Running head: IMMUNIZATIONS FROM A GLOBAL HEALTH PRESCPECTIVE

Immunizations from a Global Health Perspective

Julianne S

Delaware Technical & Community College

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Abstract

Immunizations are one of the most beneficial accomplishments in healthcare to date. When

administered and used properly, immunizations can protect against various infectious diseases.

Through immunizations, disease prevalence is declined and both quality of life and life

expectancy are increased. Immunizations are imperative to under developed countries due to the

high prevalence of disease. Several health determinants exist globally that prevent proper

immunization schedules, programs, and availability. These determinants exist in large part due

to socioeconomic factors. Socioeconomic issues surrounding vaccinations include, poverty,

educational status, under five mortality rates, cold chain issues, and infectious disease prevalence

in developing countries. Through changing the context to make default healthy decisions,

counseling, education, clinical interventions and long-lasting interventions these health

determinants can be addressed and slowly overcome to improve global health. Recognizing and

understanding health determinants is imperative to improve access and availability of

immunizations.

Keywords: immunizations, global health, health determinants, socioeconomic factors

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Immunizations have made a significant contribution to healthcare worldwide.

Immunizations have been successful in decreasing the spread of disease and improving health

overall. This is a segment of healthcare that is crucial for global health. As stated by Cemma

(2017), “Global health is focused on human health issues that transcend national borders, it has

components of both preventative and individual-level clinical care” (Global Health, para. 1).

Using immunizations, infectious diseases can be decreased and even eliminated. This was

evident when immunizations successfully eradicated small pox. If immunizations and

immunization programs were more readily available, then they could be more easily utilized

worldwide. As a result, we would see an increase in overall global health. While is apparent

that immunizations are imperative to improve global health, several determinants to health exist

that make immunizations on a global level more challenging. “A recent systemic review

addressing the reasons for under- or non-vaccination of children from low-and middle-income

countries suggested that social determinants may have a substantial impact on routine childhood

vaccination” (Glatman-Freedman & Nichols, 2012, p. 293). These health determinants tend to

be more significant is underdeveloped countries, which tend to have a higher prevalence of

disease. Through using Frieden’s 5-tier pyramid it is easy to understand immunizations from a

global health perspective. This pyramid outlines interventions that can have the most impact at

the bottom. In ascending order the pyramid addresses socioeconomic factors, changing context to

make healthy decisions, long-lasting interventions, clinical interventions, and counseling and

education (Frieden, 2010).

One of the major health determinants to immunizations is socioeconomic factors. The

fact exists that less developed countries have the most burden of disease and the least access to

proper healthcare. “Low income countries carry a high burden of vaccine-preventable diseases, a
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situation which is often exacerbated by inconsistent vaccine supply” (Glatman-Freedman &

Nichols, 2012, p. 293). This is important to understand from a global health perspective. In

developed countries, there is less burden of disease and better access to healthcare. “In rapidly

growing slum areas of low-income countries, access to health care services in general and

immunizations in particular were found to be limited, contributing to a large burden of diseases

and spread of infections to other communities” (Glatman-Freedman & Nichols, 2012, p. 293).

The areas in the most need, have limited access. Education significantly impacts

socioeconomics because higher levels of education tends to improve socioeconomic status, and

therefore, access to vaccinations. It is also important too note that areas that have higher

emphasis on education tend to have better access to healthcare, and they have more education on

the benefits of immunizations. “Lack of education can potentially lead to misconceptions about

vaccines. In regard, a study conducted in Uganda found that reduced participation in National

Immunization Day for polio was due, at least in part, to concerns that vaccines may cause

malaria or contain contraceptives” (Glatman-Freedman & Nichols, 2012, p. 294).

When exploring socioeconomic factors surrounding immunization accessibility, it is

important to understand both the under 5 mortality rate and cold-chain issues. The child

mortality rate is defined as “the probability that a newborn baby will die before reaching age 5,

expressed as a number per 1,000 live births” (Sklonik, 2016, p. 23). The child mortality rate is

directly impacted by vaccinations. This is because with proper immunizations the rate would

decline. In some of the poorest countries, such as Angola and Chad, the rate can be over 150 per

1,000 live births” (Skolnick, 2016, p. 24). This means 15 percent of children in these less

developed countries will die before the age of five. Many of these deaths are caused by

communicable diseases that have vaccinations available. This is an unfair disadvantage to

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children from lesser developed countries, which is important to keep in mind when

understanding how immunizations impact global health. The other issue to consider is cold-chain

issues. These cold-chain issues can affect the safety and efficacy of immunizations. This is

important to consider for less developed countries because proper storage and temperature

control are less available. Cold chain issues have resulted in “risks of reduced potency of

vaccines administered (e.g. due to poor temperature control, nonfunctional equipment), poor

availability of immunization supplies (due to inadequate storage capacity, disrupted service

delivery, vaccine stockouts, etc) and inefficient use of limited financial and human resources”

(Ashok, Bruson, & LeTallec, 2016). By improving cold-chain issues vaccinations can be more

readily available and implemented.

One way to improve the use and success of vaccinations is to change the context to make

individuals default to healthy decisions. This is done through changing the context to make the

decision default to healthy regardless of environmental factors. In terms of immunizations, the

easiest way to do this is to offer combination vaccines, free vaccinations or financial assistance,

improved accessibility to vaccines, and immunization programs (Ventola, 2016). Through

combination vaccines, less needles and visits are required, which increases compliance to

immunizations. Since socioeconomic factors play such a large role in immunizations, it is easy to

understand that immunization programs, financial assistance, or free vaccines would improve

compliance.

Another method to improve immunizations is through long lasting protective

interventions. These are “one time or infrequent protective interventions that do not require

ongoing clinical care” (Frieden, 2010). Public reminders and recall strategies are very successful

in terms of aiding to long lasting protective interventions. A recent “study reported a completion
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rate for a three-dose vaccine that was nearly 10% higher for a group that had received a

reminder, compared with a control group” (Ventola, 2016). Alternative public and private venues

can also improve immunizations. “Improvement in childhood and adolescent immunization rates

has also been achieved by opening a walk-in vaccination clinic run by a nurse practioner on

evenings and weekends” (Ventola, 2016).

The next tier in Frieden’s pyramid is clinical interventions. Clinical interventions that

improve immunizations include vaccination schedule recommendations. This provides a

guideline to the public of when vaccinations should be administered and a plan the public can

adhere. Electronic medical records, EMR, play a large role in clinical interventions that improve

immunizations success. However, this mainly is beneficial to more developed countries since the

use of technology advancements are limited in underdeveloped countries. EMR allows alerts to

be set for needed vaccinations and consolidated immunization records (Ventola, 2016).

Counseling and education is the final part of the 5 tier pyramid and an important factor in

immunizations. It is imperative that healthcare workers, especially nurses, are informed, make

recommendations, and can provide educational resources to patients regarding vaccinations

(Ventola, 2016). Since lack of education is a major factor in less developed countries,

counseling and education is important to help overcome any false beliefs in regard to

vaccinations. “In 2003, political and religious leaders in three Nigerian states boycotted a WHO

polio vaccination campaign, claiming that the vaccine caused sterility and AIDS” (Jheeta &

Newell, 2008). This cultural belief that vaccinations would cause harm is a prime example of

lack how a of education can become a health determinant. It is also an example of how

counseling and education on a global level is necessary for vaccine success. “Similarly, certain

Hindu and Muslim groups in India have held the belief that vaccination is a covert method of
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family planning, primarily targeting Muslims” (Jheeta &Newell, 2008). The more conversations,

programs, and knowledge provided to those in less developed countries, the better the outcome

in terms of global health.

Looking to the future of immunizations, further research and development will lead to

improve availability and increased amounts of vaccine. “Considerable progress has been made in

the past decade in strengthening immunization programs across the world and in the

development and deployment of new vaccines” (Greenwood, Salisbury, & Hill, 2011). The goal

with vaccinations is to lead to disease eradication, which was successfully accomplished with the

small pox vaccine.

There are many opportunities is health care to become involved in global health,

especially as a healthcare worker. Volunteer opportunities, refugee opportunities, and disaster

relief are a few ways to make an impact. A significant way to make an impact is by “providing

clinical mentorship in an international setting…the focus is on building local clinical skills

through teaching programs such a as neonatal resuscitation education program that require a

commitment to ‘training the trainer’ so you can share expertise with local nurses, midwives, and

physicians” (Callister, 2009). This is an excellent way to use clinical skills to improve access to

healthcare on a global level.

Global health is a crucial topic to consider for those in the healthcare field. Healthcare

workers carry the ethical responsibility to improve access and availability to those in need

worldwide. Immunizations are a section of global health that has a tremendous impact on life

expectancy and quality of life. By providing greater access to immunizations regardless of

socioeconomic status, health will be improved on a global level. This can only be achieved by

understanding the health determinants that exist, especially in underdeveloped countries.

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Through understanding health determinants, interventions can be put into place to overcome the

determinants and improve access to healthcare.

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References

Ashok, A., Brison, M., & Letallec, Y. (2016, September 23). Improving cold chain systems:

challenges and solutions. Vaccine 35(2017). 2217-2223.

https://dx.doi.org/10.1016/j.vaccine.2016.08.045

Callister, L. (2009). Global health and nursing: So you want to make a difference in global

health. The American Journal of Maternal/child Nursing 34(4), 263-263. Retrieved from

https://www.nursingcenter.com/journalarticle?Article_ID=869705

Cemma, M. (2017, September 26). What’s the difference? Global health defined. Global Health

Now. Retrieved from https://globalhealthnow.org/2017-09/whats-difference-global-

health-defined

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact

Pyramid. American Journal of Public Health, 100(4), 590–595.

http://doi.org/10.2105/AJPH.2009.185652

Glatman-Freedman, A., & Nichols, K. (2012). The effect of social determinants on immunization

programs. Human Vaccines & Immunotherapeutics, 8(3), 293-301.

http://doi.org/10.4161/hv.19003

Greenwood, B., Salisbury, D., & Hill, A. (2011). Vaccines and global health. Philosophical

Transactions of the Royal Society B: Biological Sciences, 366(1579), 2733-2742.

http://doi.org/10.1098/rstb.2011.0076

Jheeta, M. & Newell, J. (2008). Childhood vaccination in Africa and Asia: The effects of

parents’ knowledge and attitudes. Bulletin of the World Health Organization 86(6).

Retrieved from http://www.who.int/bulletin/volumes/86/6/07-047159/en/

Skolnik, R. (2016). Health determinants, measurements, and trends. In R. Riegelmn(Ed.), Global

IMMUNIZTIONS FROM A GLOBAL HEALTH PRESPECTIVE
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health 101 (3rd ed., pp. 19-55). Burlington, MA: Jones & Bartlett Learning

Ventola, C.L. (2016). Immunization in the United States: Recommendations, Barriers, and

measures to Improve Compliance: Part 1: Childhood Vaccinations. Pharmacy and

Therapeutics, 41(7), 426-436. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927017/