Monday, July 16, 2012

Childcare 9: Immunization and Government

Immunization of children of some preventable infectious/communicable diseases, well those diseases that tend to victimize the young and which there are existing vaccines already, whether patented or off-patent, is one important role that governments can provide. So again, I am no health anarchist, rather a health (or other social issues) minarchist.

For lifestyle-related diseases affecting many adult people, government should step back, allow people to take more personal responsibility in running their own lives. They can purchase private health insurance for instance, since they have the resources to buy plenty of alcohol and/or tobacco products, plenty of money to over-eat high-fatty, high-salt fast food, it should be fair that they also set aside money for their private health insurance, on top of government mandatory health insurance. This is one government coercion that is difficult or almost impossible to be shrunk and limited.

Sharing below three articles by the Executive Director of PHAP, Reiner Gloor, on immunization and vaccination of children, published in his column in BusinessWorld. These papers are about (a) immunization, (b) controlling pneumonia, and (c) anti-flu vaccines.

(1) Immunization as national priority  

July 13, 2012
Medicine Cabinet -- Reiner W. Gloor

Ministers of health from 194 countries recently endorsed a global roadmap to prevent millions of deaths by 2020 through wider and sustained access to vaccines.

During the 65th World Health Assembly, health ministers set into action the Global Vaccine Action Plan (GVAP) that hopes to achieve an ambitious vision of a world where all individuals and communities enjoy lives free from vaccine-preventable diseases in a decade’s time until 2020.

The mission of the so-called Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are or where they live.

During the decade, one of the goals is to achieve commitments to eliminate and eradicate poliomyelitis, measles, rubella and neonatal tetanus at the global or regional level. The GVAP emphasized that attaining the goal within the decade is critical as success will encourage the realization of further goals while “failure means millions of preventable cases of disease and death will continue to occur.”

Apart from saving millions of lives by the end of the decade, realization of immunization-specific goals will result in economic productivity gains and at the same time, contribute to exceeding the Millennium Development Goal 4 to reduce child mortality by two thirds.

It is estimated that about 26 million future deaths could be prevented if the coverage targets for introduction and/or sustained use of 10 vaccines are met in 94 countries within the decade. The said estimate is for the 10 vaccine preventable diseases: hepatitis B, Haemophilus influenzae type b, human papillomavirus, Japanese encephalitis, measles, meningococcus A, pneumococcus, rotavirus, rubella and yellow fever.

Hopes are high about reducing vaccine preventable diseases following important milestones including the development, licensure and introduction of new and improved vaccines and technologies for high-burden diseases.

However, the GVAP stressed that these accomplishments will not be sustained unless countries take full ownership of their routine immunization programmes. As such, one of the six strategic objectives of GVAP to achieve the goals of the Decade of Vaccines is for all countries to commit to immunization as a national priority.

Acknowledging the value of immunization as an important public health intervention to save lives is the first step. Setting national targets and providing needed financial and human resource investments are relevant to demonstrate commitment to immunization.

In the Philippines, President Aquino himself recognized immunization as part of his priority universal healthcare agenda. He said that win the war on poverty, the country must also turn its attention to public health.

“And, as we focus on the health of our country, economy, government, the overall health of all Filipinos also remains a top priority. We want our people to be empowered individuals capable of standing on their own two feet -- strong, healthy, and skilled men and women who can take advantage of the opportunities that life affords them,” President Aquino said during the launch of the an immunization program targeting 700,000 poor children.

He added that “just as fighting corruption and poverty are the means to ensure a healthier, fairer, and more prosperous society, so too will programs like these help improve our public health system, resulting in a society where the vulnerable are made strong, and the weak are empowered to contribute to the well-being and the happiness of the whole.”

Progress on this specific objective can be monitored at the country level with the presence of key indicators such as a legal framework and legislation that guarantee financing for immunization and the establishment of an independent technical advisory group that meets defined criteria.

In a form of legislation, Republic Act No. 10152 or the “Mandatory Infants and Children Health Immunization Act of 2011” was signed by President Aquino in July 2010 to mandate basic immunization for children under five years of age aside from those that will be determined by the Secretary of Health. Specifically, this Law provides for all infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of birth.

Crucial as it is, country commitment to immunization does not necessarily mean that immunization programs will be prioritized or funded at the expense of other important health initiatives. It is also imperative that national immunization plans are crafted with the participation of stakeholders while governments demonstrate good stewardship and implementation of their national health plans.

(2)  Preventing the world’s biggest killer infectious disease

October 28, 2011
Medicine Cabinet -- By Reiner W. Gloor

Every 20 seconds, a child dies from pneumonia somewhere in the world. This accounts for more than one-and-a-half million children under the age of five unnecessarily dying each year due to pneumonia.

This same disease is burdening our elderly, affecting adults especially those 50 years and older.

Pneumonia is one of the six killer infectious diseases identified by the World Health Organization (WHO). This group of infectious diseases that include malaria, measles, HIV-AIDS, diarrhea and tuberculosis, have been ravaging populations around the world more effectively than wars, added the WHO.

In the Philippines, pneumonia remains the number four cause of death among Filipinos following non-communicable diseases such as diseases involving the heart, cardiovascular system and malignant neoplasms.

The Philippine Health Statistics also named pneumonia as the number one cause of illness in 2005.

The Centers for Disease Control and Prevention explained that pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. These infectious agents include Streptococcus pneumoniae, the most common cause of bacterial pneumonia; Haemophilus influenzae type b (Hib), the second most common cause of bacterial pneumonia in children; and respiratory syncytial virus which is the most common viral cause of pneumonia.

The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes, said the WHO. When a person has pneumonia, the alveoli are filled with pus and fluid, which limits oxygen intake and makes breathing painful.

The symptoms of viral and bacterial pneumonia are similar and must not be confused with ordinary cough or flu. Symptoms of pneumonia include rapid or difficult breathing, cough, fever, chills, loss of appetite and wheezing which is more common in viral infections.

Some people are at a greater risk of acquiring pneumococcal disease to include the adults who are 65 years of age or older and so as children younger than the age of five. But regardless of age, people with underlying medical conditions, those with weakened immune system, smokers and individuals who are exposed to air pollution have increased risk of getting pneumonia.

Pneumonia can be spread in a number of ways, the WHO pointed out.

The viruses and bacteria that are commonly found in an individual’s nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze.

Several years of pharmaceutical research and development (R&D) efforts have yielded important treatment options to combat pneumonia and other infectious diseases. These treatments include antibiotics or anti-viral drugs.

On the other hand, pneumonia is highly-preventable through vaccination, good hygiene and nutrition and avoiding pollution.

Several vaccines have been developed that prevent infection by bacteria or viruses that may cause pneumonia, said the CDC. They are Pneumococcal, Haemophilus influenzae type b (Hib), Pertussis (whooping cough), Varicella (chickenpox), Measles, and Influenza (flu) vaccines.

Following good hygiene practices can also help prevent respiratory infections, said the WHO. This includes regular hand washing, cleaning hard surfaces that are touched often (like doorknobs and countertops), and coughing or sneezing into a tissue or into one’s elbow or sleeve.
Minimizing one’s exposure to air pollution and strengthening a person’s immune system will likewise help in reducing risks of getting pneumonia. But for some, exposure to pollution and other environmental conditions are not a matter of choice.

Take for example the employees of the Metropolitan Manila Development Authority (MMDA) such as traffic enforcers, street sweepers and sewage cleaners. Due to the nature of their work, many of them are exposed to hazardous elements such as pollution and extreme weather changes.

Realizing the importance and susceptibility of these frontliners in keeping Metro Manila roads safe and clean, the PHAPCares Foundation recently held a mass pneumococcal vaccination for the employees of MMDA with products donated by member company MSD.

MMDA Chairman Francis Tolentino and General Manager Corazon Jimenez led the launch of the vaccination campaign for their 2,500 employees that highlights the importance of public-private partnerships in preventive health care.

(3)  It’s the season to be flu-free

November 4, 2011
Medicine Cabinet -- By Reiner W. Gloor

With the holiday season just around the corner, some people may have already started planning for a well-deserved vacation. For those with families or friends abroad, usual destinations include countries in the northern hemisphere where millions of Filipinos are either living or working.

Planning for a vacation, on the other hand, must also include knowing how to care for one’s health specially when traveling abroad. For one, seasonal influenza or flu epidemics appear annually during autumn and winter in temperate regions, advised the World Health Organization (WHO).

Influenza is a viral infection that causes severe illnesses and could result in deaths for higher risk populations. While anyone can get seasonal influenza and can affect all age groups, children under two years of age and those 65 years or older, pregnant women, and those with weakened immune system or with certain medical conditions are at higher risk.

Usually, most people recover from influenza within a week but the illness could also result in hospitalizations and deaths among high-risk groups namely the very young, elderly and chronically ill.

Influenza symptoms include high fever, chills, usually dry cough, headache, muscle and joint pain, fatigue, severe malaise, sore throat and runny nose. It could also cause pneumonia, make existing medical conditions worse and result in seizures and diarrhea in children.

The WHO said that worldwide, these annual epidemics result in about three to five million cases of severe illness, and about 250,000 to 500, 000 deaths.

Seasonal influenza is contagious and can easily spread in schools, dormitories, workplace and communities. It is transmitted from one person to another when an infected person coughs or sneezes and infected droplets get into the air.

To prevent its transmission, it is important that people must cover their mouth and nose when coughing or sneezing and wash their hands regularly.

The WHO, on the other hand, noted that the most effective way to prevent the disease or severe outcomes from the illness is vaccination. Pharmaceutical research and development (R&D) has enabled the use of safe and effective vaccines for more than 60 years now.

The two types of influenza vaccines are inactivated (killed) vaccine or that which is given by injection and the live, attenuated (weakened) vaccine or that sprayed into the nostrils. Meanwhile, it is always advised that people should first consult a doctor before getting a flu vaccine so that benefits and risks can be further discussed.

The Centers for Disease Control and Prevention (CDC) said that the timing, severity and length of the influenza epidemic depends of various factors, including what influenza virus are spreading and whether they match the viruses in the vaccine. It added that influenza viruses are always changing, thus annual vaccination is recommended.

The changes in the influenza virus could either be "antigenic drift" or the "antigenic shift." Antigenic drift happens when a person infected with a particular flu virus strain develops antibody against that virus.

When newer virus strains appear, the antibodies against the older strains no longer recognize the "newer" virus, making reinfection possible.

Antigenic shift, on the other hand, is an abrupt, major change in the influenza A viruses. The CDC said that "antigenic shift" results in a new influenza A subtype or a virus with a hemagglutinin or a hemagglutinin and neuraminidase combination that has emerged from an animal population that is so different from the same subtype in humans that most people do not have immunity to the new virus.

It could be recalled that in 1999, the WHO declared a flu pandemic when a "shift" or a new H1N1 virus with a new combination of genes emerged to infect people and quickly spread, causing a pandemic.

When shift happens, most people have little or no protection against the new virus. In August 2010, the WHO reported that more than 214 countries or overseas territories or communities had confirmed laboratory cases of pandemic influenza H1N1 with more than 18,000 deaths.

Knowing how to prevent flu and other infectious diseases has become more timely with the onset of the colder season specially for those traveling outside the country and with more people crowding in one place at the start of the holiday rush.

For those traveling to countries in the northern hemisphere countries such as United States, Europe and Canada, the so-called Northern Hemisphere flu strain vaccine can be given before their travels to these destinations from December to February.

In the Philippines, the vaccine is best given in March to June for protection during flu peak season from the rainy months of May to November. The vaccine can still be of benefit until October if people missed the March to June recommended period for flu vaccination.

Recognizing the need to avert infectious diseases like influenza, the PHAPCares Foundation has embarked on a "Bakuna Caravan" which is a vaccination drive with products donated by member companies.

In a recent partnership with member company GlaxoSmithKline, about 20,000 people benefitted from the flu vaccination campaign as part of the industry’s continuing commitment to public-private partnerships in promoting preventive health care.

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