The Progress of Nations 2000

The power of immunization
By Dr. William Foege

Immunization stands at a crossroads after an
astounding 15 years of vigorous campaigns
around the world. Through determined efforts of
national governments, international agencies
and hundreds of thousands of volunteers, 2.5
million children's lives are saved each year. But
there are still 30 million infants not protected by
routine vaccination in developing countries. They
are among the 11 million children who die from
preventable causes every year. How to reach these
unreached children and extend the power of
new or improved vaccines within poor countries
are the twin challenges now facing the world.

(can think of ) no ot her liinan endel(lavour that has
as (dralmlatic, (deep) and
Pos)itive a legacy as (does
i1111 ization.
Il (co)nttless tiny villages and
dl(ense Urban cen ('(ltres, from'()ll Africa
and Asia to ILatin Amierica and
t llt foril(er Soviet U nllirl, nu)re
t hall 100 1illioi( b)al)ies a year are
illlnize(l, rece('('iving va('ccines
to preven't (lil)htheria, tetanus,
whoo l ing ('coulgl., p)()lio, measles
and t iberculosis. saving millions
from (death and sparing iilliolns
(ore at n)iinimal (cost from plaralysis, visual il)airment an(l brain
(lamnage.
Generations of healt aldults
owe their very lives to) I he fact

that they were inlnunize(d as
children and protected against
life-threateni ng diseases. And(
the material andi human progress
so many societies have made rests
heavily on public( health imp)rovemlents, of which immunization is
a linchpin.
Yet immunization's success is
a low-key, quiet and self-effacing
story taken for granted by miany,
esl)ecially in the industrialized
world(, where it is still saving lives.
It (los not receive the attention
anil acclaim it dleserves eveni in
the (developing world, where its
cont ribution, Iparticularly over
the p)ast 15 years, has been truly
remarkable. Since the 1970s,
gl)ob)al coverage has soared from

less than 10 per cent to ahnlmost
75 per cent, saving the lives of
2.5 million children each year.
Not since the eradlication of
smallpox over 20 years ago has
the power of immunization )een
so evidlent as in the stinning success of the 12-year ('ampaign to
eradicate polio. The world has
watchedl and applaudled as immnization efforts have pushed
back the wave of dlisability, suffering and death )rought on bylv
polio. Polio cases, which reached
an estimated 350,000 a year as
recently as 1988, had dropped to
al)out 7,000 by 1999.
In a global mobilization ulrmatched in peacetime, 470 nmillion children munder five years of
age were inrnunized( in 1999, an
extraordlinary achievement malde
possibl)e vby the selfless, cornmitted an(l sustained efforts of
Rotary International, UNICEi,
WHO and( more than 10 million
volunteers in nearly 100 nations.
The efforts have been well rewardled. North and South America have officially been certified
polio-free, and in Europe onlvy
Turkeyv reported a few cases iii
1998. The disease is rapidly (lisappearing from most of eastern
and soutlhern Africa, North Africa
andl the Arabian Peninsula. In
East Asia and the Pacific, the last
indigenous case was reported in
Cambodia in 1997. Polio has now
retreate(d to outposts in Afghanistan, Bangladesh, India, Nepal
and Pakistan in Asia, and Somalia,
Sudan and parts of West anid

C(entral \Afr'ica, where it clings oii
partly beause( of w-ars, 1)overt
and (liffictlties in reaching some
areas. But the world is determined to lprevail against polio.
A spotty scorecard
The exl erience with polio(), while
filling us with satisfaction, must
also drive uts to (()conso()li(ate our
accomp)lisliients by turning the
power of iinniizatioli on diseases that are still killing millions of ('chil(lren and ilmpairing
the abilities of (couitless others.
We must aimn fr fhil (-overage antl
col)lete effectiveness of immnization, not the sp)otty scorecard that I)io()laims slc('ess iI
scattered ('cornler's of thie globe
and neglect iil many others.
* There are still 30 () million infants in the( developi)ing world
who are not immunized before
their first birtllay.
SMore thaln 900,000 chil(lreni
un(der 'fie still d(lie each year
fromi lileasles.
" Neonatal tetanus kills 200,00()
each year.
" Annually. 370.000 unler-fives
die from whooping ('cough and
50000 fro'ni tul)er'c losis.
SDiplittheria has re-emerged inI
parts of the former Soviet
Union.
" Half of all p)regnant xo()iien are
not iuniiinized against maternal tetanuts, which kills 30,000
women every year.
The ('continuation of this stuffe'ring and loss of life ('caint ravenes
the natural human instinct to

Dr. William Fooge is Presidential Distinguished Professor of International Health at the
Rollins School of Public Heahlth, at Emory University in Atlanta, Georgia. He is a Senior
Adviser for the Bill and Melinda Gates Foundation and Principal Investigator on Grants
awarded to the Task Force for Child Survival and Development.

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