Immunizing the World's Children
This issue of "Population Reports" is focused on immunization against childhood diseases. Such efforts save the lives of 1 million children in developing countries each year; however, over 3.5 million additional children are killed or disabled by diseases that immunization could have prevented. At present, fewer than half of 1-year-olds have been immunized against the major preventable diseases. Efforts are now underway to expand immunization services to all infants and pregnant women by 1990. The World Health Organization (WHO) Expanded Program on Immunization (EPI) targets 6 diseases: measles, pertussis, neonatal tetanus, polio, tuberculosis, and diphtheria. Immunization against these diseases is safe and effective. Experience in both developed and developing countries confirms that morbidity and mortality from these diseases decline sharply when immunization is widely available. An infant can be fully immunized for as little as US-$5-15, but may programs reach under half of the population at risk. 4 main strategies have been used to deliver immunizations services: 1) fixed facilities offering immunizations at any time or on weekly or monthly basis; 2) outreach services periodically offering immunizations at locations away from fixed facilities; 3) mobile teams traveling to areas that have no other access to immunization services; and 4) intensive activities, such as mass campaigns and national immunization days, in which large numbers of people are vaccinated in a short time. The planning of immmunization delivery must take into account the vaccination schedule, the state of existing health care systems, the communication/transportation infrastructure, and the local pattern of vaccine-preventable diseases. Immunization programs should work closely with family planning programs, since both are essential to child survival and health. A major logistical problem is keeping vaccines cold to protect their potency. Recent program evaluations point to common problems, including limited surveillance of disease cases and immunization coverage, inadequate supervision, and insufficient communication efforts.