Immunisation: Crisis and Benefits

The discovery of the benefits of vaccines has arguably been among the greatest developments in modern healthcare. Based on objective data, UNICEF states that,

Immunization is one of the most cost-effective public health interventions to date, averting an estimated 2 to 3 million deaths every year. As a direct result of immunization, the world is closer than ever to eradicating polio, with only three remaining polio endemic countries – Afghanistan, Nigeria and Pakistan. Children under 5 deaths from measles, a major child killer, declined by 85 per cent worldwide and by 89 per cent in sub-Saharan Africa between 2000 and 2016. And as of March 2018, all but 14 countries have eliminated maternal and neonatal tetanus, a disease with a fatality rate of 70 to 100 per cent among newborns.

However, recent articles on the WHO, UNICEF, BBC and CNN websites have highlighted emerging challenges that are counteracting the attempts at achieving universal coverage. The WHO quotes Dr Seth Berkley, who summarises the factors as the following:

Complacency about the disease and the spread of falsehoods about the vaccine in Europe, a collapsing health system in Venezuela and pockets of fragility and low immunization coverage in Africa are combining to bring about a global resurgence of measles after years of progress.

That the spread of falsehoods about vaccines is not limited to Europe is evident from the CNN article, which highlights problems in the USA and steps being taken by some local authorities to try to mitigate against the risks posed by unvaccinated individuals who may be carriers.

UNICEF provides some useful data on vaccine coverage, some of which is shared below. The first series of pictures are based on global coverage of the first dose of diphtheria, polio and tetanus.

The review of the third dose of DTP is presented in an interesting way, highlighting the countries with the greatest deficits in care. Of the 19.9 million infants who are not fully vaccinated with DTP3, almost 8 million (40%) live in fragile or humanitarian settings, including countries affected by conflict. About 5.6 million of them live in just three countries – Afghanistan, Nigeria and Pakistan – where access to routine immunization services is critical to achieving and sustaining polio eradication.

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When it comes to a review of measles vaccination, we see that rates remain too low to prevent outbreaks. Globally, 85% of children have been vaccinated with the first dose of measles vaccine by their first birthday through routine health services and 67% with a second dose. 167 countries have included a second dose of measles vaccine as part of their routine vaccination schedule. Nevertheless, coverage levels remain well short of the WHO recommended measles immunization coverage of at least 95% to prevent outbreaks, avert preventable deaths. and achieve regional elimination goals.

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The final image relates to the coverage of HPV vaccination. Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, and can cause cervical cancer, other types of cancer, and genital warts in both men and women. The benefits of HPV vaccination are discussed in greater detail here. By 2017, the HPV vaccine had been introduced in 80 countries covering 22  percent of global cohort of 15 year old girls.

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To summarise, it is important that we maintain vigilance and continue to both promote and practice effective vaccination so that we can reduce and eventually eliminate the burden of unnecessary deaths that affects vulnerable people across the globe.

 

 

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Why you are NOT in complete control of your health

In a world in which everyone’s opinion is valid, it can sometimes be difficult to separate truth from misinformation. When it comes to an understanding of the determinants of health, opinions vary from total abdication of responsibility …

“Not my fault” GIF
“Not my fault” GIF

to a belief that the individual is fully accountable (and responsible) for everything related to personal health.

Total blame GIF
Total blame GIF

That either extreme is untenable should be evident. For instance, the Daily Mail recently published a piece that acknowledges that apparently healthy people sometimes have unexplained deaths, once consideration of all relevant lifestyle factors is taken.

Another way to look at this is to think of the factors that impact on any decision one makes to adopt a healthier lifestyle. For instance, should you be interested in accepting the growing evidence of a more beneficial impact on personal and environmental health associated with a vegan lifestyle, you have to consider the relative affordability of vegan foods when you go out. The price that you pay for your vegetables, fruit and grains will be influenced by the level of VAT set by the government. When you need to quench your thirst, you might find that bottled water is more expensive than soft drinks. Obviously the state then has a role in setting policies that favour healthy choices.

Moreover, we find that certain communities are more at risk of certain medical conditions due to dietary or lifestyle practices across those communities.

This is something that Dahlgren and Whitehead discuss at length and present diagrammatically in their summary of the determinants of public health, shown below:

Dahlgren and Whitehead: The Determinants of Public Health
Dahlgren and Whitehead: The Determinants of Public Health

This gives a more comprehensive view and shows that health will be determined by:

  1. Non-modifiable factors such as age, sex and genes
  2. Individual lifestyle factors (diet, exercise, weight)
  3. Social and community networks (including where the individual lives)
  4. General socioeconomic, cultural and environmental conditions, which are largely influence by political factors

In view of these considerations, you might want to pause before making a judgment next time you discuss an individual’s health.

Improving Productivity through Intrusion?

The BBC has an interesting piece about the methods being used by companies to monitor employees and enhance productivity. These include the following:

  1. Logging keystrokes and using software to monitor the relationship between the help given to customers and whether they subsequently took loans or other offers.
  2. Tools to analyse e-mails, conversations, computer usage, and employee movements around the office
  3. Monitoring heart rates and sleep patterns to see how these affect performance
  4. Gathering “data exhaust” left by employees’ email and instant messaging apps, and uses name badges equipped with radio-frequency identification (RFID) devices and microphones
  5. Checking how much time employees spend talking, their volume and tone of voice, including whether or not they dominate conversations
  6. Embedded chips in their hands to open doors and use equipment
  7. Heat sensors at desks to monitor when employees are at their work stations

These are over and above the “routine” CCTV used by a lot of employers. The following video shows a live example.

Apparently there are benefits to employees, including providing evidence in disputes over harassment or discrimination claims; or where certain medical conditions have a serious impact on actual productivity. I would assume that the effective implementation of such approaches acts as a management substitute by reducing the need for direct line management in those organisations that employ such tools.

I’m personally interested to see which, if any, of these approaches will find their way into the pharmaceutical industry. I can see how they could easily be used in the manufacturing sector; but even within the retail sector there are already companies relying on electronic logging in and out of employees to monitor attendance.

There is a fine balance to be struck between protecting individual freedoms and ensuring that employees are productive. Employees at The Telegraph are said to have felt that the bar had been pushed too far in the intrusion direction. I guess time will tell where the pharmaceutical industry takes this going forward.