Time for a Routine Immunization Communication Effort
SCOTT C. RATZAN
In the midst of the global public health discussion of avian flu and
the 25th anniversary of the discovery of HIV, a relatively unnoticed
reality continues:routine immunization coverage is only at about 78%
worldwide. This added up to an estimated 2.1 million people around the
world dying of vaccine preventable diseases in 2002. The toll included
1.4 million children under the age of five. Among these childhood deaths,
over 500,000 were caused by measles; nearly 400,000 by Haemophilus influenzae
type b (Hib); nearly 300,000 by pertussis; and 180,000 by neonatal tetanus.
In the past century, numerous success stories relate to
scientific progress with immunization – smallpox has been eliminated
from the planet and polio is nearly eradicated. Additionally, since
1985, the World Health Organization and UNICEF have successfully campaigned
for routine immunization; more than 70% of children in developing nations
were vaccinated against basic childhood diseases in the early 1990s.
But the immunization success has been short-lived as children in developing
countries struggle to get the basic routine immunizations against diphtheria,
pertussis, tetanus, tuberculosis and measles. Even worse, in 14 of the
world ’s poorest countries, immunization coverage is below 35 %.
Overall, this translates into one quarter of the world ’s children
not being vaccinated by their first birthday, with approximately 1.4
million children (in 2002) dying from diseases preventable with widely
available vaccines for diphtheria, pertussis, measles, tetanus, Hib,
polio, and yellow fever.
Additionally, there are wide disparities of coverage such
as the 27 million children worldwide who did not receive three doses
of diphtheria-tetanus-pertussis (DTP3) vaccine in 2003, including 9.9
million in South Asia and 9.6 million in sub-Saharan Africa. In 2003,
72% of developing countries did not achieve over 80% coverage among
infants with the basic DTP3. Routine immunization programs tend to miss
people living in remote locations, urban slums and border areas. They
also include indigenous groups, displaced populations, those lacking
access to vaccination because of various social barriers, those lacking
awareness or motivation to be vaccinated and those who refuse.
The WHO Expanded Programme on Immunization began in 1974,
and WHO and UNICEF have recently instigated a global immunization vision
and strategy for the years 2006-2015. Its goal is to protect more people
against more diseases by expanding the reach of immunization to every
eligible person, including those in age groups beyond infancy, within
a context in which immunization is high on every health agenda. The
global strategy highlights how the need for immunization can both benefit
from —and contribute to —the development of the health sector
and to overcoming system-wide barriers. It also links the contribution
of immunization to global preparedness for epidemics and complex emergencies.
This Global Immunization Vision and Strategy (GIVS) uses seven guiding
principles within four strategic areas and with 24 strategic approaches.
The guiding principles have inspired the formulation of the global strategy:
1. Equity and gender equality
2. Ownership, partnership and responsibility
3. Accountability
4. Assured quality and safe products and services
5. Strong district-based immunization systems
6. Sustainability through technical and financial capacity building
7. Policies and strategies based on evidence and best practices
The ideals of this approach address the underlying ethical
issues and transference of knowledge and evidence to policies, strategies
and practices. But, the sharing of lessons and experiences from similar
circumstances is limited with only one of the strategic areas focused
on communication.
Strategy 22:Improve communication and dissemination of information
In GIVS, the issue is addressed as follows:
‘‘Communication must be improved in order to
ensure that the public, policymakers, and health workers understand
the vital importance of immunization for the health of both children
and adults. This is essential both in ensuring support for the current
immunization programme and in providing information about the introduction
of new vaccines or technologies to a national schedule. As delivery
systems become more complex and the diversity of available products
increases, the demand for clear guidance on programme preferences will
also intensify. In view of the globalization of the media, including
widespread access to Internet-based information, it is of critical importance
to make use of the available media both to provide evidence-based information
about the value of immunization and to counter false information about
vaccine safety issues.’’
This is key for success, yet the program may not have
the wherewithal to develop their goal by limiting this critical area
to three measures:
1. Develop new ways of using the globalized media, including
the Internet, to build public awareness of the benefits of immunization.
2. Produce quality and timely information on the benefits of immunization
and associated risks, and develop key messages to promote immunization
according to national needs and priorities.
3. Through regional and global channels, document and systematically
communicate the experience gained by countries that have added new vaccines
and technologies.
The evidence in the published literature and analysis
of lessons learned from other immunization efforts reinforces the need
to utilize multiple channels and sources to be successful. Global proclamations,
policies and top-down approaches have limited effect. Evidence suggests
that an ongoing, culturally sensitive communication effort with key
audiences participating is the key to sustainable success. Hence, there
is a need to adapt and brand materials, documents, and tools to reverse
the immunization gap between children in the developing and developed
world. A strategic and systematic approach should be central and be
designed principally for the health worker(s) and consumer(s) in mind.
These audiences will not only be recipients of the value of routine
immunization, but in turn be equipped to advocate and articulate the
need for vaccinations for the policymakers, community leaders and the
public(s) for which they serve.
Today, immunization is a highly cost-effective and relatively
inexpensive health intervention. However, as we develop new opportunities
to prevent viral disease and their sequalae including cancers, the overall
cost of immunization and the potential innovation with therapeutic vaccines
and other such areas, including the procure- ment of new vaccines, new
vaccine formulations and technologies, are expected to rise sharply
in the future. Such spending in public health is well allocated if it
concomitantly builds a health competence at all levels of society where
people value health security as societal capital and wealth.
Those of us as health communicators must continue to articulate
the central value of our efforts to advance public health with the capacity
and focus that progress towards the global strategic goals in GIVS.
Yet, the health communication capacity is an entry point for developing
efforts involving partnerships at all levels to improve ethical approaches
with advocacy, policy and social marketing strategies to advance public
health, while employing continuous quality improvement while we monitor
and evaluate results.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also is Vice
President, Government Affairs, Europe for Johnson & Johnson with
academic appointments at George Washington University School of Public
Health, Tufts University School of Medicine, Yale University School
of Medicine, The College of Europe, and University of Cambridge.
