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Tuesday February 19, 2019

Vaccines can play a big role in fighting top global health threats


One reason that increasing numbers of people resist being vaccinated themselves or following the recommended immunization schedule for their children is that they don’t see the diseases prevented by vaccination as serious issues. 

Now the World Health Organization is here to tell us otherwise. In its list of the  top 10 threats to global health, vaccine resistance is right up there. WHO is the health arm of the United Nations. 

In its new report, “Ten Threats to Global Health in 2019,” WHO says: 

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved. 

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence. 

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines. 

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.  

But these aren’t the only ways in which vaccines could help address the most serious health concerns raised in the report. Another item on WHO’s top 10 list is antimicrobial resistance – in other words, infections that are increasingly difficult to treat with antibiotics, antivirals and other treatments that used to be highly effective. Antibiotics in particular have long been overused, leading to such antibiotic-resistant infections as MRSA.

The WHO report says:

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy. 

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.

Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials. 

But did you know that vaccines also play a role in reducing the use of antibiotics and of course some antivirals? One clear example: People who avoid the flu by getting their flu shots don’t need the antivirals used to treat flu in its early stages. Those people also will avoid getting pneumonia that can result from flu, requiring antibiotics.

There are plenty of other examples. A 2017  study published in the journal Pediatrics found that a dramatic drop in the number of ear infections in young children is associated with the pneumococcal vaccine, which protects against a bacterium that also causes many middle-ear infections. More than 10 million prescriptions for children’s ear infections are written every year, according to the American Academy of Pediatrics.

That same year, New Zealand researchers reported in Lancet that they’d found a surprising side benefit in that country’s vaccination campaign against serogroup B meningococcal disease: The young adults vaccinated were significantly less likely to develop gonorrhea. The bacteria that cause gonorrhea and meningococcal B disease share 80 to 90 percent of their DNA, and antibiotic resistance is a serious problem in many cases of gonorrhea.

“The bacteria that cause gonorrhea are particularly smart,” Dr. Teodora Wi, a medical officer in human reproduction at WHO, said at the time. “Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”

A third threat to global health listed in the WHO report – another flu pandemic that will almost certainly occur sooner or later – could be reduced if scientists currently at work on finding a universal flu vaccine meet with success.

In other words, the development and use of vaccines could play a major role in reducing almost a third of the threats listed by WHO in its reports. Vaccination – it’s not just a side issue in the world’s health, or yours.



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