Why vaccinate? A global health symposium in Amsterdam

On the 18th of December Health[e]Foundation organized together with the Amsterdam Institute of Global Health and Development a symposium on vaccination. Vaccination is for most of you a no-brainer: the impact of vaccines shows itself day after day and year after year.

The older generation of us might still have had classmates with poliomyelitis; the polio vaccine was introduced in the Netherlands in the mid-fifties. Once you have seen someone affected with the disease even the last doubt about vaccination vanishes. Younger people who did read the book “Nemesis” by Philip Roth, on the outbreak of polio in the mid-forties of the last century (the result is shown on the picture above) realize immediately the dramatic impact of an epidemic in times before any vaccines were broadly available.

But even today the value of vaccines against pathogens that cause outbreaks are indirectly visible. One has to only think of the recent Ebola outbreak in the Democratic Republic of Congo and the launch of the first experimental vaccine against Ebola. But we cannot deny that the vaccination coverage all over the world is decreasing. Also outside religious groups, there is hesitance to vaccinate one’s children with sometimes even resistance to get vaccinated. Many European countries miss out on the needed herd immunity of 95% for some vaccines. That means that the protection against infection for those that are too young or immunosuppressed and cannot be vaccinated is not secured.

The presentations during the symposium did cover global vaccination efforts by GAVIs CEO Seth Berkley (University of Geneva), the challenges of flu vaccines by Jaap Goudsmit (University of Amsterdam and Harvard), the Dutch experience with vaccines by Jaap van Dissel (RIVM and University of Leiden) and the growing vaccine resistance by Stuart Blume (University of Amsterdam).

The keynote lecture was given by Seth Berkley. Seth Berkley heads the vaccine alliance based in Geneva that provides most vaccines worldwide, was created in 2000 to improve access to new and underused vaccines for children living in the poorest countries of the world. Their results are stunning: in some cases, the vaccination coverage is currently higher than in the West and the North. He stressed ‘the importance of reaching the people hardest to reach with immunization: those who are not receiving immunization are not getting anything [healthcare] else’. GAVI brings public and private sectors together with the goal of creating equal access to vaccines for children wherever they live.

Jaap Goudsmit focussed on the challenges of flu vaccination. The yearly updated vaccine composition is often of the mark and frequently not able to protect against infection, hospitalization and death, particularly in the most vulnerable of the population. But there are options to improve the vaccine substantially and by vaccinating schoolchildren to free their grandparents from infection and provide the elderly themselves with more immunogenic vaccines closer to the start of the yearly epidemic.

The hesitance to vaccination was introduced by Jaap van Dissel, head of the Dutch Center for Infectious Disease Control. It used to be exclusively the religious population in the Dutch Bible Belt that refused vaccination: today, in times of the internet, also the more well- educated population expresses hesitation to follow the Dutch vaccination program.

Stuart Blume warned us not to focus specifically on the groups that criticize vaccination, nor the non-believers or the followers of these groups on Facebook. We should go back in history, when the smallpox vaccine was in the 19th century criticized heavily. Or observe more intensely society and identify what trends these groups follow and what context they are exposed to.

During the discussion the audience joined in, everybody was curious what the drivers of these opinion makers are and were looking for answers.
In short food for thought just before the December break and start the new year with good ideas on how to study these trends jointly with social scientists.