Vaccination: A community-based approach is needed

March 18, 2017

Today, as vaccinations are being used as a political weapon, we need to look again at the science and when, where and how they matter. We also need to question whether the punitive way the major parties are driving policy on immunisations will increase the vaccination rate.

Over hundreds of years, immunisation has been scientifically proven to prevent many diseases. It is worth examining some of the history that promoted the realisation that diseases can be prevented.

The first vaccines

The practice of immunisation dates back hundreds of years. Buddhist monks drank snake venom to confer immunity to snake bite. Skin tears were smeared with cowpox to confer immunity to smallpox in 17th century China.

Edward Jenner was considered the founder of vaccinology in the West when in 1796 he inoculated a 13-year-old-boy with cowpox and demonstrated his resulting immunity to smallpox.

In 1798, the first smallpox vaccine was developed and, over the following two centuries, the systematic implementation of mass smallpox immunisation culminated in its global eradication in 1979.

In the past 100 years, we have developed a greater understanding of tuberculosis (TB), which generally affects the lungs. However, there has been an increase in the number of victims along with deteriorating medical methods of controlling it.

Some medical professionals, such as Robert Booy from the University Sydney, say tuberculosis will never be defeated by medical advances alone. The prevailing global inequities of wealth and health care also need to be tackled.

The same approach applies to Indigenous and non-Indigenous children hospitalised for pneumonia.

Comparing 1996–2000 with 2001–05, pneumonia hospitalisations fell by 28–44% in Indigenous children aged 6–35 months, with no equivalent decline in non-Indigenous children. The unique Australian pneumococcal vaccine program is likely to have had a significant effect, but changes in socioeconomic factors have also contributed to the decline, according to five researchers writing for the Journal of Epidemiology and Community Health in 2012.

The global polio eradication initiative ensured that 5 million people escaped paralysis by 2005 and the infection rate fell by 99%. More than 95% of deaths from measles happen in poor countries with weak health infrastructures.

Globally, an estimated 535,300 children died of measles in 2000. A global measles vaccination program over 2000–10 resulted in a 74% drop in deaths from the disease.

The science has progressed by leaps and bounds and has enabled the prevention of millions of deaths and disabilities. But the various arguments against immunisation have had a very negative impact.

The research of Dr MD Innis, the Australian haematologist who suggested a link between the diphtheria, tetanus and whooping cough vaccine and childhood leukaemia, and Andrew Wakefield who theorised that the measles, mumps and rubella vaccination causes Autism, were later proven to be false.

Cuba shows the way

John Kirk, a Canadian professor of Spanish and Latin American Studies at Dalhousie University, led a research team to Cuba in 2006 to investigate that country’s high level of immunisation. The team found that, without fail, everyone knew exactly what immunisations they already had, the science behind them and at what ages the immunisations needed to be updated. They found that Cubans saw vaccines as not only a basic human right, but also an obligation.

The numbers say it best. According to the World Health Organization’s (WHO) 2014 global summary on vaccine-preventable diseases and academic studies, Cuba has not had a single reported case of measles since 1993, or rubella since 1989. Five cases of mumps have been reported since 2000; the last in 2010. Pertussis, or whooping cough, has not been reported since 1994.

By contrast, Canada has had 2203 cases of measles, at least 1529 cases of mumps, and 21,292 cases of pertussis reported since 1990.

Kirk’s research team said that one of the most innovative aspects of Cuba’s public health system was its emphasis on vaccine education from an early age. From the time children start school through to graduation, vaccination is consistently incorporated into courses and class discussions.

In addition, they attributed Cuba’s immunisation successes to the higher number of doctors in the country and their close relationship with community groups and the government.

Cuba’s Family Doctor and Nurse Program, which began in 1984, lies at the heart of the country’s health care system. Its mandate is preventive — rather than curative — medicine.

The program makes a point of meeting with patients twice a year and keeping meticulous immunisation records. The doctors and nurses are involved with education campaigns in schools and students receive a check-up each month. This relationship with medical staff fosters trust between doctors and patients.

Cuba’s national immunisation program now protects children from 13 diseases, including meningitis B, the vaccine for which was developed in Cuba and is considered the world’s first effective vaccine against the disease.

The success of the program is attributed to active community participation and a program which does not charge for any vaccinations.

Role of public health

While some diseases, such as scarlet fever and typhoid, have been reduced because of improved hygiene conditions, many diseases do need a vaccination to prevent death. But as the Cuban example shows, the key lies in community participation and encouraging people to take control of their wellbeing.

Lack of community participation in immunisation programs can lead to misinformation and less understanding about strategies to prevent ill health.

Australia is second only to the US in immunisation innovation and implementation. But, relative to its wealth, Australia could be performing far better, especially among the poor and First Nations communities.

The bipartisan approach to health cuts and privatisations of the health sector means that the cost of health is being shifted onto the individual. Health is not considered a human right. Preventive health — except for immunisation — has been downplayed for decades.

The poor, homeless, mentally ill, unemployed and underemployed cannot easily access the health system for preventive treatment. Many do not immunise due to a lack of accessibility and the cost of attending a surgery. The model that prevents every person from seeing a doctor, as in Cuba, means that health is not continuously monitored.

This lack of commitment to a free, quality health system opens the space for MPs to politicise health. Consecutive conservative governments have neglected to ensure that preventive health care is a priority.

The Coalition government’s 2016 “No Jab, No Pay” policy — denying welfare payments to families with unvaccinated children — which has the support of the opposition, is a punitive and ineffective approach.

The ignorant remarks of One Nation’s Pauline Hanson about immunisation during the recent WA election campaign were so widely condemned she was forced to back away from them and issue an apology.

While good health remains a privilege for the wealthy, the immunisation rate will remain low and that is a major problem.

Immunisation is a key ill health preventive measure. Children should be vaccinated before entering childcare and school to ensure the safety of the collective. But the best way of doing this is for the government to provide the vaccines and the medical support for free. If a poor country like Cuba can do it, it should be easy for Australia.

[Lalitha Chelliah is a registered nurse and a member of Socialist Alliance.]

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