Inoculating our future

28 October 2020

By setting out a clear and comprehensive plan for vaccination against diseases such as measles, governments across the world can promote improved public health outcomes and can also provide hope for their citizens in these difficult times

Will Barber Taylor

Since Edward Jenner first used cowpox as a means of vaccinating against smallpox, the importance of vaccination for public health and wellbeing has been clear. It was vaccination that helped eradicate smallpox and bubonic plague which, while uncommon in Europe after the 17th century, continued to rage throughout Asia well into the 20th century. The 1906 outbreak of bubonic plague in India and what is now Myanmar claimed the lives of 8,637 people, including my great, great grandmother.

Had governments and organisations like the World Health Organisation (WHO) not worked together in the 1970s to tackle the disease, thousands of people across Asia and Africa would doubtless still die from smallpox each year. It is only through coordinated planning and painstaking co-operation that countries can fight diseases effectively. This is the key to ensuring a healthy and successful future for us all.

Vaccination is crucial in ensuring that disease does not control our economic or personal well-being. This article will argue that vaccination is not only important for the government to champion because of the significance of COVID 19 but also because of the falling rates of childhood vaccination. If the government can provide a plan that deals with both then they will have achieved a healthcare coup and also given momentum to a more vigorous investment in public health.

Given the ongoing COVID-19 pandemic, dozens of vaccines trials are underway in laboratories around the world in pursuit of an effective vaccine. Whether it be through Matt Hancock’s declaration on 20 September that ‘the cavalry is coming’ or President Trump’s assertion that a vaccine will be ready ‘by the end of October’, many politicians have tried to sweeten the bitter pill of restrictions on movement and economic activity with the promise that things will return to normal once a vaccine has been developed.

Yet, so far at least, politicians have failed to explain how any successful vaccines will be disseminated. Given, as I shall argue, that the uptake on vaccinations for ailments like measles has gone down due to COVID and other factors, the failure to outline how COVID 19 will be vaccinated against is concerning.

To be able to vaccinate the world’s billions, huge amounts of space, financial resources and access to supply chains will be needed; governments will not be able to rely on providing inoculations simply at hospitals or health care centres. If a system is put in place that can be shown to quickly and safely disseminate proven vaccines for vulnerable children who have not been able to get them due to lockdowns and overcrowding of the health care system, this will effectively then make it far easier to inoculate people across Britain and other countries when a vaccine is available.

What’s more, if a clearer and safer system of dissemination is not set out soon governments will be asking people who may be vulnerable or carrying the virus to interact with others while waiting to be vaccinated. This is a recipe for disaster. Given that we are continuing to see spikes in the disease around the world, such a plan could result in an upsurge in cases just as the means for halting or eliminating the disease altogether is being produced.

However, it is not only an issue of under-preparedness for distributing any future COVID-19 vaccine that should concern us but the rising lack of vaccination amongst children and young people in diseases that we think of as being consigned to another era.

Even prior to the onset of the pandemic, due to the rise in salience of anti-vaccination movements in many places, and the increasing global cost of healthcare, question marks over the levels of vaccinations among many children were increasingly apparent.

Last year in the United States, there were nearly 1,300 cases across 31 states, the highest number of measles cases for 27 years. At the beginning of the decade, only 63 cases of measles were reported in the United States with figures staying fairly stable until 2016, after which point cases began to increase year-on-year. What is even more remarkable is that measles was declared extinct in the US as recently as 2000, demonstrating not only a severe failure of health prevention policy but also of the growing significance of children going unvaccinated, and potentially of the influence of anti-vaccination movements.

To ensure that the emergence of diseases like measles does not create greater strains on healthcare under COVID-19, we must be prepared to combat anti-vaccination rhetoric with gusto. The lack of vaccination is a more severe problem in the US than the UK but its growing presence across Europe is a cause for concern.

This growing trend in the US is that a variety of deadly diseases are reappearing including measles, mumps and pertussis causing not only a weakening of the immune system for those who become infected but also increasing financial costs for US citizens who have to try to cover the costs that can result from a family member becoming ill, given the enormous inequality in that country with respect to access to healthcare. This is a significant consideration for any government or organisation who are concerned with public health, particularly as the US is not alone in this regard.

It has also been the case in Europe – in 2019, 763 cases of measles were confirmed in the UK. Whilst there were no confirmed cases during the period of April to June this year during the initial stages of the UK’s national lockdown, this is only likely to be a case of delaying the inevitable increase which will occur if there isn’t an uptake in vaccination. By failing to promote vaccination for these diseases, the government is leaving themselves open to an even greater health care disaster down the line.

During the same period of April to June this year the rates of uptake of the Measles, Mumps and Rubella (MMR) vaccination for infants’ rates fell by 20% in England, dipping also in Scotland. Given that the highest occurrences of these diseases are in countries in which, according to the Stockholm-based European Centre for Disease Prevention and Control (ECDC), there are also low rates of vaccination, such as Romania and Bulgaria, it’s clear that it isn’t just the spread of COVID-19 that we should be concerned about but also that of equally pernicious diseases such as measles.

Given that increased cases of measles, mumps, rubella and other illnesses could be around the corner due to a fall in the rates of vaccinations for these diseases, governments must act now to prevent underlying diseases from mingling with coronavirus that would only weaken children’s immune system and that would pile further pressure on the already strained NHS. Governments need to put energy into promoting vaccinations and providing access to them through the provision of doses, trained staff, and appropriate supply chains and facilities to distribute them.

This distribution element is pivotal for stemming the spread of disease and also for ensuring that areas that are worst affected by the COVID 19 Pandemic do not become economically damaged as a result. The key balancing act – at least from a governmental perspective- has been the balance between protecting people and the economy.

Ensuring a stronger uptake of vaccinations now across a country ensures not only that an outbreak could be more effectively dealt with but also that governments would be prepared for any future outbreaks.

Part of this focus should, of course, be on ensuring that parents feel that they and their children are safe when getting vaccinated in the first place.

Given the fears of many parents about potentially catching COVID-19 when getting their children vaccinated, governments must provide a safe, direct way to ensure that children can be safely inoculated, and that parents’ concerns can be addressed. Knowing where potentially at-risk children who should be vaccinated are is not the difficult part of the issue.

Rather it is facilitating their vaccination that is the key struggle of government. If children are not safely inoculated, they can potentially risk spreading the disease further than if they are safely inoculated. The potential danger is a snowball effect – if at risk children have a disease such as COVID, which is often asymptomatic in children and they go to  be vaccinated for measles and unintentionally spread the disease to other children who are waiting to be inoculated then inoculation can become part of the problem as much as it can be part of the solution.

Working with schools and local authorities to ensure the greatest number of children are vaccinated safely, quickly and without causing any greater spread of the disease is clearly vital. If the government could pilot a scheme to locate facilities and supply chains that are suitable for vaccination that are safe for parents and children to visit, they would be ensuring the prevention of spreading diseases and also be setting the groundwork for the mass inoculation of the population against coronavirus once a vaccine became available.

It is also worth noting that this is not only applicable for present governance but for future instances that may arise that will be comparable to the current pandemic. It is clear that across the world, whilst there were strong responses in many quarters, some countries were relatively slow and lax in recognising the threat posed by COVID 19 and in introducing measures to combat it.

Hope is a precious commodity at times like these; by setting out a clear and comprehensive plan for vaccination against diseases such as measles,  governments across the world can promote improved public health outcomes and can also provide hope for their citizens in these difficult times.