1. Raising Immunization Levels in Impoverished Populations:
Creating Specialized Diagnostic and Treatment Centers Aimed at Immunizing the Impoverished
by Austin Bach
Abstract
The percentage of people beneath the poverty line that currently have all of the proper immunizations is approximately 7% below the percentage of people above the poverty line who have proper immunizations, and approximately 5% below the national average of people with proper immunizations.  Creating specialized Diagnostic and Treatment Centers, open all year long, for childhood and adulthood immunizations, will raise the percentage of immunization of people below the poverty line to that of the people above the poverty line. This will be done by having Diagnostic and Treatment centers aimed at enabling impoverished parents to make an easy trip to one of the clinics once a year for their children, and even themselves, to receive a “well visit” and receive the proper immunizations.
Table HEALTH4 Childhood immunization: Percentage of children ages 19–35 months vaccinated for selected diseases by poverty status, race, and Hispanic origin, selected years 1996–2003
Total
Below Poverty
At or above poverty
Characteristic
1996
1997
1998
1999
2000
2001
2002
2003
Combined series (4:3:1:3)
76.4 76 79 78 77 81 69 71 74 73 72 80 82 83
Combined series (4:3:1)
71.6
72.4 75 84
DTP (4 doses or more)
81.5 85
73.9 86 87
Polio (3 doses or more) 91 90 89 92 88
89.3 93
Measles-containing (MCV)
90.4
Hib (3 doses or more)
91.4 94
86.9 95
Hepatitis B (3 doses or more)
80.7
Varicella 12 26 43 58 68 5 17 41 55 64 15 29 44
Table 1: Percentage of children ages 19–35 months with the 4:3:1:3 combined series of vaccinations by poverty status, 1996–2003 (
Background
“[Vaccinations are] much like bailing out a boat with a slow leak. When we started bailing, the boat was filled with water. But we have been bailing fast and hard, and now it is almost dry. We could say, "Good. The boat is dry now, so we can throw away the bucket and relax." But the leak hasn't stopped. Before long we'd notice a little water seeping in, and soon it might be back up to the same level as when we started” (CDC, 2003b). If we were to one second stop and think of what diseases would return if we were to stop vaccinating our children, we would have nightmares. We would see the return of Polio, Measles, Haemophilus Influenza Type b Meningitis, Pertussis (the whooping cough), Rubella, Terrible cases of the Chicken Pox, Hepatitis A, B and C, Diphtheria, Tetanus and the Mumps, just to name a few (CDC, 2003a; Manning, 2005; Children’s Hospital of Philadelphia, 2005). Pediatrician Stephen Cochi, acting director of the Centers for Disease Control and Prevention's National Immunization Program in 2005, said “that for the first time, the immunization rate for toddlers exceeds the goal of 80% set by Healthy People 2010, a federal program designed to improve health nationwide through several strategies, such as boosting vaccination rates” (Manning, 2005). The only problem with his statement is that this is including only the United States of America. He warns that the lack of immunization in the rest of the world still puts our children at risk for these terrible diseases that we are trying so hard to protect them from.
According to the CDC, the average annual number of smallpox cases in was 48,164. The number of cases in the United States per year since 1950 is 0. The number of worldwide cases per year since 1977 is 0. We have done the same, eradicating, the wild type Polio virus and done very well with most of the other aforementioned viruses (Barret, 2000). Imagine the possibilities, if we were to have all of our children all over the world up to date on their immunizations, we could potentially rid ourselves of an enormous amount of life-threatening diseases.
While the general numbers in the United States seem to be extraordinary, there is still a large discrepancy between the immunization rates of those that are above the poverty line and those below it, though the fact still remains, immunizing our children helps prevent disease in those that cannot or do not immunize (CDC, 2000). There are a number of main reasons why people will not get immunizations. Not mentioning all of the misconceptions and trepidations about vaccines, people might not have the money or time to bring all of their children to a far away doctor’s office for a long wait just for a simple shot. There are many people who do not even bring their children to doctors. But why not try to help those who can immunize their children but don’t have the means to. This will not only help their health, it will also aid in the worldwide fight against disease.
Myths
Myth 1: Getting so many vaccines will overwhelm my child's immune system.
No doubt about it, the immunization schedule recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) can seem daunting. Your child can receive up to 23 shots by the time she's 2 years old and as many as six shots at a singledoctor visit. So it's not surprising that many parents have concerns about how vaccines might affect a child's developing immunity and often cite these as a reason to refuse a vaccine.
But it should be the least of your worries. "Children have an enormous capacity to respond safely to challenges to the immune system from vaccines," says Dr. Offit. "A baby's body is bombarded with immunologic challenges - from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean." In fact, Dr. Offit's studies show that in theory, healthy infants could safely get up to 100,000 vaccines at once.
The bottom line: It's safe to give your child simultaneous vaccines or vaccine combinations, such as the five-in-one vaccine called Pediarix, which protects against hepatitis B, polio, tetanus, diphtheria, and pertussis (also known as whooping cough. Equally important, vaccines are as effective given in combination as they are given individually.
Myth 2: As long as other children are getting vaccinated, mine don't need to be.
Skipping vaccinations puts your baby at greater risk for potentially life-threatening diseases. "The ability of immunizations to prevent the spread of infection depends on having a certain number of children immunized," says Thomas Saari, M.D., professor of pediatrics at the University of Wisconsin Medical School in Madison. "Scientists refer to this as 'herd immunity.' Unfortunately, the level of immunization required to prevent diseases such as measles from spreading from child to child is high - 95 percent." In 2003, the national vaccination rate in children ages 19 to 35 months was only about 80 percent - though that number increases to the mid-90s when children reach school age. These rates may not be high enough to provide herd immunity, especially as exemptions from school vaccines are on the rise.In studies from Colorado, where residents claim high numbers of vaccine exemptions for medical, personal, and religious reasons, kids who are not immunized are at greater risk for disease. Case in point: They're 22 times more likely to come down with measles.
Myth 3: Now that major illnesses have largely disappeared, we really don't need vaccines anymore.
Don't bet on it. Despite our relatively high vaccination rates in the U.S., many American communities still have outbreaks of diseases like measles and pertussis, a respiratory illness characterized by spasms of coughing that can last for weeks or even months. In 2003, 13 children died of the infection.
Unvaccinated children can also spread infection to vulnerable family members. "Those children are more likely to give a disease to those who can't fight it off, such as a six-month-old or a grandparent living at home," says Dr. Saari. The incidence of whooping cough has been increasing since 1980, and the Centers for Disease Control and Prevention recently recommended a pertussis booster shot for 11-year-olds because the risk of passing the disease to a vulnerable relative is so high.
What's more, diseases are spread by people from foreign countries who travel here. "Air travel has extended the range of diseases from countries where people aren't immunized," says Dr. Saari. "We're no more than one airplane ride from being exposed to many diseases."