Immunization

Preamble
Immunisation is the most important component of provision of health care that has resulted in a significant decrease in morbidity and mortality from vaccine-preventable diseases. The constant high uptake of immunisation within countries will result in herd immunity and the eventual eradication of some diseases. Smallpox is an old success story with its eradication in 1980. Polio is on its way out with only two remaining countries with endemic spread. These two countries are in our Asia Pacific Region and with the rapidity of air travel, the polio virus can spread between countries and continents.

The emergence of measles in countries that have been declared eliminated like in Mongolia and the United States of America calls upon more vigilance and also increased uptake of the MMR vaccines. In Malaysia, we have had outbreaks of diphtheria involving 14 children and 5 deaths this year that is a concern since we have not seen any diphtheria in a long time. We are at an age where the internet and social media play a big role in dissemination of information. The good, bad and ugly are out in social media and the average person cannot differentiate the three.

The Asia Pacific Pediatric Association Technical Advisory Group on Immunisation (APPA TAGI) can play a role in helping to coordinate and collate information from different countries.

Role and Objectives
Among the roles of APPA TAGI will be to:

1. Be a resource for individual countries on matters and issues related to immunisation
2. Share relevant data on immunisation and outbreaks of vaccine-preventable diseases within our countries
3. Share activities related to vaccine advocacy within our countries so that these may be used in other countries, where applicable
4. Help each other in promoting under-utilised vaccines like the rotavirus, pneumococcal, meningococcal and influenza vaccines, among others that are locally relevant.
5. Review our individual national immunisation schedules and look at gaps that need to be filled. The data obtained from such an activity can be published and be presented at national levels to narrow these gaps in immunisation practices.

Activities
Activities have to cover a wider scope of comparing and sharing data so that a publishable material covering the whole region can be produced.

The first step will be to share information in each of our countries and collate the national immunisation programs (NIP) to look at the obvious gaps between countries in our region. A table of the vaccines in our NIP can easily be created using an excel folder as a start.

With the move to measles and rubella elimination, we have to help each other in trying to engage relevant authorities and improve access to information within our countries. Among the biggest hurdle to measles and rubella vaccination is the anti-vaccine lobby spread through social media. These have to be tackled so that more parents will accept vaccination rather than refuse it. Data on vaccine hesitancy and refusal within each of our countries can be shared as well as efforts to tackle these. We may not be able to combat the tech-savvy approach involving celebrities, Facebook, Twitter, etc of the anti-vaccine groups but we can make our presence felt within our local communities with efforts shared with regional colleagues and efforts as noted in the subsequent paragraph.

Next will be to share available resources on immunisation that are available online created by each of our countries. Indonesia was working on a vaccine website that we can share. In Malaysia, we have developed a comprehensive website called Immunise4Life (www.immunise4life.my or www.ifl.my) that can be accessed for information. It's also available on Facebook and an app for smartphones called MYVaksinBaby has also been launched for parents to track their children's immunisation progress and learn about vaccination from their smartphones. As information becomes more easily available from the phone, we have to meet this technological advance and make information available to parents and the public.

Other websites include the Immunization Action Coalition (IAC) that provides useful information in addition to the usual WHO and CDC websites. Other countries that have developed websites or social media applications may share these and we can update member countries using the APPA Bulletin and APPA website and email blasts.

The third activity will be to promote currently under-utilised vaccines including rotavirus, pneumococcal, meningococcal, influenza and dengue vaccines. Even the Haemophilus influenzae type b (Hib) vaccine is not in all our countries. Other than Hib vaccine, these are currently supported by pharmaceutical companies that have obvious commercial vested interest in the promotion of these vaccines. It is this interest that has caused the anti-vaccine lobbies to act against professional groups like ours. Nonetheless we have to proceed with our own agenda of promoting immunisation as a preventive strategy to reduce morbidity and mortality in children in our region.

Other activities will be shared during our subsequent meetings and email exchanges.

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Links

Off-label use of vaccines-Vaccine March 2017

NFHS 4-India

Making the leap into the next generationA commentary on how Gavi

A randomized study of fever prophylaxis and the immunogenicity of ped vaccines-Vaccines March 2017

Vaccine impact Benefits for human health Vaccine 2016

Vaccine development From concept to early clinical testing Vaccine 2016

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