IN A NUTSHELL Author's note…Outbreaks have costs to the health system, the family, and the patients. Vaccines are cheaper than the costs of epidemiological management, hospitalizations, etc. The support of the system is crucial for reaching protective coverages. Adequate planning, training, coordination, and especially sustained financing are crucial for a functional immunization program.
By Francisco Becerra-Posada, MD, MPH, DrPH
Immunization Programs and Health Services
Most countries have a vaccination program that most probably started as an independent vertical program. There is enough discussion and evidence of the pros and cons of this kind of interventions. Some examples had a positive impact, as the smallpox eradication program, and others failed due to a lack of coordination.[1]
Either way, vertical programs do have to coordinate and use the health services. Health services, as part of the health system, are key for the success of any program. Immunization programs are not the exemption.
When managing immunization programs, coordination is essential for its success. From the planning stage to calculate the demand according to the cohorts, to the logistics and operational issues, it has to coordinate with many instances within the health system. If any of the different areas fails, vaccines do not get to the clinics and people are not vaccinated.
During the pandemic, many preventive programs, and actions, were not available due to closing of clinics, moving health personnel to clinical work to care for COVID-19 patients. However, in many countries’ vaccine coverages were not the desired ones to ensure protection to the population and a decrease of coverage was seen.
However, there are signs of recuperation. WHO states that from 18.1 million children that had zero doses in 2021, decreased to 14.3 million in 2022, close to the pre-pandemic value of 12.9 million in 2019. A slight increase, from 81% in 2021 to 83% in 2022 for measles vaccination, is still below the 2019 value of 86%. Vaccination against DPT (diphtheria, tetanus, and pertussis vaccine) recovered from 81 (2021) to 84% in 2022.[2]
Outbreaks, commonly in countries with weak immunization programs, are now being detected worldwide. There are various outbreaks worldwide and developed and high-income countries are reporting outbreaks. The US has recently reported measles outbreaks in various states.[3] Approaches to deal with them have varied, from very by the book approaches, to an unusual approach in Florida where health authorities diminished the problem.[4] Europe has recently reported a diphtheria outbreak with a focus on the Czech Republic and the first death by the disease since 1969.[5]
Health systems and services are important to ensure that vaccination programs are managed in and efficient and effective way. Cold chain has to be preserved and functional during the whole logistic chain, from the producer to the country, to the clinic, to the person’s arm. Vaccines have to be seen under a vision of life course. Health personnel, be it at the Primary Health Care setting to the specialized care, have a role to play as vaccine promotors. OB/GYN with pregnant women for influenza and diphtheria; internal medicine, cardiologist, pneumologist, with patients with hypertension, diabetes, obesity, should receive influenza vaccines on time.
Outbreaks have costs to the health system, the family, and the patients. Vaccines are cheaper than the costs of epidemiological management, hospitalizations, etc. The support of the system is crucial for reaching protective coverages. Adequate planning, training, coordination, and especially sustained financing are crucial for a functional immunization program.
References
[1] Cairncross S, Peries H, Cutts F; Vertical health programmes, Lancet 1999; 349 (supl III):20-22 https://doi.org/10.1016/S0140-6736(97)90079-9
[2] Vaccines and immunization, https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
[3] Measles Cases and Outbreaks, CDC at https://www.cdc.gov/measles/cases-outbreaks.html
[4] Florida refuses to bar unvaccinated children from school suffering a measles outbreak https://apnews.com/article/measles-outbreak-florida-school-ladapo-259440881f1d5e11dc69ed64ff055418
[5] Muerte por Difteria en Praga, república Checa. https://fundacionio.com/muerte-por-difteria-en-praga-republica-checa/ (in Spanish)
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