Vaccines: Realizing their potential as tools for health equity
September 18, 2024
Read recent commentary on global health research issues from current and immediate past directors of the Fogarty International Center.
On September 9, 2024, I had the honor of (virtually) delivering the Edward Jenner Lecture for the
18th Vaccine Congress in Lisbon. Edward Jenner was an 18th century physician, who is often referred to as the “Father of Vaccinology.” He pioneered the use of vaccination to control an infectious disease—specifically, he used a cowpox virus inoculation to protect against smallpox. What Jenner understood is that the two viruses, though distinct, come from the same orthopoxvirus family, and so immunization with one would protect against the other. In a treatise describing his work,
Jenner wrote, "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."
I received a smallpox vaccine as a child, more than 150 years after Jenner delivered his first inoculation. Many of you reading this blog didn’t receive a vaccine, because you didn’t need one. Smallpox was eradicated worldwide in 1980.
My plenary talk, “Vaccines as tools for health equity,” discussed the phenomenal impact of vaccination programs. Over the past half century, in addition to eradicating smallpox, vaccines are estimated to have averted 154 million deaths and saved 9 billion years of life. Here in the U.S., routine immunizations have prevented more than one million deaths and conserved an estimated $540 billion dollars over the past 30 years.
Unfortunately, and paradoxically, global childhood immunization levels stalled in 2023. Armed conflicts and the inability to reach children are the primary cause of this drop in vaccinations. Remarkable scientific advances have catalyzed the development of new and better vaccines, yet such challenges mean that too many people do not benefit. Vaccine misinformation, vaccine hesitancy, and lack of access to vaccines have likewise contributed to the declines.
The mpox virus is an orthopoxvirus in the same family as smallpox. Mpox infections have been increasing in Africa for more than a decade. This has coincided with decreased population immunity following the discontinuation of smallpox vaccines. In 2022, mpox spread around the world and was declared a Public Health Emergency of International Concern (PHEIC). A new strain of mpox is now widely disseminated in parts of Africa, leading the WHO to declare a second mpox PHEIC.
Courtesy of the National Library of MedicineEdward Jenner, an English physician, performed the first vaccination against smallpox in 1796.
High resolution version of this image can be found on the National Library of Medicine website.
Fogarty-funded public health scientists are among those leading the charge to raise awareness about mpox and to combat the outbreak in Africa. In
an article published on the same day as my lecture, Fogarty grant recipient Dr. Jean Nachega and his colleagues delineate the multiple reasons why Africa, once again, must confront a public health emergency: Poverty, population displacement, lack of diagnostics, lack of vaccines… in summary, a general lack of political will. To contain the mpox outbreak, Nachega and colleagues called for long-term research investments, a leveraging of Africa's post-COVID-19 mRNA vaccine manufacturing hubs, and equitable access to diagnostics, vaccines and therapeutics. It is important to build a research infrastructure through scientific training, capacity building and partnerships, consistent with our Fogarty International Center mission. We at Fogarty are committed to scientific training and capacity building, understanding that the development of a scientific workforce will be key to preventing future pandemics and other health emergencies, while enabling a more resilient future.
As I write, vaccines have reached the Democratic Republic of Congo, but vaccination programs have not even begun. In contrast, mpox vaccines were widely available in the U.S. and other high-income countries during the 2022 outbreak.
I can’t help but be reminded of the famous painting,
Jenner: Smallpox is Stemmed, painted by Robert A. Thom. In it, Dr. Jenner is depicted inoculating a young boy to prevent smallpox, a disease that had immense impact on children in his time. Despite the outsized effect of mpox on African children today, there’s no similar picture of a child receiving a vaccine in the context of the mpox outbreak.
I can only hope that new picture will be available soon—more than two centuries after Jenner advanced his own dream of health equity.
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Updated September 18, 2024
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