By Mahlon Meyer
NORTHWEST ASIAN WEEKLY
Dr. Esther Chung recalls during her final year as a resident, several decades ago, when a school-aged child was brought to the emergency room with diarrhea. Within a matter of minutes, the child became gravely ill, developing a widespread rash and requiring intensive care.
“It was one of the worst cases I’ve ever seen,” said Chung, now a professor of Pediatrics at the University of Washington School of Medicine. “This child lost limbs due to overwhelming meningococcal disease.”
We now have a vaccine that helps to prevent this devastating disease. In 2005, the Centers for Disease Control and Prevention first recommended that the meningococcal vaccine, MenACWY, be given to preteens and teens.
Today, however, such strides are being undone. While a plethora of vaccines have been developed that prevent diseases like meningococcal infection, tens of millions of children have failed to receive them in recent years.
According to “The State of the World’s Children 2023” report by UNICEF, 67 million children did not receive some or all of their childhood vaccinations due to the pandemic.
The pandemic preoccupied frontline health care workers, disrupted health care systems, and created shortages of supplies needed to make vaccines.
“Disruptions caused by the pandemic interrupted childhood vaccination almost everywhere, setting back vaccination rates to levels not seen since 2008,” said the report.
Even in Washington state, routine childhood vaccinations dropped 13% in 2021, when compared to before the pandemic, leaving children and families here exposed to vaccine-preventable diseases that in many cases had previously been wiped out.
Another reason for the decline in childhood vaccination, especially in the U.S., is growing distrust of vaccines in general. In the U.S., only 79% of people have “confidence” in vaccines for children—the same number as for Mongolia (the highest rate was in India, with 98% of the population believing that vaccines helped children).
According to the UNICEF report, sentiment in the U.S. against vaccines has only grown stronger since the pandemic.
“One of the main reasons for vaccine hesitancy is fear,” said Chung, in an interview. “When people are scared, they turn to anecdotal reports of adverse events and other reasons that reinforce their fears.”
Normally, a child will follow a sequence of shots that protects him or her from contracting two dozen of the most terrifying diseases that have largely been eliminated.
The sequence begins on the first day of an infant’s life, when the Hepatitis B vaccine is delivered in the hospital.
Parents are counseled about the dangers of Hepatitis B and any potential rare side effects from the shot.
“We don’t give it immediately, we give the family time to bond with the child, and ideally breastfeeding takes place, which you could say is the first form of immunization,” said Chung, since the mother passes some of her immunity to her child.
A clinician will share information sheets from the CDC, ideally, and get the parents’ consent.
“We want parents to have an opportunity to ask questions and discuss their concerns,” said Chung.
In recent years, medical science has combined multiple vaccinations into single shots, so the childhood schedule of immunizations is simplified.
Children go on to get over a dozen routine vaccinations throughout their childhood and into their teenage years that cover everything from Rotavirus, Diphtheria, and Tetanus, to HPV and Meningococcal infection.
Why the setback?
But now, because of the pandemic, children all over the globe have missed out on this series.
“Why did the pandemic set back childhood immunization? It placed huge new demands on health systems, which they were often ill-equipped to cope with. It exacerbated existing shortages of health workers. It placed heavy strains on frontline health workers, mostly women, who were also coping with additional care burdens at home,” according to the report.
Out of sight
The effects have been exacerbated by mistrust of vaccines. In some parts of the U.S., for instance, some religious communities have been opposed to vaccines. Members of those communities, usually high school or college students, at times have gone abroad, and contracted measles or other diseases, and brought them back home.
Nor do the current wave of medical students and residents necessarily counsel parents about vaccines the same way as earlier generations may have.
“Most students have not seen first-hand the effects of some of these diseases that have largely been eradicated,” said Chung.
“Many people, for instance, might think mumps involve merely swelling of the cheeks,” said Chung.
But in fact, the childhood illness can cause swelling of the testicles and fertility problems, Haemophilus influenzae type b, which until recently was on the wane, can cause life-long catastrophic damage.
“I saw it as a resident—children were quite sick and went on to have neurologic damage and some of them are now wheelchair bound,” said Chung. “I’m happy to say that we don’t see many of the diseases I saw as a resident, thanks to childhood vaccinations.”
One of the greatest achievements
What is even more lamentable is that progress in eradicating many of these diseases, through vaccination, was considered one of the greatest achievements of modern medicine, according to many benchmarks.
“Since 1900, the average lifespan of persons in the United States has lengthened by greater than 30 years; 25 years of this gain are attributable to advances in public health,” according to the CDC. “Vaccination … has resulted in the eradication of smallpox; elimination of poliomyelitis in the Americas; and control of measles, rubella, tetanus, diphtheria, Haemophilus influenzae type b, and other infectious diseases in the United States and other parts of the world.”
Moreover, the financial return on vaccination efforts is unprecedented in health care history.
For every $1 spent on vaccination, $26 is saved in health care costs on average globally.
In strictly financial terms, that would be like having a stock that returned 26% of its value each year—virtually unheard of.
And the “return” in this case is measured in children’s lives.
Because of the strain of the pandemic on health care, we are now back at levels of vaccination rates almost two decades in the past—roughly at the benchmark of 2008, when vaccine campaigns were really starting to spread and take hold.
The good news is that given how rapidly and efficiently much of the world’s population was able to be vaccinated against COVID-19, a similar campaign for renewed childhood vaccination can be achieved, according to UNICEF.
“The decline in immunization throughout the pandemic should sound an alarm bell: Routine immunization must be a priority in the coming years. We must take concerted action to catch up with children who missed out on being vaccinated during the pandemic, rebuild systems, and tackle major gaps in health systems,” according to the report. “Failure to act will devastate the lives of today’s children and adolescents and tomorrow’s adults.”
For many children, however, it will soon be too late, according to UNICEF, because they will be beyond the age of typical childhood vaccination.
As it is, the return of some of the worst diseases from the past, due to under vaccination, is virtually assured.
What can be done?
“For vaccination to happen, political will must be a number one priority across countries,” said the report.
It urged polities to find the will to vaccinate every child, strengthen confidence in vaccination, spend more and in more efficient ways on immunization, and build shock-proof health care systems.
Mahlon can be reached at firstname.lastname@example.org.
This health series is made possible by funding from the Public Health – Seattle & King County, which has no editorial input or oversight of this content.