World Immunisation Week: Call to action

Expert opinionGlobal healthHealthVaccines

World Immunisation Week (24^th-30^th April) is a celebration of one of the most astonishing and under-recognized feats of human innovation, a British invention, vaccination.

Edward Jenner, who coined the term vaccination, predicted in his treatise on smallpox in 1796 that the disease could be eradicated from the planet through his approach to prevention using inoculation with a harmless related virus (called cowpox). At that time about 1 in 10 people died from smallpox and almost half of all children died from other infectious diseases (yes that is one out of every two children). His prediction was proven to be correct in 1980 when WHO declared the smallpox virus eradicated through a global vaccination effort which has confined the virus to history. Furthermore, his work has had a profound impact by being the inspiration behind development of other vaccines, which have been so successful that most doctors in the UK today won't ever see many of the awful diseases which our NHS vaccines prevent. This has been happening in front of my eyes as a paediatrician in the NHS for over 30 years with some types of meningitis, pneumonia, and severe diarrhoea disappearing since I was a junior doctor, and the viruses which cause most cases of cervical cancer are being eliminated by the amazing NHS HPV vaccine programme which started in 2008.

This year World Immunisation Week is a special one, as it marks the 50^th anniversary of the World Health Organizations (WHO) efforts to transform global child health by preventing life-threating infections like those which killed so many children in Jenner's day. The initiative, which started in 1974, is called the Expanded Programme on Immunisation (EPI). At its inception, EPI focused on preventing just 6 killer diseases, but today there are 13 horrible diseases prevented by the programme (and 17 others used in some populations or circumstances), which reaches remarkably around 90% of the 140 million babies born each year.

Core EPI vaccines for the world:

Bacillus Calmette-Guérin (BCG), diphtheria, pertussis, tetanus, Haemophilus influenzae type B (Hib), Hepatitis B (HepB), polio, measles, rubella, pneumococcal disease, rotavirus, human papillomavirus (HPV), and COVID-19 (for adults).

So, if we have such powerful tools, why are we seeing outbreaks of measles in London, the West Midlands, and all over Europe, and a rise in whooping cough here in the UK. Vaccines work brilliantly in acting as a safety shield preventing these killer diseases, but they only work if we use them. Unfortunately, unlike the eradicated smallpox virus, the microbes that cause the other life-threatening infections of children are still out there, and as soon as we become complacent about maintaining the vaccine shield for every child the diseases can start spreading again, and they will cause disability or kill. With around 20 million children in the world unvaccinated or under-vaccinated EVERY YEAR there is a huge and growing pool of unvaccinated kids to spark devastating disease outbreaks.

The bottom line is that we are not doing enough to ensure that children receive their vaccines on time. The evidence clearly shows that under-vaccination is predominantly a problem of access - obviously in many low resourced countries with fragile health systems, natural disasters and conflict it is easy to see how immunisation services are difficult to deliver. But the outbreak of measles here in the UK shows that even in one of the richest nations in the world, we are failing to fully immunize our children. Given that the future health of our children and their very lives are at stake, this situation is shameful.

It is easy to dismiss this all as a problem with vaccine confidence or the rise of anti-vaxxers. And it is clear that for some parents there are issues of confidence in vaccines which need to be addressed. But the evidence has consistently shown that the main issue in the UK, is the same as in the poorest countries of the world, access. For example, a UKHSA survey in 2019 found that the main reasons for under-vaccination were timing of appointments, availability of appointments and childcare duties. Moreover, under-vaccination tracks with deprivation status, showing that the problems are greatest in communities with the greatest need…. and inequality in our society continues to drive the risk to the health of our children. This is evidently a systems problem which has to be understood and solved at the local level to make immunisation work for the local community. If it isn't easy to access immunisation services, vaccination won't happen.

For those of us working in vaccine research, it could not be a more exciting time, with technology rapidly advancing such that it is possible to see that vaccines will in future prevent more infections, prevent and treat cancer and even potentially prevent some neurological and degenerative diseases. But knowing these future prospects for the technology should be a wake-up call for the NHS and its political leaders that we need to get the systems right today to deliver the remarkable and beautiful innovations that are the vaccines that we already have.

Professor Sir Andrew Pollard, Director of the Oxford Vaccine Group, University of Oxford