Global Immunization Strategic Framework 2011–2015: Background and Introduction
The burden of vaccine-preventable diseases (VPDs) in the United States has been greatly reduced due to childhood immunization. However, even as VPDs such as polio, measles, and rubella have been eliminated in this country, the United States remains vulnerable to disease importations as long as they persist elsewhere. In an era of mass travel and global epidemics, the health of U.S. citizens is closely related to disease occurrence in other countries. Thus, support for immunization programs worldwide contributes toward providing an "umbrella of protection" for the United States, as well as fulfilling the U.S. government's broader commitment to global health.
Childhood immunization is one of the most cost-effective public health interventions. Basic immunizations are estimated to prevent more than 2.5 million annual child deaths globally, primarily due to prevention of measles, pertussis, and tetanus. Vaccines also prevent severe morbidity from other devastating diseases such as polio for millions more children. Vaccination of children also is expected to avert adult deaths by preventing hepatitis B virus (HBV)-related cirrhosis and liver cancer and human papillomavirus (HPV)-related cervical cancer. However, immunization can potentially do much more. The World Health Organization has estimated that about 1.5 million children under age 5 years continue to die annually from VPDs (approximately 20% of overall childhood mortality). In particular, pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type B (Hib) vaccine, and rotavirus vaccine prevent pneumonia and diarrhea, the two leading causes of death among children under age 5 years in the developing world; the expanded use of these vaccines will be critical for achieving UN Millennium Goal 4—to reduce 1990 child mortality levels by two-thirds by 2015.
An estimated 130 million infants are born around the world each year. Protecting each new birth cohort from VPDs requires a well-functioning and accessible immunization service delivery system as a cornerstone of national public health systems. Routine immunization service delivery at fixed posts or through periodic outreach activities (e.g., child health days, immunization weeks) provides at least three contacts per year to more than 100 million infants and their caretakers. In addition, supplemental immunization campaigns play key roles in making progress toward meeting targeted disease control goals such as polio eradication and measles mortality reduction. However, these achievements are temporal because large outbreaks are probable, and cases and deaths are likely to increase, without further improvements in immunization service delivery.
As a well-accepted and demanded community health program, the immunization service delivery platform is key in ensuring equitable distribution of other essential health services and decreasing morbidity and mortality from other diseases. Through either routine immunization services or supplemental immunization campaigns, immunization service delivery is the backbone upon which multiple additional services are added, including delivery of de-worming medicine, vitamin A, long- lasting insecticide-treated bed nets, safe water systems, and other health commodities. Also, the infant immunization contact provides opportunities to screen mothers for HIV/AIDS and provide health education on a variety of topics. The integrated service delivery process must be coordinated and rational so that health care workers are not overburdened. However, if done effectively, integrated service delivery offers the potential to efficiently expand outreach for multiple health care services to previously unreached populations.