2.1 Immunisation
According to Baker (2000), childhood immunisation constitutes one of the great success stories of American public health in the 20th century. Whereas the British led the way in introducing formal clinical trial methodology in the field of immunisation development, the Americans excelled in the rapid translation of laboratory knowledge into strategies suitable for mass application.
To achieve its aim of eradicating infectious diseases, WHO launched the Expanded Programme on Immunisation in 1974. At the time only 5 per cent. of the world’s children under one were immunised against six target diseases: diphtheria; tetanus; whooping cough; poliomyelitis; measles; and tuberculosis. By 1994 almost 80 per cent. of children under one were immunised against these diseases (Kassianos, 2001).
The world’s poorest regions are still suffering a heavy toll of premature death and disability from infectious diseases for which vaccines do not exist or else need to be improved. Infectious diseases are responsible for a third of all deaths in the developing world, killing at least 15 million people a year. The health disparity between rich and poor countries results in average life spans of 77 and 52 years respectively. Deaths attributable to infectious diseases contribute most to the disparity. Of these, more than 5 million are children under five. According to the World Healt Organiseation (2003) “The most effective way to reduce disease and death from infectious diseases is to vaccinate susceptible populations”.
Cuba is one of the world’s poorer countries. Since Fidel Castro came to power in 1959, it has developed an excellent health care service that boasts of 95 per cent. immunisation coverage, low infant mortality rates and life expectancy much higher than other developing countries. In fact, these indicators are equivalent to western European countries and the United States (MacDonald, 1999). Fidel Castro is known to boast “Cuba is a poor country that dies of rich man’s diseases” .
The theory of immunisation programmes works mainly in two ways: on an individual basis to protect specific persons at risk; and on a population basis to provide “herd immunity” to protect individuals who have not been vaccinated (Bedford and Elliman, 2000).
The observation that recovery from smallpox prevented subsequent attacks of the disease was made in both ancient Greece and China and, in 1798, in Britain when Edward Jenner discovered that cowpox inoculation prevented later infection with smallpox. This was the start of a new science, which is the basis for medicine’s programmes for preventing disease (Coulter and Fisher, 1991).
The advent of modern medicine, the discovery and invention of vaccines and antibiotics and the establishment of public health agencies promised to make recurring epidemics a thing of the past. The smallpox chapter of the history of immunisations was closed in 1980 when WHO declared the disease officially eradicated. WHO aims to eradicate poliomyelitis and measles worldwide in the next few years (WHO, 2003).
Diphtheria, tetanus and pertussis (whooping cough) may seem distant to young parents living in the UK, but they can still strike fear into the hearts of grandparents and people living in the third world. During the nineteenth century and the early part of the twentieth, diphtheria and pertussis each infected more than 100,000 people a year in the UK– mostly children – and tens of thousands died as a result (WHO, 2003). Tetanus, although less common, killed several hundred people per year during the same time period.
These figures prompted scientists to develop vaccines for these deadly diseases. First on the market was a vaccine for rabies in 1885, followed by diphtheria in 1923, pertussis in 1926, tuberculosis in 1927 and a tetanus vaccine in 1928. A combined vaccine – DPT – became available in 1946 (WHO, 2003).
A diphtheria vaccination programme was introduced in the UK in 1940. At the time there were 46,281 notifications of the disease, resulting in 2,480 deaths. Since 1970 only 9 deaths have resulted from diphtheria, the last in 1994 (Bedford and Elliman, 2000).
A pertussis vaccine was introduced in the UK in 1953; notifications were 100,000 at the time, mortality rates were estimated to be 1/1000. By 1973, immunisation coverage was 80 per cent. with only 2,400 notifications (Kassianos, 2001).
Following the inauguration of the NHS and after the austerities of the war years, most people in Britain probably saw ‘health’ as being the absence of disease (MacDonald, 2003). Physicians began directing their attention to eradicating the common diseases of childhood. A vaccine for measles was developed in 1960, rubella in 1966, mumps in 1967, and a vaccine against chicken pox is now available.