Vaccines: The Best Investment in Children’s Health

Ask Dr. Jon Abramson if he thinks vaccines work and he will smile, nod knowingly and ask, “How many people do you know who have had smallpox?”

He has a point. A number of the most deadly and communicable infectious diseases have been eradicated from the United States in the last 50 years due to the effectiveness of vaccines. Small pox has been eliminated from the entire world. Most people can thankfully answer Dr. Abramson’s question with one word. “None.”

“Vaccines are one of the most effective health measures we have to prevent deaths in this world,” Abramson, the chair of the department of pediatrics and physician-in-chief of Brenner Children’s Hospital, said. “This is population-based preventative medicine at its best. From a public health standpoint, vaccines are an incredible development.”

In 1999, as the second millennium approached, the Centers for Disease Control and Prevention chose vaccination as one of 10 top public health achievements of the 20^th century, according to Walter Orenstein, M.D., professor of medicine and pediatrics at Emory University and associate director of the Emory Vaccine Center.  “A cost- benefit analysis covering 10 vaccine-preventable diseases of childhood, diphtheria, tetanus, pertussis, polio, hepatitis B, Haemophilus influenzae type b, measles, mumps, rubella, and varicella, estimated that for every dollar spent on childhood immunization in 2001, there were $5.30 saved in direct costs and $16.50 saved by society,” Orenstein said.

The World Health Organization estimates that 13 percent of children die worldwide each year from vaccine-preventable deaths. For Dr. Abramson, that number is much too high.

“There is no reason for any child to die from a disease for which there is a proven vaccine available to prevent that death,” he said.

So he spends time on his mission to help children worldwide live healthier by serving as chair of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).  This CDC committee makes recommendations to the U.S. government on whether vaccines should be administered, how often and at what age. He has also served as the chair of the American Academy of Pediatrics Committee on Infectious Diseases. This group writes the nation’s “Red Book” guidelines – a tool used by most practicing pediatricians in the country to determine how to prevent and treat infectious diseases.

And he is just getting warmed up. As one of the nation’s leading experts on vaccinations, he has testified before Congress regarding the efficacy of vaccines and the importance of them to the nation’s health. In addition, he has made presentations around the globe about ways to administer and afford vaccines for our world’s most needy population.

Are Vaccines Safe?

It’s a question he is asked often. Sitting in his office, you can see his passion for this cause as he discusses what has been a controversial issue among some parents. A few years back, a group of parents waged war against pharmaceutical companies and the healthcare industry for administering the Measles, Mumps, Rubella (MMR) vaccine, saying the vaccine caused autism in their children.

Groups, including the highly-respected Institute of Medicine, immediately began to look at the safety of the vaccine and the validity of their claims and determined them to be unfounded. However, questions as to the safety of vaccines arise from time to time. And while no medical intervention can be said to be 100 percent safe, the benefit versus the risks associated with vaccinations greatly favors their use, Abramson says.

“We are always working to improve our vaccines,” he said. “Even after the vaccine has been tested in large Phase 3 clinical studies and approved by the FDA because the vaccine is deemed safe and effective, there continue to be large post-licensure, Phase 4 studies to confirm these findings. If we think a vaccine is causing harm, then we pull it from the shelves until it can be deemed safe and effective.”

Most vaccines are more than 80 percent effective in preventing disease and in those cases where disease does occur it is often less severe, he says. For example, the effectiveness of the flu vaccine is based on how well the strains in the vaccine match the strain of flu virus that infects the community that year. Other vaccines’ effectiveness wanes over time and they must be re-administered to protect the recipient from contracting the disease. For example, the pertussis or whooping cough vaccine is only effective for about 10 years. Another dose has to be administered every decade to protect people from developing the disease.

But Abramson warns just because vaccines are not 100 percent effective, this is not an excuse to forego booster vaccinations or opt out of the shots altogether.

“At this time, we have some of the highest vaccination rates ever in this country and this has lead to the elimination or marked decline in the occurrence of these vaccine-preventable diseases,” he said. “But if people stop taking their vaccinations, then we will see the resurgence of some of these deadly diseases. Until we totally eradicate these diseases, we must keep administering vaccines.”

History of Vaccines

In the past five years, more vaccines have been introduced into the U.S. health care system than in the previous three decades.  Dr. Abramson attributes the explosion of vaccines into the marketplace to the fact that health organizations around the world are recognizing the benefits.

Most people in the world are vaccinated against measles, diphtheria, tetanus, pertussis (whopping cough) and polio. (A small number of polio cases are still reported in Africa and remote parts of Asia.) More and more children are being vaccinated against hepatitis B. Smallpox vaccine, which had been used worldwide, stopped being used in the United States in 1972. Eradication of the disease was not made official until 1979 and most other countries stopped using the vaccine in the 1980s.

Haemophilus influenzae type b meningococcal and pneumococcal vaccines (to protect against the three most common causes of bacterial meningitis), varicella (to prevent chicken pox) and the rotavirus vaccine (to prevent a virus that can cause severe diarrhea in infants and young children) have all been introduced to the U.S. immunization schedule in the last 15 years. About half of these have been recommended in the last 5 years.

Dr. Abramson is particularly excited about the new cancer-preventing vaccines recently approved by the FDA. Last June the FDA approved Gardasil, made by Merck & Co., to protect teens from a sexually transmitted virus that can cause 70 percent of cervical cancer cases. In 2005, another vaccine was approved for the Hepatitis B virus, which can cause liver cancer. Additional vaccines routinely used in the United States include those against influenza virus and the hepatitis A virus.

And more vaccines are in the development stages.

When asked about whether companies will continue to make and produce vaccines, Dr. Abramson is cautiously optimistic that they will. “There was a time when we worried that we’d have no pharmaceutical companies left to manufacture vaccines,” he said. “With the birth of bio-technical companies, this worry has diminished. Most bio-tech companies see the development of new vaccines can be profitable. Most everyone gets vaccines – often multiple doses – whereas a smaller percentage of the population may take a blood pressure medication or cholesterol-lowering drug The companies develop a vaccine and get it far enough along for one of the larger pharmaceutical companies to come along and form a partnership or buy them out.”

Protecting our children at what cost?

In 1999, it cost an average of $186 to give a child all the recommended vaccines. Today, the current vaccination schedule will cost a parent more than $1,000.

“We are working to find ways to help the medically underserved get these vaccinations,” Abramson said. “It’s imperative that these children have the same chance at a healthy childhood.”

However, each state funds vaccinations differently and he is afraid many children will fall through the cracks. “As we increase the number of vaccines we give to children, it will be harder for states, in tight economic times, to find funding in the budget to help the percentage of the population that doesn’t qualify for Medicaid and has no private insurance or insurance that does not adequately cover the full costs of the vaccine. At a time when states are struggling to balance the budget, this can be additionally draining.”

Yet, that doesn’t stop him or his committee from making recommendations on new vaccines. “The ACIP is charged with determining the safety, efficacy and cost effectiveness of the vaccine,” he said. “The ACIP is prohibited from worrying about how it is going to be paid for. Our primary concern is the public’s health.”

Many countries now administer the MMR and polio vaccines and many kids receive the diphtheria, pertussis and tetanus boosters as well, but Dr. Abramson would like to see all children receiving other vaccines that are available.

He would also like to see the cost of vaccines used in developing countries decrease, making it more affordable for third world countries.

“A dose of vaccine in the U.S. can cost as much as $150 and children often need more than one shot,” he said. “Obviously, for these vaccines to be used in developing countries, the cost must come down dramatically.”

However, when you think about the expense of a lengthy hospitalization or life-long health complications from one of these diseases, isn’t it worth the cost?, he asks. “I think that is something each parent has to weigh for themselves. In my family, my children are vaccinated with all of the routinely recommended vaccines. Period.”

Dr. Orenstein agrees. “Most vaccine-preventable diseases are spread from person to person,” he said. “A child who is vaccinated is not only gaining protection for herself but also for the community.  The more immunity in the community, the less likely there will be outbreaks of disease should infection be introduced.  Persons indirectly protected by high immunity levels include children too young to have received all recommended doses of a vaccine, children whose immune systems are compromised, children who have contraindications to vaccination, and the few persons not protected by vaccines. When children cannot gain access to vaccines because of cost considerations, they can serve as a reservoir of infection, seeding the community at large.  That’s why it is in the interests of the poor that the rich be vaccinated, and in the interests of the rich that the poor be vaccinated.

Anxiety over too many vaccines at such a young age

Dr. Abramson says fears that children are receiving too many shots are unwarranted. “A child is exposed to thousands of different antigens in the first few years of life,” he said. “Our body is equipped to deal with that. I am not worried that we are giving too many vaccines.”

Dr. Orenstein says education is key to maintaining high immunization rates. “The tremendous success in the current immunization efforts means that most parents today have never heard of many of the vaccine-preventable diseases, have no personal experience with these diseases, nor understand the reasons why each new child born needs to receive a complete series of vaccines,” he said. “Assuring their child is vaccinated may become a low priority given the many other concerns parents have.  It will be critical to educate future generations of parents about the safety and effectiveness of vaccines and why it is important for them to assure their children get all recommended doses at the recommended ages.”

New vaccines on the horizon

Vaccines for HIV, the virus that causes AIDS, are currently undergoing clinical testing as are immunizations for malaria, TB and other diseases. Other vaccines already on the schedule will be expanded and recommended for additional age groups. For example the influenza vaccine currently recommend for children ages six months to five years may soon be recommended for older children as well.

According to Dr. Orenstein, vaccines are under development for a number of diseases and by 2020, hopefully, some will be licensed and available for use in children.  Efforts are underway to develop vaccines against respiratory syncitial virus, a common cause of severe respiratory illness in young children; cytomegalovirus, a major cause of congenital infections leading to long term neurologic problems including deafness; Epstein-Barr virus, the cause of mononucleosis; Group A streptococcal infection, and many more diseases, Dr. Orenstein said.

When asked how a vaccine is chosen, Dr. Abramson says the committee looks at diseases with life-threatening or life-altering complications. “We select the most communicable diseases,” he said. “By immunizing most of the population, you often end up providing protection to the entire population. All of us would rather avoid having a disease rather than having to treat the disease once it occurs. Immunizations remain one of the most cost-effective public health interventions available within the United States and the world. It is imperative that we fully utilize this preventive measure to improve the health of all children and adults.”