Vaccination: Perspectives from the Haves and Have-Nots

I recently read news report in the British Medical Journal about pneumococcal vaccination of infants in developing countries. Nicaragua will be the first of about 40 developing countries to begin pneumococcal vaccination of all children less than 12 months of age. The vaccine is now made available via a funding mechanism devised by the Global Alliance for Vaccines and Immunization (GAVI Alliance), a public-private partnership set up in 2000 to quicken the introduction of new vaccines into poor countries. This will result in a greater than 90% vaccine price reduction for developing countries. Understandably, there is much excitement as vaccination for S.pneumoniae has significantly decreased morbidity and mortality from pneumonia and meningitis in wealthy nations.

In wealthy countries, conversely, vaccination appears to generate little excitement save for the vocal anti-vaccine movement. This is particularly evident in Western Europe, the USA, Japan and Australia. The skilled use of the media and internet has resulted in immense influence by the anti-vaccine movement. One interesting review proposed the ‘pyramid effect’ as an operative for understanding how societal decisions about vaccine acceptance are made.

• The pyramid base represents the broad impact that vaccination policy can have on a common disease
• The pyramid peak represents harm or risk from vaccination
• The vast majority who benefit from vaccination are passive participants while the minority who experience or perceive harm become passionate and vociferous opponents

Vaccines have become victims of their own success: as widespread vaccination lessens or eliminates the risk of a disease, the public’s perception of the vaccines’ value and impact will paradoxically diminish as the illness is no longer perceived as a threat.

Perhaps one day Nicaragua and similarly impoverished countries will have the luxury of their own anti-vaccine movement.