The Public Health Crisis of Under-Immunization: A Global Plan of Action

EMBARGOED FOR RELEASE: Nov. 6, 2019; 23.30 UK time / 6:30pm ET

CONTACT: Karen Teber / km463@georgetown.edu

WASHINGTON D.C. – In the midst of a “public health crisis of under-immunization,” leading global health experts in law and infectious diseases have developed an action plan to increase global vaccination uptake based on scientific evidence, ethics, and human rights that spans multiple governments, organizations, disciplines, and sectors.

The plan is outlined in the journal The Lancet Infectious Diseases published Nov. 6.

As the authors’ note, while vaccinations against smallpox, polio, measles, mumps and pertussis have saved billions of lives, 1 in 5 children worldwide are not fully protected resulting in 1.5 million deaths annually.

“Underlying this public health crisis is a striking paradox—vaccines are victims of their own success,” they write. “Immunizations are remarkably effective, closely monitored, and very safe. Consequently, many clinicians and parents have not seen the consequences of vaccine-preventable diseases and underestimate their harms.”

According to the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), global immunization rates for common childhood vaccines have flat-lined at 86% over the past decade with vaccinations falling below levels needed for “herd immunity” in multiple countries.

“Devastating childhood diseases are fully preventable, but our culture of individualism has overshadowed the common good,” says Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law and lead author of the recommendations. “A parent surely has the right to rear her or his child, but does not have the right to put that child, or others, at risk. When we have most people in the community vaccinated, everyone is protected. But when enough parents, for whatever reason, opt out, then it can lead to large outbreaks and spread. We have seen the consequences when members of religious or other communities refuse to vaccinate their children. When that happens, everyone suffers. We need to ask, not what rights I have, but what duties I have to my neighbors and to my community.”

Several factors impact the lack of uptake including costs, scarcity and accessibility, public confidence, politics and governance, opt-out laws, and humanitarian challenges such as civil unrest, political violence and natural disasters. 

Gostin and his colleagues offer three “sustainable solutions” to address the global crisis of under-immunization.

The first is innovative financing for vaccine affordability, accessibility, and availability.

WHO’s 2013 Global Vaccine Action Plan estimated that $60 billion would be needed for nearly 100 low- and middle-income countries from 2011-2020. Most costs center on immunization services including management, training, social mobilization, and surveillance.

“Dedicated funding for national immunization programs is an essential driver for national and global initiatives,” the experts write. 

“Countries around the world, including the United States, chronically underfund vaccination access and health education,” Gostin says. “Yet, ample funding would pay back in saved lives and in lower health care costs. Every country should allocate robust funding for vaccines from their national health budgets. Health dollars couldn’t be spent more wisely than on vaccinations.”

The second solution is to develop evidence-based health communication campaigns at local, national, and global levels.

“Gaining trust has become difficult with the rise of nationalist populism, which often questions science and casts doubt on ‘expert’ opinions,” state the authors.

Gostin and his colleagues suggests that an effective communication campaigns should “include objective messaging in traditional and social media designed to assuage fears and promote accurate health information and immunization outcomes. Campaigns should recruit well-trusted spokespersons such as leaders in sport, entertainment, and religion.”

“Corporate social responsibility means nothing unless social media companies like Facebook, Twitter, and Google make a genuine effort to restrict patently false information about the safety and effectiveness of vaccines,” says Gostin.

Finally, the experts say laws must be reformed and fairly implemented and public acceptance gained.

“Governments should consider repealing or restricting permissive religious and philosophical exceptions . . . Parents are responsible for not placing their own, and other, children at risk of serious infections. Well-tailored laws can also help reduce the number of people objecting to vaccinations due to misinformation.”

“The Supreme Court has made clear that states are empowered to require everyone to receive their recommended vaccinations prior to school entry, irrespective of their religious beliefs,” explains Gostin. “A person’s religion doesn’t provide a right to place the community in jeopardy. Everyone must follow the law that is intended to safeguard the public.”

“A global commitment to vaccine access and delivery through law is essential,” notes co-author James G. Hodge Jr., the Peter Kiewit Foundation Professor of Law at the Sandra Day O’Connor College of Law, Arizona State University, “but it must also be tied to international and regional efforts to address vaccine hesitancy stemming from misinformation campaigns.”

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In addition to Gostin and Hodge, authors include Barry R. Bloom, MD,  Harvard T.H. Chan School of Public Health; Ayman El-Mohandes, MD, CUNY Graduate School of Public Health and Health Policy; Jonathan Fielding, MD, University of California-Los Angeles; Peter Hotez, MD, National School of Tropical Medicine, Baylor College of Medicine; Ann Kurth, PhD, Yale School of Nursing; Heidi J. Larson, PhD, London School of Hygiene & Tropical Medicine; Walter A. Orenstein, MD, Emory University School of Medicine; Kenneth Rabin, MD, Journal of Health Communication: International Perspectives; Scott C. Ratzan, MD,

Mossavar-Rahmani Center for Business and Government Harvard Kennedy School; and Daniel Salmon, PhD, Johns Hopkins Bloomberg School of Public Health.

The authors declare no conflicts of interests except: Larson reports grants and other funding from GlaxoSmithKline (outside the submitted work); and Salmon reports personal fees from Merck Co. and prior grants from Walgreens Co. (outside the submitted work).

The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure. The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.

Press Release Global Health Policy & Governance Infectious Diseases