Our immunity obligation

One of the blessings of the present is that we can speak about smallpox in the past tense. It was a disease that killed a third of those it infected, a scourge responsible for an estimated three hundred million deaths in the 20th century alone – and it had been plaguing humanity possibly since the time of the Pharaohs.

But in December of 1979, the world celebrated the global eradication of this centuries old bane of humanity. This was made possible not through the efforts of any one person, nor any one nation, but through a concerted and science-based eradication campaign centered around mass vaccination.

The invention and spread of vaccination is, factually, one of the most important and beneficial developments in human history.

Yet even before the arrival of COVID-19, the rate of vaccination in the Philippines was already in a worrying decline. Last year simultaneous outbreaks of measles, dengue, and polio moved the World Health Organization (WHO) to push for a strengthening of the country’s routine immunization system. Reports indicated that more than half of children under five years were not fully protected against polio, with DOH records indicating that the average national polio vaccination stands at about 66 percent to 68 percent – far from the 95 percent target for herd immunity that would protect those who cannot be vaccinated. This allowed polio to return to the nation after years of the Philippines being free of the disease.

With the onset of the COVID-19 pandemic, immunization efforts worldwide have taken a major hit. Areas hit hard by the virus such as New York City have seen vaccinations decrease by 63 percent, and a staggering 91 percent for children under two. Data from the Measles and Rubella Initiative estimated that 178 million people are at risk of missing measles shots in 2020. In the Philippines, while the DOH has committed to continue vaccination of children aged 0-12 even during the pandemic, the logistical and psychological hurdles are daunting. Public transportation, already difficult before the pandemic, will not be returning to its previous capacity anytime soon. Health workers previously available for vaccinations may now be reassigned to COVID-19 cases, or to cover for others in more “urgent” areas. The DOH noted that fully immunized child coverage for the first quarter of the year was half the average, and this was at the beginning of the pandemic. Many nations have put immunization campaigns on hold.

But we cannot delay immunizations indefinitely without catastrophic consequences. Herd immunity – when enough of a community is immune to a disease such that it becomes unlikely or unable to spread – requires a high proportion of immunity in the population. With herd immunity, even those who are not immune to the disease are protected: this includes people who are unable to get vaccinated, those with weak immune systems, and those whose immunity has waned with time. Without herd immunity… well, we are already beginning to see the effects with diphtheria, cholera, polio and measles cases on the rise around the globe after years in decline.

The last thing we need is multiple pandemics going on at the same time. It is imperative that, before this happens, we strengthen and revamp our programs and vectors of immunization.

Our health system cannot allow itself to default to old methods in the face of the current crisis. We must be flexible, and adapt our methods to the realities of the pandemic in order to ensure that immunization programs can still reach the people they need to reach. We must ensure that the supply and transport of vaccines and health workers be unimpeded, even when different localities are under different levels of quarantine. We must reallocate health personnel back to immunization efforts. We must expand the available avenues for immunization, using methods such as home visitation and vaccinations done in cars – whether in makeshift “drive thrus” or in the parking lots of hospitals so patients do not need to go into the buildings in order to get their shots. In conjunction with this, insurers must be prevailed upon to cover immunizations not done at the traditional venues, to prevent parents from being faced with a choice between cost, exposure to COVID-19, or the risks of delaying immunization. It would be wise to look into the creation of immunization registries, such as those which exist in the US, that would keep track of immunizations and provide both reminders for the next dose, as well as serve as a means of third-party verification that a person’s vaccinations are up to date.

Would these require substantial investments of resources when the government is already struggling with the costs of the pandemic? Undoubtedly, but it would be an investment well made, particularly considering what most hope would be the endgame for COVID-19. Much of the hope of a return to “normal” life has been placed on the creation of an as yet non-existent COVID-19 vaccine – but even that miracle drug would be of little help if we do not have a healthcare system capable of delivering it efficiently, safely, and equitably to the population. A system that cannot handle existing routine immunizations will not be able to handle the demand for a COVID-19 vaccine.

But just as important as ensuring our healthcare system is ready to ramp up vaccination, is making sure that the Filipino know how important vaccination is.

For all the good that vaccination has done, there has been a concentrated effort to undermine the public impression of its benefits. Conspiracy theories and misinformation abound about vaccination, and the manner that the issue has been presented to the public – providing equivalence between rigorous science and fringe assumptions – has led to a decline in public confidence. In 2018, vaccine confidence in the Philippines dropped to 32 percent from a high of 93 percent just three years prior.

A crisis in confidence in vaccines begets a crisis in public health. The government, the media, and social platforms must commit to undoing the damage done and get the message out: Vaccination is safe. Vaccination is protection. Vaccination is an obligation – for ourselves, for our families, and for our communities.