For more than 200 years, human beings managed to avert widespread pestilence with vaccines. While not a silver bullet, vaccines provide us with the freedom to engage with the world without the fear of debilitating disease. As we reflect on the global relevance of vaccines during World Immunization Week, we quickly acknowledge that persistent societal disparities have affected our ability to equitably vaccinate, a phenomenon that has been illuminated by COVID-19. As we pursue systems designed to equal the playing field in the spirit of collective global welfare, we must consider whether immunizations are simply products of universal access, or are themselves are enablers of this global target.
Global value of immunization diminished by health inequalities
Despite the target for global equitable access to immunization by organizations such as GAVI and the World Health Organization, there remains a huge gap in levels of vaccine accessibility at both national and global levels. Low and middle-income countries have notably reduced access to vaccines, and within countries, social factors such as like conflict and destitution have detrimental effects on immunization.
Despite the global successes we have achieved with elimination of smallpox and near-elimination of polio, inadequate access remains a challenge in many regions in the world. Up to 15% of the world’s children have no access to immunization, and millions of children still die from infections, including pneumonia and diarrhoea, many cases of which could be prevented by vaccination.
Global vaccine inequity has been seen even more starkly in the pandemic where low-income countries have struggled to get access to vaccines. As of 4 March 2020, many such countries had yet to administer a single dose while many of their larger contemporaries had enough doses to inoculate their populations several times over. Our pleasant illusions of equitable access were quickly supplanted by the harsh reality of the perennial global economic disparities, and their tangible effects on global health were impossible to ignore.
Vaccines are not a simply a product of UHC, they also drive UHC
Regarding global health inequities, it is clear that universal health care (UHC) is an enabler of widespread immunization given its inclusive mandate of bringing all under the net of healthcare access. Greater access to healthcare services inevitably translates into greater opportunities for immunization. Interestingly, one may argue that this relationship also exists in the reverse, where the pursuit of routine and universal immunization itself can serve as a potent platform towards enabling coverage for all. Immunization is one of the few platforms that bring most households into contact with healthcare systems five or more times during the first year of a child’s life. This offers a clear opportunity for providing additional primary healthcare services at these touchpoints, and we must consider whether it can serve as a platform upon which additional healthcare outcomes can be built.
Furthermore, vaccines have indirect effects on driving access to healthcare resources through influencing the distribution of healthcare services. Through averting preventable diseases which consume copious health resources, vaccines permit the deployment of capabilities towards those who need them most. Immunization programmes take pressure off healthcare systems, enabling allocation of resources to the underserved, particularly around non-communicable diseases which are now responsible for over 70% of global mortality. This phenomenon is shown in the pandemic, where greater levels of vaccine uptake have finally allowed for the allocation of resources towards other socially valuable initiatives.
Finally, considering that poverty is a key factor standing in the way of UHC, it is clear that immunization permits the maximization of our economic potential and drives poverty reduction. It has been projected that vaccines administered between 2016 and 2030 will prevent 24 million people in 41 of the world’s low and middle-income countries from falling into poverty, and has been shown to drive significant value-creation – with every $1 invested in immunization driving a return of $54 in social and economic value.
Speed of vaccine development brings hope for UHC
COVID-19 has been our most pressing challenge, and our world has managed the mammoth task of condensing several years of vaccine development into a single year. The global health community has never been more connected, engaged and collaborative, and levels of interest in supporting immunization services, vaccine development and effective procurement systems have never been higher. True to the theme of World Immunization Week, vaccines have indeed “brought us closer” to economic, social and psychological normality. Necessity has been the mother of invention and several of the assets developed through this pandemic – immunization programmes, embracing health technology, and greater public health awareness – will serve us well in the days to come.
The spirit of collaboration demonstrated between competing companies such as Pfizer and BioNTech illustrate the potential unlocked through collaboration and the power of resolve. With the second wind of hope promised by our experience with vaccines, it is hoped that we will be able to solve the problems in vaccine development against more complex infections, such as malaria and HIV, which have seen substantial but modest success in recent times. Significant progress has also been made in vaccine development against many non-infectious diseases such as Alzheimers and diabetes, and therapeutic cancer vaccines remain promising. Greater levels of prevention, treatment and access to care are expected in the days to come and vaccines will continue to offer opportunities for expanding our ability to influence global health.
No arm left behind
Though we face an uncertain future, the pandemic has reminded us that we now live in a global village and that no one is safe until there is safety for all. It is hoped that we are able to take our immunizations, our learnings and our resolve and maintain commitment to the Immunization Agenda 2030 and SDG3. True to the words of Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, “There is no health for all without vaccines for all…” As we move beyond the pandemic and reflect on the idea that vaccines have indeed “brought us closer” let us ensure that in the days to come there is no man, woman or arm left behind.
Source: World Economic Forum
