A trip to Senegal made me question the realities of the large and varied childhood vaccine gap. Global surveys suggest that children who are not vaccinated could be a real risk factor for potentially deadly diseases in the future. In Senegal, I learned that four in ten children are not immunized, many of them because of cultural beliefs, low immunization rates, and poor access to vaccination.
Last week, I traveled to Senegal to see how the U.S. Agency for International Development is using technology to prevent preventable diseases. The U.S. Agency for International Development’s (USAID) Program for Health Information Exchange (PHII) is supporting Senegal to expand digital health records into 98 out of 99 counties. PHII is a program of the State Department’s Population, Health and Family Planning Bureau, and because Senegal is immunization targeted, the program integrated immunization tracking into its efforts. The project’s scale-up is groundbreaking.
Why immunization tracking?
Several reasons. Vaccines are expensive and there is a broad range of potential risks and costs from immunization: some reactions may even be permanent and cause lifelong illnesses. In addition, vaccination also provides important protection against infectious diseases. For an example of this, take the measles and mumps outbreaks in Northern California – which had many children who were not immunized, and these children had been exposed to people living in their communities who were not vaccinated. Their exposure to those vaccines – and the people they were exposed to – caused them to develop certain immunological conditions. The health workers who vaccinated them, however, could not accurately tell the difference between the ones who got vaccinated and those who did not. There was therefore a gap between reporting what happened to immunized children and what happened to those without vaccines who received exposure to the same exposure. Vaccines, therefore, are sensitive and variable and this makes them difficult to estimate accurately.
Led by USAID, an integration of vaccine tracking into the PHII project is addressing this big gap. The integration is trying to give health workers a clear picture of vaccines’ exposures in people in their communities. For example, family members may have been exposed to two or more vaccines. As a result, data can be collected for their present lifestyle and health status. The data is then automatically recorded into health records within a county, and the reported profile is compared to available data on vaccines within the state. The idea behind the integration is to increase the number of people around the community aware of exposure to vaccines, thus speeding up the rate of immunization. This is particularly important with several diseases that cause high death rates among children. For example, measles kills 300,000 children under 5 every year. The United States is a donor nation that provides funding to try to reduce or eliminate the disease. When an outbreak of measles starts, cases can be transmitted rapidly and often, too many infants are not vaccinated against the disease. Once an outbreak starts in countries, it can be even harder to fight as there are not many agencies and organizations working together to minimize the illness and reduce the death toll. The death toll, however, could be reduced by 25 percent by using electronic records to protect and help prevent outbreaks like measles.
From developing country to developed: Why it is important
It is difficult to think of diseases we usually associate with developing countries – like measles and meningitis – being present in the United States. Having the ability to protect vulnerable populations from communicable diseases is important because these are the communities that often need vaccinations the most. That is why it is so critical to find better ways to track children’s exposure to vaccines that they are not being vaccinated. Countries like Senegal need access to new vaccines that they cannot access otherwise to protect the young people and children that live within their borders. This is why it is so important for the U.S. government to invest in vaccines that are among the most effective and have one of the largest lifesaving impact – like the latest generation of HPV vaccines and pneumococcal conjugate vaccines – for which Senegal has been a donor nation. With this project, we will bring the vaccine-maker face-to-face with the people they should be talking to in countries like Senegal. As someone who has worked on vaccines, it is just plain compelling.
The data being created by the PHII integration will have a huge impact on helping vulnerable populations of vaccine-preventable diseases, including many who are not known to get vaccines yet who are at risk. It will also benefit future generations.
— Julie Adams is a technical and policy analyst at the State Department’s Population, Health and Family Planning Bureau, and the author of “Pivotal Moments in Immunization: How Technology Is Changing the Game For Us All.”