Vaccination: A public health achievement of the 20th century 

11142015 6In a country where a quarter of its population, roughly over 25 million people, live in poverty and cannot afford decent meals, let alone avail themselves of health services, preventing infections and diseases is the best strategy to ensure that people stay healthy and in good condition.

Considered an important component of preventive health is vaccination or immunization. It is a widely accepted practice in the world, yet many still doubt if it is safe and effective.

Dr. May Emmeline B. Montellano, head of the Department of Pediatrics of the Mary Chiles General Hospital and the president of the Philippine Foundation for Vaccination, described vaccination as one of the greatest public-health achievement of the 20th century.

“Better than safe water and antibiotic,” she said.

Montellano said the goal of vaccination or immunization is to control the transmission of an infection, the elimination of a disease and the eventual eradication of the etiologic agents that cause this infection or disease.

She said vaccination helps the body develop and strengthen its immune system to fight against future infections and diseases.

“The best way to be immune to an infection is to contract it by natural means. However, when one contracts an infection, this can lead to disease, disability or death. Vaccination ensures immunity by providing a preventive medicine to the body as protection against a disease when a person is exposed to it in the future. Immunity from a vaccine is similar from what is acquired from natural infection, but without the disease,” Montellano explained.

Another advantage of immunization, Montellano said, is what doctors call the “herd effect” of the vaccine.

“It means that those who cannot be vaccinated because of contraindications to vaccination—those who are immuno-compromised, immuno-suppressed and have not been vaccinated for any reason—may be protected indirectly by those who have been vaccinated as long as there is a high vaccine coverage against the infection in the general population,” she said.

Indirectly, vaccines can also reduce the complications or exacerbations of chronic diseases, which can lead to disability or death. She said Hepatitis B vaccine can prevent Hepatocellular Carcinoma and Human papillomavirus (HPV) vaccine can prevent cervical cancer. Vaccines that can prevent respiratory diseases, like influenza, can also prevent chronic respiratory diseases from having severe manifestations and can precipitate hypertension, which leads to stroke and heart attack.

But Montellano said vaccination cannot guarantee 100-percent immunization from an infection or a disease. She said some vaccines provide nearly complete and lifelong immunity against disease, some only provide protection against severe manifestations of an infection, and some must be re-administered periodically to maintain its effects.

According to Montellano, immunologic response to vaccination is dependent on the type and dose of the vaccine, the effect of the adjuvant—an agent that is added to a vaccine to strengthen a person’s immune response to a vaccine—and host factors, such as age, preexisting antibody, nutrition, concurrent disease and genetics.

On the other hand, the doctor countered that vaccines cannot cause autism, infant death and other syndromes, as some people believe.

“Scientific evidence has not supported these claims. The Institute of Medicine specifically found no link between immunization and these diseases,” Montellano said.

“The doctor who made the study about the causality of measles, mumps and rubella vaccine to autism has been debarred by the British Medical Council after thorough investigation. A public apology was made and the study was retracted and removed from archives,” she added.

To date, there are now 23 diseases that can be prevented through vaccines, Montellano said. Some examples are tuberculosis with Bacillus Calmette-Guérin vaccine, tetanus with tetanus toxoid, chicken pox with the Varicella vaccine and influenza with trivalent or quadrivalent flu vaccine, among others.

Most notable about vaccination or immunization is its success in eradicating cases of small pox since 1977. Montellano said the medical world also aims to completely eliminate cases of polio by 2018. She said only Pakistan and Afghanistan have reported cases of polio, to date.

The Philippines, on the other hand, has been enjoying its polio-free status since 2000.

Montellano said the Department of Health implemented a program recommended by the World Health Organization (WHO) in 1993, which led to the eradication of polio in the country.

“This is a program where, aside from the primary series of vaccination for polio, there are five additional vaccine shots yearly for the next five years. In 2000 we were finally declared by the WHO as a polio-free country,” she said.

The country has also implemented a measles program since 1970s, according to Montellano. She said the program has led to a significant decrease in the measles incidence in the country, which is why the WHO declared that the country is capable of eliminating measles in 2008.

“Unfortunately, because of low vaccine coverage there was a resurgence of measles in our country and, as an action of the government against measles, a house-to-house measles vaccination was done,” Montellano said.

In order the make vaccination more accessible to Filipinos, the government implemented the National Immunization Program since the 1970s.

This program initially offers vaccine to infants under 1 year of age, Montellano said.

“For so long, only 6 vaccines were given by the government. But in 2006, Hepatitis B vaccine has been legislated to be given at birth, anti-rabies vaccination in 2007 for school-aged children and flu vaccination for senior citizens,” she said.

She added that rotavirus vaccine was given to poor Filipinos and that pneumococcal conjugate vaccine, which was initially given in the Caraga region and the Autonomous Region in Muslim Mindanao in 2012, has been extended to six additional regions. HPV vaccine has been offered to adolescents starting this year.

Aside from the infant vaccination program, the government is also carrying out its Adolescent Immunization Program, according to Montellano. This program provides HPV vaccine, measles and rubella virus vaccine, and tetanus and diphtheria vaccine to adults.

There is also a school-based immunization program, which provides booster doses of diphtheria, pertussis and tetanus vaccine, measles and rubella virus vaccine and tetanus and diphtheria vaccine.

Montellano said all these vaccines are given to the public for free.

Meanwhile, the Philippine Health Insurance Corp. reduced the price of pneumococcal vaccines for the elderly.

Private sectors and nonprofit organizations, such as the PFV, the Philippine Pediatrics Society, Pediatric Infectious Disease Society of the Philippines and the Philippine Society for Microbiology and Infectious Diseases have been doing advocacy programs to promote vaccinations in the form of research, recommendations and development of immunization schedules, as well as conducting lay and scientific fora, Montellano said.

With the government and medical institutions’ effort to make vaccination more accessible to Filipinos, many now enjoy lesser health risks. Montellano said she believes that vaccination or immunization, as a tool in preventing disease, disability and death, is a cost-effective investment.

“It is one of the most cost-effective investments for health. With the use of vaccines, the lesser the chance that a Filipino will be infected with vaccine-preventable diseases. Therefore, there will be a decrease in the need for medical care utilization. It stands true that ‘Health is Wealth’,” she said.