Driving Resilient Pediatric Immunization Programs Globally

Vaccination is one of the most powerful and cost-effective tools in the history of public health, with important health, economic, and social benefits. Pediatric vaccinations help protect children and adults from serious, preventable, and sometimes life-threatening diseases and are a key contributor to supporting global health security.

Globally, vaccination coverage has stagnated at around 85 percent from 2011 to 2019, with some regions reaching excellent results. However, since the onset of the COVID-19 pandemic, global childhood vaccinations have experienced the largest sustained decline in 30 years. Globally, in 2021 alone, 25 million children missed out on one or more doses of diphtheria, tetanus and pertussis (DTP3) through routine immunization services. 18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia, and the Philippines recording the highest numbers. The figure is extremely alarming because DTP3 is considered a marker for immunization coverage within and across countries and broader healthcare access; if children are missing these vaccinations, they are probably also missing preventive care visits and crucial vaccinations for many other diseases.

Nearly 25 million children missed their first measles dose in 2021. Almost 15 million children did not receive their needed second dose. In 2021, compared to 2019, nearly 7 million more children missed the third dose of polio vaccine. Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio, underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.

Conflicts worldwide and related population displacement are placing additional pressure on health systems and exacerbating disruptions to routine immunization programs. To date, the war in Ukraine has led to at least 5.6 million refugees being hosted in European Union countries. This has resulted in an increased threat of vaccine-preventable disease outbreaks in the region.

We live in a world where health systems are constantly facing threats, and preventing the spread of vaccine-preventable diseases is a key component of global health security. Recent pressures on the health system and geopolitical conflicts underscore the need for resilient immunization programs that are able to withstand major shocks and disruptions, quickly adapt to changing circumstances, and maintain high vaccine uptake and acceptance over time. Prioritizing immunization as an essential health service and ensuring pediatric immunization programs are resilient in the face of current and new threats are of the utmost importance to ensuring populations are healthy.

The WFPHA and the World Association for Infectious Diseases and Immunological Disorders organized a World Leadership Dialogue (WLD) session “Driving Resilient Pediatric Immunization Programs Globally” during the 17th World Congress on Public Health (WCPH), on May 02 to 06, 2023, to provide a platform to engage health leaders from governments, public health authorities, communities, and advocacy groups to discuss how to build resilient pediatric immunization systems through effective monitoring, communication, legislation, funding, and crisis-preparedness planning.

This WLD session is organized to highlight progress in pediatric vaccination and discuss the impact of COVID-19 and other external factors on vaccine coverage rates; to utilize real-life experiences from select countries to discuss barriers and opportunities to developing resilient immunization systems and ensuring health system strengthening; and to create a sense of urgency to drive policy decisions that support resilient immunization systems and concrete crisis preparedness plans globally to ensure efficient pediatric immunization programs.

WFPHA Stands in Solidarity with the Ugandan LGBT Community – Denounces the Ugandan Anti-Homosexuality Act (2023)

On March 21, 2023, the Ugandan Parliament passed the Anti-Homosexuality Act (2023). By criminalizing same-sex conduct, the Act criminalizes all lesbian, gay, bisexual, and transgender (LGBT) Ugandans, the provision of services to LGBT Ugandans, and the dissemination of information about the LGBT community. The Act also requires Ugandans to report any individual who is suspected of being LGBT and forbids the sheltering of a LGBT person. The Act also provides for the death penalty for the crime of ‘aggravated homosexuality’. By undermining access to medical services by at-risk populations, the Act also threatens to undermine Uganda’s proud record of HIV prevention and control built over three decades. President Museveni has agreed to assent to the Act after changes are made regarding ‘rehabilitation’.

LGBT persons have existed throughout human history and across cultures. Natural variations of sexual orientation and gender identity exist regardless of enacted laws and policies. Beyond the direct and obvious consequences that the law will have on the health and human rights of those prosecuted, it will also have broader detrimental public health impacts. Research has shown that structural anti-LGBT legal climates further promote hostility, violence, and harassment against LGBT individuals (Hatzenbuehler et al. 2019; Van der Star et al. 2020) as well as directly jeopardize a plethora of health outcomes across the entire community, including psychological distress (Van der Star et al. 2021), life satisfaction and wellbeing (Van der Star & Bränström, 2015; Pachankis & Bränström, 2018), risk for psychiatric disorders (Hatzenbuehler et al. 2010), and suicidal ideation (Pachankis et al. 2021).

In addition to these direct ramifications for LGBT health in Uganda, the negative public anti-LGBT discourse surrounding the Act may also instigate harassment and discrimination (Hatzenbuehler et al. 2019) as well as reduce psychological wellbeing (Frost & Fingerhut, 2016) among LGBT Ugandans and their families, friends, and close communities.

In 1995, Uganda acceded to the United Nations’ (UN) International Covenant on Civil and Political Rights (ICCPR; UN Treaty Collection, 2023). For some 30 years, the Covenant has been interpreted to include protections against discrimination based on sexual orientation, gender identity or expression, and sex characteristics (UN OHCHR, 2019). UN legal experts have stated that the imposition of the death penalty based on the Act is per se an arbitrary killing and a breach of article 6 of the ICCPR (UN OHCHR, 2023). An official Ugandan Parliamentary briefing on the Bill incorrectly asserted that international law does not apply because the Constitution of Uganda ‘specifically bars sexual acts between sexual minorities’, while it does not. As a matter of international law, no country’s national constitution or other laws can be assumed to override its international legal obligations.

The WFPHA calls on the Ugandan President, Parliament and Government to foster an inclusive and safe environment for all citizens, while safeguarding the human rights of each individual, irrespective of their sexual orientation or gender identity.

A Review of the Impact of the COVID-19 Pandemic on Health Workers’ Sentiment towards Influenza Vaccination

During the COVID-19 pandemic, immunization of health workers (HWs) has become a top priority. According to the Centers for Disease Control and Prevention (CDC), reducing the risk of patients catching influenza from health professionals, protecting healthcare staff and their families against influenza, and reducing health professionals’ absenteeism and consequently costs on the National Health Service are key reasons for the cost-effectiveness of influenza vaccination strategies among HWs. Although healthcare professionals are cognizant of the significance of immunization for protection against infectious diseases, there are various obstacles and factors that impede the uptake of influenza vaccines. Vaccine hesitancy among HWs is one of the major hurdles to optimum immunization practices.

In an article published by the researchers of the WFPHA and its International Immunization Policy Taskforce, they investigated the impact of the COVID-19 pandemic on the sentiment of influenza vaccination among HWs through the identification of relevant determinants, barriers, and interventions to counteract vaccine hesitancy.

Determinants of Vaccine Hesitancy

According to the article, age, gender, comorbidities, profession cadres, and vaccination history are the determinants of vaccine hesitancy among healthcare staff. Within the COVID-19 context, physicians and residents were more willing than nurses to adhere to influenza vaccination. Young HWs, particularly males and those with chronic comorbidities, demonstrated the highest acceptance of the influenza vaccine. HWs’ immunization history is associated with higher influenza vaccine adherence.

Enablers of Vaccine Acceptance

There are several factors that influence the acceptance of influenza vaccines by healthcare staff. According to the article, healthcare staff’s knowledge of the influenza vaccine, concerns about protecting themselves or others, and the rising perception of risk and fear from COVID-19 infection are among the main factors.

Barriers to Vaccine Acceptance

According to the article, the main barriers were negative perceptions about vaccine safety and effectiveness, insufficient time for vaccine uptake, and confidence in natural or acquired immunity.

Interventions for Vaccine Hesitancy

Interventions adopted during the COVID-19 pandemic to increase HWs’ influenza vaccine acceptance ranged from: awareness campaigns alongside education and training to target hesitancy; mandatory HWs’ influenza vaccination; promotion of vaccine culture in workplaces; the incentive approach; and increasing vaccine affordability and accessibility.

According to the article, the COVID-19 pandemic had a critical impact on the success of influenza campaigns among HWs. In the context of COVID-19, confidence in influenza vaccines and the perception of risk from COVID-19 infection have increased among HWs.

Eliminating HPV Globally: From Strategy to Implementation

Cervical cancer is a disease that exemplifies global inequalities to a significant extent. Each year, more than 600,000 new cases of cervical cancer are diagnosed globally. Around 90% of the approximately 342,000 deaths resulting from cervical cancer in 2020 took place in low- and middle-income countries (LICs/LMICs).

Human papillomavirus (HPV) is responsible for over 95% of all cases of cervical cancer. Cervical cancer is the fourth most common form of cancer among women worldwide, but it is preventable and curable if detected early and managed effectively. HPV additionally causes anal, penile, oropharyngeal, vulval, vaginal, and other cancers. At least 10%, and possibly up to 40%, of cancers caused by HPV are in men.

The global coverage of the first dose of HPV vaccine in girls is only 15%, and the COVID-19 pandemic fueled the largest continued backslide in vaccination and screening. While in high-income countries people can be vaccinated against HPV and women have access to regular screening and treatment, this is not the reality in LICs and LMICs. Moreover, males are currently excluded from most HPV vaccination programs. Gender-neutral vaccination would protect women and men and accelerate the elimination of cervical cancer.

The World Health Organization (WHO) has developed an aspirational strategy to eliminate cervical cancer as a public health problem (Global strategy towards eliminating cervical cancer as a public health problem, adopted by the World Health Assembly in 2020), aiming to increase HPV vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%.

In line with the global strategy as well as Europe’s Beating Cancer Plan, the WFPHA, the Union for International Cancer Control, and the European Cancer Organisation organized a World Leadership Dialogue (WLD) session “Eliminating HPV Globally: From Strategy to Implementation” during the 17th World Congress on Public Health (WCPH), on May 02 to 06, 2023, to provide a platform for health leaders from governments, United Nations agencies, the private sector, civil society, and patients to share progress and challenges toward eliminating all HPV-related cancers.

This WLD session is organized to highlight progress towards the WHO’s 90-70-90 cervical cancer elimination goals; to discuss the determinants of health that limit women’s access to health services, screening, and treatment, starting from the real experience of some countries; to consider the merits of gender-neutral HPV vaccination; and to create a sense of urgency to direct policy decisions toward concrete actions to prevent and treat HPV-related diseases and to increase investments to scale access to these tools.

During this WLD session, health leaders listen to and discuss with communities and policymakers to define the best approaches and leverages to implement concrete actions based on the WHO global strategy to prevent and treat HPV locally and worldwide and to facilitate intersectoral collaborations to achieve this common goal.

#WorldinTurmoil: Prioritize Primary Healthcare, Public Health, & Collaboration with Communities: Lessons from Costa Rica & the Pandemic

Few countries can be proud of having comprehensive primary healthcare. One of these countries is Costa Rica. Costa Rica is an example of political commitment and strong leadership. It is a country that has put public health as a priority, and the investments and efforts that the government has made over the last 25 years have borne fruit, especially during challenging times like the COVID-19 pandemic.

Dr María del Rocío Sáenz Madrigal, who was Minister of Health in Costa Rica from 2002 until 2006, is interviewed by Prof. Bettina Borisch, Executive Director of the WFPHA, and talks about how the pandemic showed and exacerbated inequalities, especially for women, in Latin America, measures implemented by Costa Rica, and what it takes to have a strong public health system.

By clicking on the link below, you can read the article on the Croakey Health Media website.

Watch the interview by clicking on the link below.

This article is published as part of the #WorldinTurmoil series.

Interview

Integrating China in the International Consortium for Personalized Medicine Project: Working Groups

Integrating China in the International Consortium for Personalized Medicine (IC2PerMed) project aims to support European Union (EU)-China collaboration over the developments of personalized medicine research, innovations, and policies through the International Consortium for Personalized Medicine (ICPerMed) initiative, providing people with access to personalized, smart, and inclusive healthcare solutions in the near future.

Three Working Groups support the IC2PerMed project. These Working Groups are composed of experts balanced between EU and Chinese stakeholders and genders.

The first Working Group’s activities focus on the awareness and empowerment of citizens and patients, the education and curricula of healthcare professionals, and healthcare sustainability.

The second Working Group’s activities focus on Big Data and ICT solutions and bringing innovation to market.

The third Working Group’s activities focus on translating basic clinical research and beyond and on research funding.

These Working Groups work together to reach the IC2PerMed project’s core objectives.

WFPHA is one of the key partners in the IC2PerMed project.