Q&A: A message to clinicians during World Immunization Week

World Immunization Week is acknowledged annually during the last week of April to raise awareness of the importance of child and adult immunizations, which prevent an estimated 2 to 3 million deaths each year from diphtheria, tetanus, pertussis and measles, according to WHO. However, an additional 1.5 million deaths could be averted with improvements in global vaccination coverage, which has remained stable over the past few years.

In 2012, the World Health Assembly approved the Global Vaccine Action Plan to eliminate vaccine-preventable diseases by 2020. Last year, however, WHO warned that only one of six midterm targets is on track: the introduction of at least one new or underused vaccine in at least 90 low- and middle-income countries by 2015. WHO reported that in 2015, about 19.4 million infants worldwide did not receive routine immunizations. More than half of these children live in 10 countries, which include Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, the Philippines and Ukraine.

William Schaffner
William Schaffner

In addition to preventing illness and death, vaccines have a positive impact on drug resistance by reducing the use of antibiotics, according to Infectious Disease News Editorial Board member William Schaffner, MD, professor of preventive medicine at Vanderbilt University. Schaffner, who also is medical director for the National Foundation of Infectious Diseases, which is holding its Annual Conference on Vaccine Research this week from April 24 to 26, spoke with Infectious Disease News about the benefits and misconceptions of vaccines, as well as the top vaccine-preventable infectious disease threats and ways to improve global immunization. – by John Schoen and Stephanie Viguers

What is the most important message for clinicians during World Immunization Week?

We need to remind ourselves that vaccines are safe, effective and a supremely efficient way to prevent many diseases. They are one of the great public health triumphs of the last century, and more vaccines are in the offing. Clinicians need to learn not to recommend vaccines but to insist upon them.

What are the most dangerous misconceptions about vaccines, and what is the best way to address patients who are hesitant to receive them?

There are many misconceptions about vaccines. For example, we’re right at the end of the flu season, and a persistent misconception is that you can get influenza from the flu vaccines. And, of course, there’s that painfully incorrect notion that some vaccines — particularly the measles vaccine — are associated with autism. Another example of a misconception is that multiple vaccines administered simultaneously might “stress” a baby’s immune system. These are all scientifically incorrect.

There are two ways to best address these concerns. One is person to person; that is, family doctors and pediatricians working with their patients at every opportunity to provide both information and reassurance along with their confidence that they’re doing the best for the children in their care. The other, of course, are the laws that we have in all 50 states concerning daycare and school attendance, and the requirements for immunization. They need to be administered fairly but rigorously. In one person’s view, the personal belief exemptions and religious exemptions should be omitted.

I think it’s worth remembering in this context that vaccines have two functions. The first, obviously, is to protect the individual who receives the vaccine. The second — since we’re talking about communicable diseases — is to provide a protected community so that the individual is not capable of spreading the infectious agent to others. Today, we have many more children and adults living among us who are substantially immunocompromised. Vaccination is a triumph of advancing medical science, but the immunocompromised often cannot receive vaccines if they have a suboptimal response to them. The way we protect these frail brothers and sisters among us is to get vaccinated and provide what’s been called a “cocoon of protection” around the frail and the weak. So, we make that contribution to others. I am unabashed in my assertion that because we live together in a highly integrated society, we have responsibilities not only to ourselves but to others as well.

The global vaccine action plan set goals to eliminate diseases like measles, rubella and maternal and neonatal tetanus by 2020, but these targets have fallen behind schedule, according to WHO. How can we get back on track?

There’s an old formula that needs to be applied that has a series of elements. The first, and most important, is commitment. Then, we need organization; then a determination to implement; and, of course, we need funding. All of those things have to be in place. I’m saddened that we are still struggling with maternal and neonatal tetanus. Those are illnesses that should have been eliminated years ago.

Another important issue is antibiotic resistance. How can vaccination help to reduce the number of drug-resistant bacterial infections?

It is often overlooked that widespread immunization clearly does have a very good impact on drug resistance. This has been best demonstrated in the use of pneumococcal conjugate vaccine in childhood. The first thing that happens is that you reduce invasive, serious pneumococcal infections. When that happens, a lot of children and adults do not need treatment, so you spare antibiotic use. It also has been demonstrated that those vaccines have prevented infection with the most multidrug-resistant pneumococcal types. So, the remaining pneumococcal infections that occur tend to be the more susceptible ones. Vaccines clearly have a role in this global campaign to combat antimicrobial resistance.

What are the biggest vaccine-preventable infectious disease threats globally, and are these diseases considered top global health investment priorities?

I would put influenza at the very top of that list because of its pandemic potential. Right behind influenza, I would put measles. There are many people today who don’t realize what a serious infection measles is, particularly younger people in the U.S. Our medical students’ jaws drop when I tell them that before we had a vaccine, in the U.S. population — which was smaller then than it is now — we had 400 to 500 children die each year of measles and its complications. That’s a stunning statistic! Those deaths have been completely eliminated! So, measles continues to be, worldwide, a killer of children, and is very important.

Another very quick observation: Of the vaccines that I should like to see developed are the big four: a universal influenza vaccine — one that would protect against all strains — and vaccines against HIV, tuberculosis and malaria. If we had those vaccines and implemented them globally, they would have a powerful, preventive public health impact on the world’s population.

Disclosure: Schaffner reports serving on Data Safety Monitoring Boards for Merck and Pfizer, and is an occasional consult to Dynavax, GlaxoSmithKline, Novavax, Sanofi-Pasteur and Seqirus.

World Immunization Week is acknowledged annually during the last week of April to raise awareness of the importance of child and adult immunizations, which prevent an estimated 2 to 3 million deaths each year from diphtheria, tetanus, pertussis and measles, according to WHO. However, an additional 1.5 million deaths could be averted with improvements in global vaccination coverage, which has remained stable over the past few years.

In 2012, the World Health Assembly approved the Global Vaccine Action Plan to eliminate vaccine-preventable diseases by 2020. Last year, however, WHO warned that only one of six midterm targets is on track: the introduction of at least one new or underused vaccine in at least 90 low- and middle-income countries by 2015. WHO reported that in 2015, about 19.4 million infants worldwide did not receive routine immunizations. More than half of these children live in 10 countries, which include Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, the Philippines and Ukraine.

William Schaffner
William Schaffner

In addition to preventing illness and death, vaccines have a positive impact on drug resistance by reducing the use of antibiotics, according to Infectious Disease News Editorial Board member William Schaffner, MD, professor of preventive medicine at Vanderbilt University. Schaffner, who also is medical director for the National Foundation of Infectious Diseases, which is holding its Annual Conference on Vaccine Research this week from April 24 to 26, spoke with Infectious Disease News about the benefits and misconceptions of vaccines, as well as the top vaccine-preventable infectious disease threats and ways to improve global immunization. – by John Schoen and Stephanie Viguers

What is the most important message for clinicians during World Immunization Week?

We need to remind ourselves that vaccines are safe, effective and a supremely efficient way to prevent many diseases. They are one of the great public health triumphs of the last century, and more vaccines are in the offing. Clinicians need to learn not to recommend vaccines but to insist upon them.

What are the most dangerous misconceptions about vaccines, and what is the best way to address patients who are hesitant to receive them?

There are many misconceptions about vaccines. For example, we’re right at the end of the flu season, and a persistent misconception is that you can get influenza from the flu vaccines. And, of course, there’s that painfully incorrect notion that some vaccines — particularly the measles vaccine — are associated with autism. Another example of a misconception is that multiple vaccines administered simultaneously might “stress” a baby’s immune system. These are all scientifically incorrect.

PAGE BREAK

There are two ways to best address these concerns. One is person to person; that is, family doctors and pediatricians working with their patients at every opportunity to provide both information and reassurance along with their confidence that they’re doing the best for the children in their care. The other, of course, are the laws that we have in all 50 states concerning daycare and school attendance, and the requirements for immunization. They need to be administered fairly but rigorously. In one person’s view, the personal belief exemptions and religious exemptions should be omitted.

I think it’s worth remembering in this context that vaccines have two functions. The first, obviously, is to protect the individual who receives the vaccine. The second — since we’re talking about communicable diseases — is to provide a protected community so that the individual is not capable of spreading the infectious agent to others. Today, we have many more children and adults living among us who are substantially immunocompromised. Vaccination is a triumph of advancing medical science, but the immunocompromised often cannot receive vaccines if they have a suboptimal response to them. The way we protect these frail brothers and sisters among us is to get vaccinated and provide what’s been called a “cocoon of protection” around the frail and the weak. So, we make that contribution to others. I am unabashed in my assertion that because we live together in a highly integrated society, we have responsibilities not only to ourselves but to others as well.

The global vaccine action plan set goals to eliminate diseases like measles, rubella and maternal and neonatal tetanus by 2020, but these targets have fallen behind schedule, according to WHO. How can we get back on track?

There’s an old formula that needs to be applied that has a series of elements. The first, and most important, is commitment. Then, we need organization; then a determination to implement; and, of course, we need funding. All of those things have to be in place. I’m saddened that we are still struggling with maternal and neonatal tetanus. Those are illnesses that should have been eliminated years ago.

Another important issue is antibiotic resistance. How can vaccination help to reduce the number of drug-resistant bacterial infections?

It is often overlooked that widespread immunization clearly does have a very good impact on drug resistance. This has been best demonstrated in the use of pneumococcal conjugate vaccine in childhood. The first thing that happens is that you reduce invasive, serious pneumococcal infections. When that happens, a lot of children and adults do not need treatment, so you spare antibiotic use. It also has been demonstrated that those vaccines have prevented infection with the most multidrug-resistant pneumococcal types. So, the remaining pneumococcal infections that occur tend to be the more susceptible ones. Vaccines clearly have a role in this global campaign to combat antimicrobial resistance.

PAGE BREAK

What are the biggest vaccine-preventable infectious disease threats globally, and are these diseases considered top global health investment priorities?

I would put influenza at the very top of that list because of its pandemic potential. Right behind influenza, I would put measles. There are many people today who don’t realize what a serious infection measles is, particularly younger people in the U.S. Our medical students’ jaws drop when I tell them that before we had a vaccine, in the U.S. population — which was smaller then than it is now — we had 400 to 500 children die each year of measles and its complications. That’s a stunning statistic! Those deaths have been completely eliminated! So, measles continues to be, worldwide, a killer of children, and is very important.

Another very quick observation: Of the vaccines that I should like to see developed are the big four: a universal influenza vaccine — one that would protect against all strains — and vaccines against HIV, tuberculosis and malaria. If we had those vaccines and implemented them globally, they would have a powerful, preventive public health impact on the world’s population.

Disclosure: Schaffner reports serving on Data Safety Monitoring Boards for Merck and Pfizer, and is an occasional consult to Dynavax, GlaxoSmithKline, Novavax, Sanofi-Pasteur and Seqirus.