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The Added Value of Vaccination

Routine immunization programs not only help to prevent outbreaks of vaccine-preventable disease, but also serve as a critical first line of defense against new and emerging pathogens. That’s because vaccination drives in lower-income countries strengthen primary health care, improving disease surveillance in the process.

More than six months after the first COVID-19 vaccines became available, it should be clear to everyone that vaccines alone won’t stop this pandemic; we also need vaccinations. For many, any delay in vaccine access will prolong a crisis that already has immeasurably scarred lives, livelihoods, and economies.

The fact that even those at high risk from COVID-19 have yet to be fully protected demonstrates the complexity of the challenge of scaling up production and vaccinating billions of people. But the pandemic also highlights the perpetual, long-standing struggle with infectious disease facing hundreds of millions of people every day.
There is usually only a thin line stopping pathogens from spilling over into human populations. When it is crossed, a small, localized disease outbreak can all too easily escalate into a global crisis at breakneck speed. Given that vaccination is often the only way to prevent this, we urgently need to revise how we view global immunization programs.

SPREADING IMMUNITY

Before COVID-19, policymakers regarded global vaccination drives through the long lens of international development and humanitarianism, and funded them accordingly. But as we grapple with the current crisis and prepare for the next pandemic, this approach clearly no longer makes sense. Global health and global health security are one and the same, and should be a national priority everywhere.

Every year, tens of millions of children in lower-income countries are vaccinated against a wide range of deadly infectious diseases. At first glance, these routine immunization programs have a straightforward objective: preventing outbreaks of diseases that once plagued the world, but which now predominantly affect people in poorer countries. And they have been extraordinarily successful, reducing vaccine-preventable diseases by 70% and preventing as many as 80 million deaths in 98 lower-income countries between 2000 and the outbreak of the COVID-19 pandemic.

But although keeping the world safe is an important part of global health security, the value of vaccination goes well beyond that. For starters, routine immunization programs are currently playing a central role in the global deployment of COVID-19 vaccines, which will be necessary to prevent the collapse of health systems and bring an end to the pandemic’s acute phase. In lower-income countries, the same infrastructure, supply chains, trained personnel, data systems, and monitoring used in these regular programs form the backbone of COVID-19 vaccine distribution.

The international community clearly recognizes the vital role that vaccines and vaccination programs are playing during this pandemic. This is evident in the unprecedented international support for the COVID-19 Vaccine Global Access (COVAX) facility, a partnership created by the Coalition for Epidemic Preparedness Innovations, the World Health Organization, UNICEF, and Gavi, the Vaccine Alliance to ensure equitable vaccine access. Gavi’s core work of helping countries to vaccinate half the world’s children through routine immunization also has received generous global backing. But to prevent the next pandemic, we need to recognize vaccination’s broader role.

Routine immunization programs not only help to prevent outbreaks of vaccine-preventable disease, but also serve as a critical first line of defense against new and emerging infectious diseases, including those for which no vaccines yet exist. That’s because regular vaccination drives in lower-income countries strengthen primary health care, improving disease surveillance in the process. Existing global surveillance networks for infectious diseases can be highly porous, despite recent efforts to improve them since the COVID-19 pandemic began. The most effective and usually the cheapest way to plug the holes is through improving access to primary health care.

After all, primary health care is typically the first point of contact that people have with medical and health services when they get sick. So, the more people who have access to this care, and the more robust its provision, the better our ability to detect outbreaks early. But because primary health care is itself often patchy, even in middle-income countries with relatively good health-care systems, large clusters of communities still miss out. In terms of global health security, these are some of our biggest blind spots.

Fortunately, the expansion of routine immunization programs is helping to address this problem, because the same infrastructure supporting vaccination drives also helps to improve access to other vital health interventions and services, such as nutritional supplements, deworming, malaria prevention, and, crucially, disease surveillance. So, every time we reach a so-called zero-dose child – one who has missed out on even the most basic vaccines – they, their parents, and their community get access to better primary health care, and our global early warning system for disease outbreaks improves a little, too.

FUTURE RESILIENCE

Within the first few months of this pandemic, 85% of lower-income countries experienced disruption to their routine immunization programs. With each day, as more people missed out on vaccinations, the risk of outbreaks of other, preventable, diseases increased. With support from Gavi and other Vaccine Alliance partners, many of these programs are now recovering well. But, to build resilience, we need to get them all back on track and more effective than ever.

In the meantime, we still need to end the current pandemic. That means not only ensuring that more people are protected with COVID-19 vaccines, but also making the best use of the doses available, so that high-risk groups are given priority everywhere. To this end, COVAX is working with donor governments and manufacturers to devise how surplus doses can be donated to lower-income countries that need them, and how existing vaccines, and new ones still in development, can be best deployed, including to tackle coronavirus variants. Therapeutics and diagnostics, as well as other non-pharmaceutical interventions, will also be key.

But the critical task of ensuring that no one in poorer countries misses out will also involve relying heavily on the meticulous micro-planning used by routine immunization programs to vaccinate hard-to-reach populations. Reaching enough people to stop COVID-19 from circulating could in turn help to expand the reach of routine immunization, which would further boost resilience and improve preparedness for future pandemics.

This pandemic has already demonstrated the intrinsic link between health and wealth, and not just in terms of direct economic effects. Even if one country manages to vaccinate its entire population against COVID-19, so long as the coronavirus circulates, new variants will emerge, reinfection will continue, and efforts to resume trade, travel, and commerce will stall.

In this sense, the pandemic has also revealed that better global health and improved global health security are two sides of the same coin. It is a coin that should be accepted in all countries.

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