreading rapidly and putting the health of the children in these countries at risk of contracting the debilitating disease (WHO 2013). According to Pegurri & Fox-Rushby et al. (2010) there are hindrances that hamper vaccination of children especially in developing countries. For instance, there are several practical problems that hamper delivery of vaccines. Vaccine delivery necessitates working freezers and refrigerators to preserve them and this in turn needs constant energy supply; good roads, as well as reliable mode of transport in order to transport the vaccines from port to hospitals and clinics; hospitals/clinics that can be easily accessed for individuals requiring immunization, parents who are aware and knowledgeable about the importance of their children getting the vaccinations; trained and skilled healthcare practitioners to administer the vaccinations; addition to sterilized syringes. Most of the developing countries which are poor where vaccine coverage has stalled do not have the entire infrastructure required for effective vaccination. For instance, in Niger it was established that freezers utilized in vaccine storage were not functional. In this study, only 16% of vaccine- importing countries were found to be having safe vaccines. Similarly, another study found that most vaccine injections administered on children in developing countries were unsafe (Milstien 2008). In addition, there have been series of issues involving the quality of vaccines and this may have negative effect on the health of the children. As Duclos & Bergevin (2012) argues, in developing countries there have been reports where vaccine administration is not done in a manner that guarantees sterility due to reuse of syringes and needles or inadequate sterilization. This can result to transmission of infectious diseases, more so blood borne microorganisms through vaccinating using non-sterile injections. Events of unfortunate vaccination program errors have also been reported for instance where children were administered with insulin rather that vaccine within developing countries. Basically, vaccination is supposed to be a safe health intervention that should not cause any harm and this is because vaccines are administered to healthy children and thus there is no reason why vaccination should harm the health of a child. This is the reason why the safety of vaccine is a top priority of WHO which has led to Immunization Priority Project being established to set up an inclusive system to make sure that all vaccines are administered safely (Global Vaccine Action Plan 2012). Generally, awareness of the value of safety is important to prevent negative effects after vaccination. In an event where adverse effect takes place after vaccination, detecting early and responding rapidly can reduce the negative effect on health of the affected children as well as on the vaccination programmes. As a result, it is important for all healthcare practitioners to report any identified adverse events to public health authorities (WHO 2010) Future Directions Vaccines are one of the major accomplishments in public health in improving the health of children and preventing fatal diseases. In spite of recent developments and remarkable progress in children vaccination, there are numerous challenges facing the vaccine-delivery system globally. Millions of children are born daily globally where every child need 15-19 doses of vaccine by the time they turn 18 months in order for them to have adequate protection against childhood diseases. To attain the full potential of vaccines in protecting child health, parents should be aware of the importance of vaccines and be better prepared to have their children vaccinated; healthcare practitioners should know the most recent vaccine developments and recommendations; vaccine supplies and funding should be more secure, in particular with new vaccines; researchers ought to tackle progressively complex issues regarding safety, efficiency, as well as vaccine delivery and conduct more research on new strategies of administering vaccines more progressively and information technology in supporting apt vaccinations should be harnessed more efficiently (Pegurri & Fox-Rushby et al. 2010). In addition, in spite of remarkable decrease in vaccine-preventable diseases in children, such diseases still persist, especially in developing countries. More efforts are required to increase the usage of current vaccines in routine childhood vaccination programmes globally and to fruitfully introduce new vaccines with their developments. Such efforts will not only help developing countries to improve child health remarkably but will also benefit developed countries by reducing disease importation from developing countries. Vaccination against diseases that can be prevented through vaccines prevents almost 3,000,000 deaths annually; more importantly, further 3,000,000 deaths are preventable by better usage of existing vaccines. For instance, WHO established that 10.5 million children below 5 years died from diseases that can be prevented through vaccination. The eradication of smallpox, a disease that used to be a fatal disease, the success of the polio eradication initiative in decreasing polio’s incidence by 99.9%, the decline in number of measles fatalities globally indicate the benefits of vaccines (Orenstein, 2010). Conclusion Vaccination is an extremely effective health intervention in disease prevention in children. Therefore, it is important to maximize the use of newly developed vaccines in order to reduce children deaths as a result of acute respiratory infections, diarrhea diseases, measles and other vaccine preventable disease by over two million annually. Globally, children are routinely vaccinated against major diseases and this alleviates morbidity and deaths among children which would have otherwise happened had the vaccination not been administered. As this evidence in this paper shows, vaccines are cost-effective and very effective in improving children health and their overall welfare. However, in spite of routine vaccination coverage globally, children living in developing countries still go unvaccinated which results from limited resources, poor health system management, and poor monitoring and supervision, inaccessibility to health facilities within the poor countries. Nonetheless, despite the few shortcoming and challenges with vaccines, due to progress within medical science, vaccines protect children against more diseases that ever before. Some diseases that previously caused disabilities, harmed or caused deaths to millions of children can be prevented and eliminated entirely through safe and effective vaccination. An example is elimination of polio, among other diseases; there was a time when polio was the most-feared disease because it caused deaths and paralysis globally but currently, thanks to polio vaccine, polio can be prevented effectively through vaccines. Lastly, vaccinations are very important in building and strengthening the immune system of children. Bibliography Alliance for Health Policy and Systems Research, 2009, Systems thinking for health systems strengthening. Geneva: WHO. Cochi, S 2011, A report of the CSIS global health policy center: The Future of Global Immunization. Will the promise of vaccines be fulfilled? CSIS. 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