The past, present and future of vaccines

This year marks an important milestone in the global public health landscape. Exactly 50 years ago, in 1974, the World Health Organization (WHO) established the Expanded Programme on Immunization (EPI).

This ushered in the era of mass vaccinations against infectious diseases such as measles, whooping cough and recently the COVID-19.

A lot has been achieved through the EPI, especially for child health services. One of the latest vaccine for children is the RTS,S vaccine, which is the world’s first malaria vaccine. It is currently being scaled up for use in other countries in Africa, after its evaluation in pilot programmes in Ghana, Kenya and Malawi.

Data from the WHO indicates that the impact of vaccination from the RTS,S in reducing mortality rates and  hospitalizations for severe malaria in eligible children is promising.

There is a recent WHO policy recommendation for a second malaria vaccine, R21. These two vaccines against child illnesses and deaths from malaria are to be used in addition to the existing prevention tools.

There is no doubt that immunization and vaccines have had huge impact on childhood illnesses and deaths.

For instance, data from the Ghana Health Service shows that neonatal tetanus has been eliminated in the country since 2011. There has also been no reported case of wild polio virus since 2008. Additionally, there is no documented death due to measles in Ghana between 2003 and 2021. Similarly, pneumonia and diarrhoea diseases in children have reduced drastically, in the country due to EPI services. 

The past

Among the accomplishments of the EPI is the eradication of smallpox in 1980. The creation of the Global Alliance for Vaccines and Immunization (Gavi) added another dimension to the EPI’s successes by supporting the introduction of a broader range of new vaccines.

This period has also witnessed the development and the introduction of vaccines targeting diseases like Hib, Pneumococcal infections, rotavirus, HPV, meningitis A, Japanese encephalitis, and malaria.

According to the  WHO,  the EPI’s  journey began with a focus on protection against six childhood vaccine-preventable diseases: BCG, diphtheria, pertussis, tetanus, polio and measles. Over the years, vaccines available in the EPI now cover older children, adolescents, and adults.

There are now 13 vaccines (antigens) recommended by the WHO for the EPI programme. They are: BCG, diphtheria, pertussis, tetanus, haemophilus influenzae type B,(Hib), hepatitis B, polio, measles, rubella, pneumococcal disease, rotavirus, human papillomavirus, and COVID-19 (for adults).  

There are also vaccines recommended for particular settings, including yellow fever, meningitis, Japanese encephalitis and cholera.

The present

Health authorities have said vaccines and EPI services are indisputable human rights issues. They also serve as platforms for ensuring global health security against infectious diseases and pandemics, since disease do not recognize national borders.   

There is a race to find new ways to deal with future pandemics, access safe vaccines and ensure equity in the distribution chain.

Additionally, there are issues of myths, fears and vaccine hesitancy to deal with in the prevention and control of infectious diseases.

Thus, although, vaccines have emerged as cornerstones of public health, there are still challenges to tackle, including access to immunization.

In 2022, the WHO indicated that 14.3 million infants did not receive an initial dose of DTP vaccine, pointing to a lack of access to immunization and other health services, and an additional 6.2 million were partially vaccinated.

According to the WHO, the year 2023, also saw the continued re-emergence of vaccine-preventable diseases such as cholera and measles in areas where they had previously been well controlled, while the total number of outbreaks of vaccine-preventable diseases also continued on an upward trend.

The global body has also reported cases of insufficient vaccination coverage, health system fragility, conflict and insecurity, as well as climate factors, population growth, urbanization and displacement as drivers in the drop of EPI figures.

Indeed, immunization and vaccines have become both health and political issues, which should concern everybody and every nation.  This is because of emerging health threats from infectious diseases, such as the COVID-19, Ebola, Marburg virus disease and Monkey pox, among other diseases of public health importance.

For instance, in 2021, West Africa’s first-ever case of the Marburg virus disease was confirmed in Guinea. According to the WHO, this was the first time Marburg, a highly infectious disease that causes haemorrhagic fever, had been identified in the country, and in West Africa.

The Marburg virus disease is a virulent, epidemic-prone disease associated with high case fatality rates. Gueckedou, where Marburg was confirmed was also the same region where cases of the 2021 Ebola outbreak in Guinea as well as the 2014-2016 West Africa Ebola outbreak were initially detected.

With the ever-changing and challenging public health landscape of infectious diseases and pandemics, the need for prevention and the scaling up of immunization should be the next big global conversation that should be sustained by concrete actions on the ground, locally, nationally and on the global stage.   

Especially because meeting vaccination target for certain diseases such as COVID-19 have been very challenges due to limited funds for vaccine supplies, vaccine hesitancy, attributable to myths, fears, misinformation, anti-vaccine conspiracy theories, and safety and efficacy concerns.

Currently, there are discussions among various stakeholders to see the next steps for vaccines and immunization. National governments and global health experts are all worried. 

In the middle of these discussions, the media becomes relevant in bringing timely, reliable, and accurate information to increase vaccine uptake.

It is for this reason that the African Media and Malaria Research Network (AMMREN), must be commended for joining stakeholders such as the Ghana Health Service and the WHO to organize various activities targeted at the media in order to get journalists to assist in sensitizing the public on the need to increase the uptake of vaccines and related immunization issues in Ghana.

AMMREN is a Network of journalists and scientists working on malaria issues in selected African countries. The Network is, however, running the media engagement project on vaccine uptake, under its AMMREN-Plus initiative. The initiative focuses on emerging health issues and diseases of public health significance, outside its malaria agenda.

The project on vaccine uptake is expected to build the capacity of media practitioners across the country to dispel misinformation, myths and wrong perceptions about vaccines and its uptake across Ghana.

The future

No doubt the future and success of the EPI can be sustained by stakeholder and community engagements, at the local, national and international level.

In a statement delivered in January this year to mark the 50th year of the EPI, the Director of the Department of Immunization, Vaccines and Biologicals at WHO, Kate O’Brien, said the milestone offers an opportunity to celebrate the programme’s success in preventing diseases, improving child and maternal health, and advancing health-care equity.

She noted that it is also an important moment to look ahead at the next decade.“The commitment of various stakeholders, including national governments, global and regional agencies, civil society, vaccine manufacturers, and many more, will be crucial for sustainability and delivering vaccines, ” she added.

There is a call for enhanced political will to increase investment in immunization.

It is significant that in September last year, world leaders adopted a political declaration calling for stronger international collaboration and coordination at the highest political levels to better prevent, prepare for and respond to pandemics, as the General Assembly held a high-level meeting.

The meeting was convened under the theme “Making the world safer:  Creating and maintaining political momentum and solidarity for Pandemic Prevention, Preparedness and Response”.

In a Political Declaration, member states of the UN expressed concerns about “glaring inequalities” in access to vaccines against COVID-19, noting that in December 2022, 22 per cent of people in low-income countries were fully vaccinated compared with 75 per cent in high-income countries.

Concerned by the hoarding of vaccines in rich countries while the populations of poor ones were left behind, United Nations Under-Secretary-General, Amina J. Mohammed, had called for preventing such a situation by implementing the recommendations spelled out in the Political Declaration.

Member States also called for strengthening local and regional vaccines and medicine production, particularly in low- and middle-income countries, through technology transfer and cooperation with voluntary patent pools.

By Eunice Menka
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