A dramatic decrease in cases and outbreaks of vaccine-preventable diseases has made many communicable diseases a rare event in Europe. Nevertheless, vaccine-preventable diseases continue to cause illness, disability and even death. Every year, 1.4 million children worldwide die from vaccine-preventable diseases before they reach the age of five years; in 2002 an estimated 2.1 million people around the world died of diseases that are prevented by routinely-used vaccines. A child in the developing world is ten times more likely to die from a vaccine-preventable disease than a child in the western world. In WHO’s European region, vaccine-preventable diseases continue to kill an estimated 32,000 children every year (1).
Despite improvements in health in recent decades, immunization has remained a priority in the fight against vaccine-preventable diseases. No other health intervention has reduced disease and mortality as effectively as immunization. Immunization is considered one of the most cost-effective health care services available.
WHO has prioritized immunization for seven key reasons (1).
1) Immunization saves lives – more than three million people worldwide are saved each year.
2) Immunization is a basic human right – nevertheless, the benefits of immunization are spread unevenly across Europe and the world. In most countries some vulnerable groups still lack access to immunization and many countries have pockets of unvaccinated children that are susceptible to infection. Some people lack an awareness and understanding of vaccination benefits, while others refuse vaccination on ethical or religious grounds. Ensuring the sustainability of routine immunization programmes presents a great challenge for some countries.
3) Outbreaks of vaccine-preventable diseases pose a constant and serious threat. Thanks to effective immunization programmes many people, including health professionals, assume that since certain diseases rarely occur they no longer pose a threat. This and other misperceptions have led to a serious decline in vaccination coverage and resurgence of highly contagious diseases such as measles, rubella, pertussis and diphtheria. An alarming threat is the growing importation of diseases from endemic to disease-free countries. The reappearance of eliminated or controlled diseases is always a concern.
4) Communicable diseases still kill. The negative consequences of failing to sustain high vaccination coverage include preventable death, disease and suffering in addition to the high economic costs of fighting outbreaks and epidemics and providing health care services. Measles and rubella are a target for elimination by 2010. Despite the fact that measles vaccine has been available for more than 40 years, over 100,000 cases were reported in central and western Europe in 2002-2004, and almost 55,000 cases of the disease were notified in Europe in 2006.
5) Vaccine-preventable diseases can be controlled and eliminated. While smallpox was eradicated in 1978, poliomyelitis was eliminated in Americas in 1994 and in Europe in 2002, measles, rubella, congenital rubella syndrome and pertussis are still a burden in Europe. With sustained high vaccination coverage, the incidence of vaccine-preventable diseases can be controlled and eliminated.
6) Immunization is cost-effective. Immunization is one of the few health services that costs very little, but offers huge benefits for entire populations. It saves millions of lives every year, preventing death and disability from communicable diseases at a fraction of the cost of disease treatment. In a study of eleven western European countries, the cost of treatment per measles case was estimated to vary between 209 and 480 €, while the cost per person of measles vaccination, including indirect costs, varied from 0.17 to 0.97 €. The cost savings associated with measles elimination in western European countries will be 36 million € annually if a two-dose MMR vaccination schedule is implemented. Immunization has significant, broader economic impacts in addition to saving costs of treatment – it entails immeasurable individual and societal benefits in terms of earning capacity, productivity and economic growth. Effective health policies, including sustained immunization coverage, and related expenditure must be seen as an investment, not a cost.
7) Children’s health depends on systems that provide safe, effective and inexpensive immunization – all children in every country must receive the right vaccine in the right time and in the right place. We should remember that while the vaccination coverage is seemingly high (>90%), the pool of susceptible children accumulates over time and these children must be reached and vaccinated. National immunization systems should be prepared for the introduction of new vaccines that can also be available to other age groups, including adults and elderly people, and risk populations. Many countries in Europe are providing additional vaccines, but they lag behind in providing the adequate number of doses or booster doses for traditional vaccines and give little or no consideration to vulnerable people and older age groups.
The EpiNorth Journal and project will remain a strong partner for all governments, organizations and health care specialists that work every day to maintain high vaccination coverage and fight vaccine-preventable diseases.
1. World Health Organization. Why immunization must remain a priority in the WHO European Region. http://www.euro.who.int/vaccine/20081210_1