Many childhood and adult diseases were a death sentence even 100 years ago, but today most of these ailments can be prevented with a simple jab. In fact, the global vaccination drive of the second half of the 20th century is one of humanity’s greatest achievements. Sri Lanka occupies a prime position in this programme, having undertaken its immunisation drive even amidst two insurgencies, a devastating war and a recent economic crisis. Moreover, countless lives were saved by the Covid vaccines at the height of the pandemic, which most people seem to have forgotten now.
Immunisation campaigns have enabled much of the world to eradicate smallpox, nearly defeat polio, and ensure more children survive and thrive than ever before. This year, the World Immunisation Week, which starts tomorrow, will celebrate 50 years of the Expanded Programme on Immunisation (EPI) – recognizing the collective efforts to save and improve countless lives from vaccine-preventable diseases and calling on countries to ramp up investments in immunisation programmes to protect the next generations.
As the World Health Organisation (WHO) notes, in just five decades we went from a world where the death of a child was something many parents feared, to a world where every child –– if vaccinated –– has a chance to survive and thrive.
At its inception in 1974, the EPI focused on protecting all children against six childhood illnesses including tuberculosis, diphtheria, tetanus, pertussis, polio, and measles., but today, this number has grown to 13 universally recommended vaccines throughout one’s life and 17 additional vaccines with context/country dependent recommendations. With the expansion of the vaccination programme across life, it is now called the Essential Programme on Immunisation (still EPI).
In the last few years during the pandemic, progress on immunisation slipped, somewhat paradoxically, since the focus was on saving lives from Covid. And the pandemic came and virtually disappeared, even as some African countries went without any Covid vaccines due to inequalities in the global vaccine distribution system. Thus they missed both Covid and other regular vaccines for almost three years.
While more than four million more children were vaccinated globally in 2022 compared to 2021, there were still 20 million children who missed out on one or more of their vaccines. Growing conflicts, economic downturns, and a rise in vaccine hesitancy due to misinformation are some of the threats to efforts to reach these children. As a result, the world is seeing sudden outbreaks of diphtheria and measles diseases that, until now, were almost completely under control. While global vaccine coverage is good –– with four out of five children fully covered –– there is still more to be done.
The reappearance of dormant diseases such as Polio in several countries including Pakistan and Afghanistan is a worrying factor. While conflict may have been a factor for this scenario, parents in many peaceful countries are also refusing to immunise their children due to the fear of getting serious side effects. This way, the anti-vaccine lobby’s social media campaigns have been remarkably successful. But most of their claims are outright lies that can unfortunately take the wind out of the sails of a successful EPI. The WHO and health services in individual countries must counter these claims through the mainstream and social media.
Nevertheless, scientists and pharmaceutical companies are constantly innovating in this sphere. There are now vaccines for Ebola and Malaria, two diseases mostly prevalent in Africa. The Ervebo vaccine is approved for use against Zaire Ebolavirus in African countries. It is also the only Ebola vaccine currently recommended for use during an epidemic. It is apparently effective in cutting mortality rates even after infection.
At least 28 countries in Africa plan to introduce one of the two WHO-recommended malaria vaccines as part of their national immunisation programmes. Gavi, the Vaccine Alliance has approved providing technical and financial support to roll out malaria vaccines in 18 countries.
The next big step in the vaccine world is the dengue vaccine. Dengue is a tropical, mosquito-borne disease that claims many lives each year in countries such as India, Bangladesh, Sri Lanka and Peru. There are two existing vaccines for dengue, but one is an expensive two-shot regimen, while the other can be given only to people who have already had a dengue infection. Scientists have just developed a new one-shot vaccine that uses live, weakened forms of all four strains of the dengue virus. It was created by scientists at the National Institutes of Health (NIH) in the United States and licensed for development by the Instituto Butantan, a huge public research institute in São Paulo. A multinational drug company has received a manufacturing license for the rest of the world. This cannot come soon enough – if commercialized within a year or so, it will be able to save thousands of lives.
But the holy grail of vaccination is a vaccine that works against all forms of cancer. Research is underway on developing vaccines against specific forms of cancer. But a vaccine against all forms of cancer could be within the realm of possibility in 10-20 years. That will be the crowning glory of EPI.
