The other vaccines

Say “vaccine” these days and people tend to think of COVID-19. It’s certainly the most urgent need right now if we are going to get to some semblance, emphasis on “some,” of normality.

“Herd immunity,” where 70 to 80 percent of a population would have fully immunized against COVID-19 (two doses for most brands, one for Johnson & Johnson) to protect the entire population, is a long way off yet, in the Philippines, for example, with only 2 percent having received at least one vaccine shot.

Meanwhile, there are other life-saving vaccines which we have been forgetting, with Unicef making a particularly urgent call to ramp up childhood immunizations.

Through the years, progress has been made to get more children covered by the most essential vaccines, but after the Dengvaxia (anti-dengue vaccines) controversy, vaccination rates drastically dropped, with parents and guardians fearing all vaccines in general.

The 2017 National Demographic and Health Survey found that only 70 percent of Filipino children who are 1-2 years old had been vaccinated. In a partial survey to cover January to November 2020, well into the pandemic era, immunization coverage had dropped to 62 percent.

Watching the weak childhood immunization coverage gives us reasons to worry about COVID-19 coverage.

The childhood immunizations are free, as are the COVID-19 vaccines, but there will be other reasons why parents and guardians don’t bring their kids to the centers for vaccination.

There are the opportunity costs, parents not being able to take time off from work to bring their children to the centers. In very impoverished areas, both urban and rural, just the transportation cost is an obstacle.

In our COVID-19 times, especially during strict lockdowns, children are not brought out for their vaccinations, especially in areas where local officials strictly adhere to the IATF ban on minors leaving homes.

There are technical problems too, including the availability of vaccines. Then there’s the cold chain and the need for adequate refrigeration. Worrisome too are the power outages—vaccines can be destroyed inside the refrigerator during brownouts.

Ultimately though, it is the demand for vaccines that is the most important and, through the years, public health experts have referred to “vaccine hesitancy” as a major problem.

We saw this even before COVID-19 or the Dengvaxia controversy. In 1995, anti-family planning groups claimed that the anti-tetanus vaccines being given to mothers would sterilize them.

The anti-tetanus vaccines had pregnant women as their main targets, given the high risks of tetanus during childbirth. With the tetanus scare, not only did the anti-tetanus coverage dropped but so too childhood immunizations because mothers were avoiding the health centers’ services, including immunization for their children.

Measles rates went up during those years, then came under control as people began to trust the health department. But following the Dengvaxia controversy, families again avoided childhood vaccinations. In 2018-2019, there were 60,000 measles cases, with more than 800 deaths.

I grew up seeing measles almost as harmless diseases because there were few complications among the upper classes. But when I began to work in rural health programs in the 1970s, I saw the devastating effects of measles, which would race through villages infecting and killing large numbers of children, stopping only when the virus had run out of potential victims.

The availability of measles vaccines, and other childhood immunizations, made such a difference, bringing down the country’s over-all death rates for infectious diseases. Polio was practically eradicated, but in 2019, we had our first polio case again after 20 years of a polio-free Philippines. Again, childhood memories returned, of a classmate in an “iron lung” used for polio patients, the large metal enclosure functioning as a mechanical lung. Our classmate lasted less than a year.

A decline in infant mortality—deaths in children below the age of one—was the most dramatic achievement although the continuing weaknesses of the public health system meant older children continued to die, for other reasons including accidents and violence.

If I might make a pitch as well for seniors, who are affected by another IATF ban, this time for those above the age of 65 being sequestered in homes. Priority is being given now to senior citizens for COVID-19 coverage but families might find it difficult to bring their elderly to vaccination centers.

Let it not be said that thousands of children and senior citizens died of vaccine-preventable diseases, including COVID-19 for seniors, because of a quarantine that was supposed to protect them.

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