Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.
WHO is supporting countries with development of national action plans and strengthening of health and surveillance systems to help prevent and manage antimicrobial resistance. Ebola and other high-threat pathogens. At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. Weak primary health care.
Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life. Health systems with strong primary health care are needed to achieve universal health coverage.
Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes. In October , WHO co-hosted a major global conference in Astana , Kazakhstan at which all countries committed to renew the commitment to primary health care made in the Alma-Ata declaration in In , WHO will work with partners to revitalize and strengthen primary health care in countries, and follow up on specific commitments made by in the Astana Declaration.
Vaccine hesitancy. Vaccine hesitancy — the reluctance or refusal to vaccinate despite the availability of vaccines — threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease — it currently prevents million deaths a year, and a further 1. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy.
However, some countries that were close to eliminating the disease have seen a resurgence. The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy.
Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines. In , WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. Last year, less than 30 cases were reported in both countries. Influenza the flu is caused by a virus. The flu is more than just a bad cold and can occasionally lead to serious complications, including death.
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Meningitis: petition adds to pressure for vaccine for every child
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Blog authors. Podcast Podcast. Vaccines Share show more. Listen show more. More show more. Vaccines help reduce the risk of certain illnesses by introducing dead or weakened versions of disease-causing germs bacteria or viruses to the immune system. Vaccines protect vulnerable people in our community — such as very young children, the elderly, or those who are too sick to be immunised. Immunisation greatly reduces the risk of catching a disease, which in turn reduces the risk of complications. When were vaccines developed?
An eighteenth century doctor named Edward Jenner noted that workers on farms who contracted the mild cowpox disease were immune to smallpox. He was correct. How do vaccines work? We gain immunity against diseases either naturally by catching an illness , or through immunisation. They are usually given by injection or a small drink that contains the vaccine.
The immune system responds to the weakened, partial or dead germ or inactivated toxin antigen as if it was a fully-fledged germ, and makes antibodies to destroy it. These antibodies are made without us catching the illness. How do vaccines help our immunity? Our immune system is like a library — it stores information about every germ ever defeated.
We sometimes call this immunological memory. But febrile seizures are short and relatively benign, and they naturally occur in 2 to 4 percent of all children under the age of five in the United States and Europe. Thus while febrile seizures are terrifying to watch, they are rare side effects of the MMR vaccine and are usually harmless.
Furthermore, vaccines actually prevent some diseases that cause febrile seizures. As noted above, one of the chief safety concerns raised by vaccine opponents is that increased vaccination rates beginning in the s may have contributed to the sharp rise in autism diagnoses over the past several decades. Fewer than 1 in 3, children were diagnosed with autism in the s; today that figure is around 1 in The causes of this rise are still unclear, but better autism screening has surely contributed to the higher rates of diagnosis.
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Vaccine opponents, however, claim that vaccines are to blame: more children are getting vaccinated than in the past, and more doses of more kinds of vaccines are being administered the CDC currently recommends vaccination against sixteen diseases for children. Most often, fingers have been pointed at the MMR vaccine, since the symptoms of autism tend to emerge at roughly the same time that children receive it — between ages 1 and 2.
Much of the concern over vaccines and autism can be linked to the discredited research of Andrew Wakefield, who claimed in a now-retracted paper that the MMR vaccine may contribute to gastrointestinal inflammation that may result in autism. The presence of the mercury-containing compound thimerosal in vaccines has also been proposed as cause of autism , since exposure to mercury is known to have neurotoxic effects.
Given the attention these claims have received, it is worth taking the time to summarize a few of the many studies that have shown there to be no meaningful link between vaccines and autism:. The researchers used a major database of U. What makes this paper so interesting is that the combined MMR vaccine was phased out in Japan in , so that none of the children born in the last four years studied to received that vaccine. They were given separate vaccines instead of the combined vaccine. The study compared neuropsychological outcomes which include measures of speech and language, verbal memory, motor coordination, general intellectual functioning, and others in children who received recommended vaccines on schedule and children who delayed having these vaccines or did not have these vaccines at all.
The researchers did find evidence of some associations between vaccines and adverse events: the rotavirus vaccine can be linked to intussusception a dangerous and sometimes deadly intestinal pathology , and MMR vaccine can be linked to febrile seizures. The evidence overwhelmingly shows that there is no link between the MMR vaccine specifically, or several vaccines taken together during childhood, and the development of autism. More studies will be done, of course — good science and good medicine demand no less.
B ut why does the safety of vaccines matter so much to us on a policymaking level? Why not let parents decide if they should vaccinate their children? Surely, some say, this is an individual and not a public-policy decision. In truth, however, the public has a stake in vaccination rates because vaccines affect not only the health of the individuals vaccinated but of the community as a whole. If fewer people can catch the disease, then fewer people can spread it, so even people who are not vaccinated are less likely to contract the disease if those around them are protected. The proportion of the community that needs to be individually immune to a disease in order to provide herd immunity is higher for diseases that are more contagious.
So for pertussis, a highly contagious disease, 92 to 94 percent of the community must be immune in order to protect those who are not immune, while for the flu, which is less contagious, herd immunity is achieved with 50 to 75 percent of the population. For measles, the disease that has most recently been in the news, 83 to 94 percent of a population must be individually immune to confer herd immunity. Because vaccination does not always guarantee complete immunity to disease, however, vaccination rates need to be higher than these theoretical immunity rates in order to secure herd immunity.
As an example of the dangers of low vaccination rates we can look to California.
Rates like these help us account for a sporadic reemergence of the virus in the United States over the past decade: there were measles cases in , cases in , and cases in the first eight months of In the recent outbreak centered at Disneyland in late and early , residents of California were infected with measles. These are troubling reemergences of a disease that, before being curbed by vaccination, used to kill hundreds of Americans every year and infect millions.
The evidence behind herd immunity is not just anecdotal. It is scientific and robust, just as it is for the relative safety of vaccines. Because the parents of unvaccinated children tend to live together in communities with low vaccination rates, the risk increases for each unvaccinated child, including both those who have specific medical reasons for not being vaccinated as well as those whose parents refuse vaccination out of a more general sense of concern.
Admittedly, herd immunity does not always work. There are instances in which a population with widespread vaccine coverage can still see outbreaks of a disease.
Vaccination - Wikipedia
In Quebec City, Canada in , there was an outbreak of more than seven hundred cases of measles in a population vaccinated at about the same level as most of North America more than 90 percent of the people had received the full two doses of the measles vaccine. O ver the years, vaccine policy has been shaped by both real and perceived risks, as both government and the medical establishment have reacted to concerns from the public and the companies that make vaccines.
Given that vaccines do carry some small degree of unavoidable risk, any company that manufactures vaccines could face lawsuits filed by patients who were harmed — or who at least believed themselves to be harmed — by the vaccines. Such litigation could be costly, perhaps even bankrupting the vaccine makers. To prevent such a scenario, nineteen countries have established mechanisms for compensating victims and families accidentally harmed by vaccines. The U. And so in , Congress passed and President Reagan signed legislation creating the National Vaccine Injury Compensation Program , colloquially known as the vaccine court even though it is not a true judicial body.
Ever since, nearly all substantial U. Money collected from an excise tax on each dose of a vaccine is used to compensate the plaintiffs whose claims are approved by the program. This means that various adverse events not proven to be caused by vaccines are compensated for by the court, including Sudden Infant Death Syndrome, Attention Deficit Disorder, and epilepsy. Critics of vaccination sometimes complain that by protecting vaccine manufacturers from liability, this program removes a crucial incentive — the cost of lawsuits — to make vaccines as safe as possible.
This is a legitimate concern, and it is one reason that the U. One is called the Vaccine Adverse Event Reporting System VAERS , which anyone, including those lacking scientific or medical expertise, can use to report adverse side effects from vaccines. Unlike VAERS, which focuses on adverse reactions and to which anyone can contribute, VSD collects all vaccine-related data from nine big health care providers around the country.
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This pool of data allows the CDC, as well as outside researchers, to track the safety and efficacy of new vaccines and to follow up on complaints raised through VAERS. For example, in the CDC and the American Academy of Pediatrics found via the research of John Salamone a concerned parent whose son had been injured by a polio vaccine that the Sabin vaccine had a small risk of causing polio. The virus in the vaccine was live and in very rare cases was not weakened enough, causing debilitating disease. Another example of improvements in vaccine safety came in , when the CDC recommended switching from one vaccine for pertussis to another.
In countries with a higher incidence of whooping cough infections and poorer quality health care, the more effective vaccine can certainly be worth the slightly greater risks. In the United States, where vaccination has already dramatically reduced cases of pertussis, a less effective but slightly safer vaccine may make more sense. Some government vaccine recommendations switch rapidly. In , the CDC recommended the universal use of a vaccine against rotavirus, an infection that causes diarrhea.
However, the vaccine was soon found to cause an increased number of cases of the intestinal disorder intussusception among children. In response to this risk, the CDC withdrew its recommendation in and the company producing the vaccine took it off the market. Yet another example of government action to deal with vaccine-safety concerns involves thimerosal, the additive that some vaccine critics long believed was associated with autism. It had been used since the s as a preservative to ensure that vaccines were not contaminated with bacteria.
Thimerosal contains ethyl mercury, which is not the same as methyl mercury, the mercury compound found in the environment that is known to accumulate in the brain and cause long-term health problems. Methyl mercury is actively transported across the blood-brain barrier while ethyl mercury is not, so ethyl mercury is much less likely to cause neurotoxicity. Nonetheless, despite the lack of evidence of harm, the CDC discontinued the use of thimerosal in vaccines in These examples of action to improve the safety of vaccines show that the medical community and the U.
But critics still question the wisdom of vaccine policy. They sometimes point out that the U. However, actual vaccine requirements are almost entirely a matter for state and local governments and usually linked to school enrollment rather than the federal government, and not all states have vaccine mandates against all the diseases listed by the CDC. Like many other countries, the United States relies on technical advisors to guide national policy and make recommendations on vaccination schedules. And contrary to the claims of vaccine critics that extensive vaccination recommendations in the United States are evidence of corruption, the U.
The history of vaccines contains clear cases of risks and injuries. But time and again, physicians, scientists, and the government have changed vaccines and vaccine policy to make vaccines safer. Sometimes, as in the case of the removal of thimerosal from vaccines, changes were even made to allay relatively unsubstantiated but widely felt concerns. Nonetheless, vaccine advocates should continue to acknowledge the minor risks posed by vaccines and the need for ongoing research to identify and mitigate even small hazards.
W e know that vaccination has saved millions of lives. In the United States alone, it has prevented over million cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis since , according to a recent estimate. And we know that unvaccinated people are at a higher risk of infection and put others around them at a higher risk of infection. We should remember, too, that anti-vaccination sentiment in the United States is not as strong as media coverage sometimes makes it seem.
According to a recent CDC survey , vaccine coverage remains very high, with roughly 95 percent of children receiving the recommended doses of some of the most important combination vaccines.
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The geographic concentration in particular communities of people refusing to vaccinate leaves those communities at a higher risk of outbreaks, but vaccine-preventable diseases are thankfully very rare in the United States; the chances for an American child to contract measles remains extremely low. And yet the debates over vaccine policy are unlikely ever to fade away entirely, as much as we might like them to. Some vaccine critics, like those in centuries past, are motivated by perennial worries about safety, others by libertarian fears about government-mandated medical treatments, and still others by a suspicious distrust of drug companies and of the medical establishment.
It is hard to see how these concerns — an eclectic combination of arguments compounded by recent ideas about patient autonomy, feminism, and environmentalism — are going to disappear, even if their consequences can be harmful.