This year’s World Immunization Week takes place against the backdrop of a global pandemic which threatens to compromise routine vaccination just as the demand for vaccines soars. The tragic irony of public sentiment towards vaccination has always been that successful immunization campaigns dampen demand for vaccines. ‘Vaccines are a victim of their own success,’ it is often said.
In practice, this means the absence of measles, of polio, of diphtheria and other infectious diseases in many of our communities breeds complacency. We don’t feel the need to protect against something so rarely seen.
It’s entirely natural, of course, but the effect is to drain public enthusiasm for one of the greatest public health tools in history - leaving public and online spaces to a small minority of vocal anti-vaccine activists.
In contrast, the sudden emergence of a new strain of coronavirus changes everything, at least temporarily. The pandemic is a harsh reminder of how an infectious disease can spread in the absence of immunity. Illness and death, economic turbulence and social disruption dominate the headlines, our conversations and our thoughts.
People want a vaccine, and soon. An effective vaccine could provide herd immunity without the mortality that comes with letting the disease run its course. It would present a path back to the social and economic activity that we took for granted until two months ago. It would offer hope of a return to normality.
Experts we spoke to believe it will take 18 months to develop, test, approve and manufacture a vaccine. That would be a record-breaking achievement, even if an impatient world finds that timeline frustrating. There are dozens of vaccines in various stages of development but none is guaranteed to succeed - many are built on promising but unproven technologies.
A new, safe and effective vaccine is essential. Shortcuts and compromises would put people at risk and jeopardise public trust in all vaccines, in science and in health authorities.
When and if a vaccine is available, new questions will arise. Billions of doses will not roll off refrigerated trucks at the same time; prioritisation will be inevitable.
Should the vaccines go first to older people as they face the highest mortality risk? To middle-aged people first as their potential healthy life years are greatest? To health workers risking their lives to help others? To children, if they are ‘super-spreaders’? To low-income countries as their access to respirators is lowest?
The global bidding war over personal protective equipment (masks, gowns etc.) and ventilators, and internal domestic disputes on how to distribute these scarce resources, suggest ‘vaccine wars’ are imminent.
Meanwhile, other global pathogens have not gone away. Some will return and flourish if routine immunisation programmes are suspended. The global polio eradication effort could be jeopardised.
Every week is Immunization Week
World Immunization Week (WIW), and European Immunization Week (EIW) (20-26 April), aim to raise awareness of the importance of immunization in preventing disease and protecting life. This year, awareness and demand for vaccines is high - but access to vaccination has suddenly become a problem.
The theme of this year’s WIW is #VaccinesWork for All. Before the pandemic, there were 20 million children who were not getting the vaccines they needed. That number may have risen in recent months and could rise further as health systems and economies feel the strain of COVID-19 outbreaks.
The WHO is also highlighting the value of ‘strong, resilient health systems and universal health coverage’ through which immunization can be delivered. The pandemic has only amplified the need for such resilient, universal systems.
As 2020 was designated the International Year of the Nurse and Midwife, their role as vaccine champions will be highlighted this week. In Europe, the EIW campaign also acknowledges nurses/midwives, noting that this year marks the 200th year since the birth of Florence Nightingale. Often credited as the ‘founder of modern nursing’, Nightingale’s name has been adopted by temporary UK hospitals rapidly built to cope with surging demand for care during the pandemic.
Finally, the focus of immunization week is to promote vaccines across the life-course. As people of all ages are affected by infectious diseases, it is vital that all of us have access to - and avail of - vaccines recommended by health authorities and our health professionals.
Given the disproportionate burden, COVID-19 imposes on older people, we should hope that the short-term impact of coronavirus on vaccination rates will be to improve flu vaccine uptake in people aged 65 and older this autumn. In the medium-term, a coronavirus vaccine may ultimately hold the key to a better future. In the long-term, let us not forget the harsh lessons the pandemic has taught us all.