Global control of infectious diseases by vaccination programs

  • Rudolf H. Tangermann
  • Hanna Nohynek
  • Rudolf Eggers
Part of the Birkhäuser Advances in Infectious Diseases book series (BAID)


In both industrialized and developing countries, childhood immunization has become one of the most important and cost-effective public health interventions. National immunization programs have prevented millions of deaths since WHO initiated the ‘Expanded Program on Immunization’ in 1974. Smallpox was eradicated in 1979, poliomyelitis is on the verge of eradication, and two thirds of developing countries have eliminated neonatal tetanus. Global immunization coverage was at 78% in 2005. Through their impact on childhood morbidity and mortality, immunization programs are contributing to reaching the ‘Millennium Development Goal 4’ — a two-thirds reduction of under-five mortality by 2015. However, the failure to reach more than 20% of the world’s children with existing vaccines was responsible for at least 2.5 million of an estimated 10.5 million deaths of children under 5 years, mainly in developing countries. Of these deaths, 1.4 million could have been prevented by vaccines currently recommended by WHO. Rapid progress in our understanding of the pathogenesis of infectious diseases, immunology, and biotechnology has increased the number of candidate vaccine antigens available. Pressures are growing on public health decision makers to establish evidence-based ways to decide which new vaccines should be introduced on a large scale into national immunization programs. The gap in access to new vaccines between the developing and industrialized worlds is still wide, and wealthy countries are still the first to introduce and use new vaccines. Interest from countries and partner agencies in vaccination, as one of the most cost-effective public health interventions, continues to be strong, also due to rapid progress in biotechnology and vaccine development and the emergence of global infectious disease threats, including HIV/AIDS, SARS, and influenza. The establishment of the Global Alliance for Vaccines and Immunization has focused global activities to support vaccination programs through raising considerable funds, and to assist especially poorer countries in improving and expanding their vaccination programs. Global efforts concentrate on further reducing the gap in the access to all existing vaccines between industrialized and developing countries.


Human Papilloma Virus Conjugate Vaccine Yellow Fever Human Papilloma Virus Vaccine Immunization Service 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Miller MA, Hinman AR (2004) Economic analysis of vaccine policies. In: SA Plotkin, WA Orenstein (eds): Vaccines, 4th edn. Elsevier Inc., Philadelphia, PA, 1463–1490Google Scholar
  2. 2.
    Bloom DE, Canning D, Weston M (2005) The value of vaccination. World Economics 6: 15–39Google Scholar
  3. 3.
    Keja K, Chan C, Hayden G, Henderson RH (1988) Expanded programme on immunization. World Health Stat Q 41: 59–63PubMedGoogle Scholar
  4. 4.
    Fenner F, Henderson DA, Arita I, Jezek A, Ladnyi ID (1988) Smallpox and its eradication. World Health Organization, GenevaGoogle Scholar
  5. 5.
    Expanded Programme on Immunisation (2006) Progress towards the global eradication of poliomyelitis, 2005. Wkly Epidemiol Rec 81: 164–172Google Scholar
  6. 6.
    World Health Organization (2005) WHO vaccine-preventable diseases: monitoring system 2005 summary. WHO IVB/2005, GenevaGoogle Scholar
  7. 7.
    World Health Organization and United Nations Children’s Fund (2003) State of the World’s Vaccines and Immunization. World Health Organization, GenevaGoogle Scholar
  8. 8.
    World Health Organization and United National Children’s Fund. Global Immunization Vision and Strategy, 2006–2015 (2005) Geneva, Switzerland: World Health Organization and United National Children’s Fund. (WHO/IVB/05.05). Accessed on June 30 at http// Scholar
  9. 9.
    Murray CJL, Lopez AD, Mathers CD, Stein C (2001) The Global Burden of Disease 2000 Project: Aims, Methods, and Data Sources (Global Programme on Evidence for Health Policy Discussion Paper No 36). World Health Organization, GenevaGoogle Scholar
  10. 10.
    World Health Organization (2006) Challenges in global immunization and the global Immunization Vision and Strategy, 2006–2015. Wkly Epidemiol Rec 81: 190–195Google Scholar
  11. 11.
    UNICEF. A world fit for children: Millennium Development Goals (2003) Special session on children documents: the convention on the rights of the child. July 2002. Accessed on June 30, 2006 at Scholar
  12. 12.
    Feudtner C, Marcuse EK (2001) Ethics and immunization policy: promoting dialogue to sustain consensus. Pediatrics 107: 1158–1164PubMedCrossRefGoogle Scholar
  13. 13.
    Global Alliance for Vaccines and Immunization (2000) Second GAVI Board Meeting, January 2000 (GAVI/00.01). World Health Organization, GenevaGoogle Scholar
  14. 14.
    Declaration of Alma-Ata (1978) International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September, 1978Google Scholar
  15. 15.
    World Health Organization (2003) Vaccines, Immunization & Biologicals. Case Information for the Development of Immunization Policy (WHO/V&B/02.28). World Health Organization, GenevaGoogle Scholar
  16. 16.
    Campbell JD, Burgess M (2004) Heterogeneity of pediatric immunization schedules in industrialized countries. In: MM Levine, JB Kaper, R Rappuoli, MA Liu, MF Good (eds): New Generation Vaccines, 3rd edn. Marcel Dekker, New YorkGoogle Scholar
  17. 17.
    Hadler S, Dietz V, Okwo-Bele JM, Cutts FT (2004) Vaccination programs in developing countries. In: SA Plotkin, WA Orenstein (eds): Vaccines, 4th edn. Elsevier, Philadelphia, PAGoogle Scholar
  18. 18.
    World Health Organization (2005) WHO vaccine preventable diseases monitoring system:2005 Global summary. Accessed June 30, 2006 at http//:www.who. int/vaccines-documents/globalsummary/globalsummary.pdfGoogle Scholar
  19. 19.
    Expanded Programme on Immunization (1987) Issues in Neonatal Tetanus Control. World Health Organization, Geneva WHO/EPI/GAG/87/WP.11Google Scholar
  20. 20.
    World Health Organization (2006) Tetanus vaccine. WHO position paper. Wkly Epidemiol Rec 81: 198–208Google Scholar
  21. 21.
    World Health Organization (2000) Sustainable outreach services (SOS): A strategy for reaching the unreached with immunization and other services. WHO/V&B/00.37. World Health Organization, GenevaGoogle Scholar
  22. 22.
    Global Tuberculosis Programme and Global Programme on Vaccines (2004) BCG vaccine — WHO position paper. Wkly Epidemiol Rec 79: 27–38Google Scholar
  23. 23.
    Yih WK, Lett SM, des Vignes FN (2000) The increasing incidence of pertussis in Massachusetts’ adolescents and adults, 1989–1998. J Infect Dis 182: 1409–1416PubMedCrossRefGoogle Scholar
  24. 24.
    World Health Organization (2000) Strategies for reducing global measles mortality. Wkly Epidemiol Rec 75: 409–416Google Scholar
  25. 25.
    Expanded Programme on Immunization (2006) Progress in reducing global measles deaths, 1999–2004. Wkly Epidemiol Rec 81: 90–94Google Scholar
  26. 26.
    Ching P, Birmingham M, Goodman T (2000) Childhood mortality impact and costs of implementing vitamin A supplementation in immunization campaigns. Am J Public Health 90: 1526–1529PubMedGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention (2005) Distribution of insecticide-treated bednets during an integrated nationwide immunization campaign — Togo, West Africa, December 2004. MMWR 54: 994–996Google Scholar
  28. 28.
    Taylor C, Cutts F, Taylor ME (1997) Ethical dilemmas in current planning for polio eradication. Am J Public Health 87: 922–925PubMedGoogle Scholar
  29. 29.
    Taylor Commission (1995) The Impact of the Expanded Program on Immunization and the Polio Eradication Initiative on Health Systems in the Americas. Pan American Health Organization, Washington, DCGoogle Scholar
  30. 30.
    Loevinsohn B, Aylward B, Steinglass R, Ogden E, Goodman T, Melgaard B (2002) Impact of targeted programs on health systems: A case study of the Polio Eradication Initiative. Am J Public Health 92: 19–23PubMedCrossRefGoogle Scholar
  31. 31.
    World Health Organization Expanded Programme on Immunization and United Nations Children’s Fund (2000) Product Information Sheets, 2000. World Health Organization, Geneva. WHO document WHO/V&B/000.13.Google Scholar
  32. 32.
    WHO and UNICEF (1999) Quality for the Cold Chain — WHO/UNICEF policy statement on the use of vaccine vial monitors in immunization practice. World Health Organization, Geneva, WHO/V&B99.18Google Scholar
  33. 33.
    Nelson CM, Wibisono H, Purwanto H, Mansyur I, Moniaga V, Widjaya A (2004) Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions. Bull World Health Organ 82: 99–105PubMedGoogle Scholar
  34. 34.
    World Health Organization (2006) Global Advisory Committee on Vaccine Safety, 1–2 December 2005. Wkly Epidemiol Rec 81:15–19Google Scholar
  35. 35.
    Expanded Programme on Immunisation (1993) Surveillance of Adverse Events Following Immunization: Field Guide for Managers of Immunization Programmes. World Health Organization, Geneva (WHO/EPI/TRAM/93.2)Google Scholar
  36. 36.
    Folb PI, Bernatowska E, Chen R, Clemens J, Dodoo ANO, Ellenberg SS, Farrington P, John TJ, Lambert PH, MacDonald NE et al (2004) A global perspective on vaccine safety and public health: the Global Advisory Committee on Vaccine Safety. Am J Public Health 94:1926–1931PubMedGoogle Scholar
  37. 37.
    Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M (1999) Unsafe injections in the developing and the transmission of bloodborne pathogens: a review. Bull World Health Organ 77: 789–798PubMedGoogle Scholar
  38. 38.
    Anonymous (1999) Safety of injections. WHO-UNICEF-UNFPA joint statement on the use of auto-disable syringes in immunization services. World Health Organization, Geneva, WHO/V&B/99.25Google Scholar
  39. 39.
    Duclos P, Delo A, Aguado T, Bilous J, Birmingham M, Kieny MP, Milstien J, Wood D, Tarantola D (2003) Immunization safety priority project at the World Health Organization. Semin Pediatr Infect Dis 14: 233–239PubMedCrossRefGoogle Scholar
  40. 40.
    Henderson R, Keja J (1989) Global control of vaccine-preventable diseases: how progress can be evaluated. Rev Infect Dis 11(Suppl): S649–S654PubMedGoogle Scholar
  41. 41.
    World Health Organization (2005) Vaccines, Immunization & Biologicals. WHO/UNICEF Joint Reporting Form on Vaccine Preventable Diseases, 2005. Accessed on the internet June 30, 2006 at Scholar
  42. 42.
    Henderson RH, Sundaresan T (1982) Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method. Bull World Health Organ 60: 253–260PubMedGoogle Scholar
  43. 43.
    de Quadros, CA, Hersh BS., Olive JM (1997) Eradication of wild poliovirus from the Americas: acute flaccid paralysis surveillance, 1988–1995. J Infect Dis 175(Suppl 1): S37–S42PubMedGoogle Scholar
  44. 44.
    WHO and UNICEF (2005) WHO/UNICEF Joint statement: global plan for reducing measles mortality 2006–2010. Geneva (WHO/IVB/05.11)Google Scholar
  45. 45.
    World Health Organization (2005) World Health Report 2005. Statistical Annex Tables 3 + 4, 191–192Google Scholar
  46. 46.
    World Health Organization (2005) Laboratory surveillance for wild and vaccine-derived polioviruses, January 2004–June 2005. Wkly Epidemiol Rec 80: 333–340Google Scholar
  47. 47.
    Bresee JS, Glass RI, Fang ZY(2004) First report from the Asian Rotavirus Surveillance Network. Emerg Infect Dis J 10: 988–995Google Scholar
  48. 48.
    World Health Organization (2004) Acute flaccid paralysis surveillance: a global platform for detecting and responding to priority infectious diseases. Wkly Epidemiol Rec 79: 425–433Google Scholar
  49. 49.
    World Health Organization (2006) Challenges in global immunization and the Global Immunization Vision and Strategy 2006–2015. Wkly Epidemiol Rec 81: 190–195Google Scholar
  50. 50.
    Hardy I, Dittman S, Sutter R (1996) Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union. Lancet 347: 1739–1744PubMedCrossRefGoogle Scholar
  51. 51.
    Tangermann RH, Hull HF, Jafari H, Nkowane B, Everts H, Aylward RB (2000) Eradication of poliomyelitis in countries affected by conflict. Bull World Health Organ 78: 330–338PubMedGoogle Scholar
  52. 52.
    Gwatkin D, Davidson A, Yazbeck A, Wagstaff A (eds) (2005) Reaching the Poor with Health, Nutrition and Population Services: What Works, What Doesn’t, and Why. World Bank, Washington, D.C.Google Scholar
  53. 53.
    Technical consultation on imbalances in the health workforce (2002) WHO/EIP/OSD/02.3. World Health Organization, GenevaGoogle Scholar
  54. 54.
    World Health Organization (2000) Key elements for improving supplementary immunization activities for polio eradication. World Health Organization, Geneva WHO/V&B/00.22Google Scholar
  55. 55.
    World Health Assembly (1988) Global eradication of poliomyelitis by the year 2000. World Health Organization, Geneva (Resolution WHA41.28)Google Scholar
  56. 56.
    Dowdle WR, Cochi SL (2002) Global eradication of poliovirus: history and rationale. In: BL Semler, E Wimmer (eds): Molecular biology of picornaviruses. ASM Press, Washington, DCGoogle Scholar
  57. 57.
    World Health Organization (2001) Transmission of wild poliovirus type 2: apparent global interruption. Wkly Epidemiol Rec 76: 95–97Google Scholar
  58. 58.
    Kew OM, Sutter RW, de Gourville EM, Dowdle WR, Pallansch MA (2005) Vaccine-derived polioviruses and the endgame strategy for global polio eradication. Annu Rev Microbiol 59: 587–635PubMedCrossRefGoogle Scholar
  59. 59.
    Dowdle WR, Hopkins DR (1998) The Eradication of Infectious Diseases: Dahlem Workshop Report. John Wiley & Sons, ChichesterGoogle Scholar
  60. 60.
    De Quadros CA, Olive JM, Hersh BS (1996) Measles elimination in the Americas: evolving strategies. JAMA 275: 224–229PubMedCrossRefGoogle Scholar
  61. 61.
    Expanded Programme on Immunisation (2006) Progress in reducing global measles deaths, 1999–2004. Wkly Epidemiol Rec 81: 90–94Google Scholar
  62. 61a.
    Wolfson LJ, Strebel PM, Gacic-Dobo M, Hoekstra EJ, McFarland JW, Hersh BS (2007) Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study. Lancet 369: 165–166CrossRefGoogle Scholar
  63. 62.
    WHO and UNICEF (2005) WHO/UNICEF Joint Statement: Global plan for reducing measles mortality 2006–2010. Geneva (WHO/IVB/05.11)Google Scholar
  64. 63.
    PAHO (2004) XVI Meeting of the Technical Advisory Group on Vaccine Preventable Diseases, Mexico City. 3–5 November 2004. Final Report. Accessed June 30 at Scholar
  65. 64.
    World Health Organization (1999) Progress towards the global elimination of neonatal tetanus, 1990–1998. Wkly Epidemiol Rec 74: 73–80Google Scholar
  66. 65.
    Vandelaer J, Birmingham M, Gasse F, Kurian M, Shaw C, Garnier S (2003) Tetanus in developing countries: an update on the maternal and neonatal tetanus elimination initiative. Vaccine 21: 3442–3445PubMedCrossRefGoogle Scholar
  67. 66.
    Adegbola RA, Secka O, Lahai G (2005) Elimination of Haemophilus influenzae type b (Hib) disease from the Gambia after the introduction of routine immunization with a Hib conjugate vaccine: a prospective study. Lancet 366: 144–150PubMedCrossRefGoogle Scholar
  68. 67.
    Steinhoff MC (1997) Haemophilus influenzae type b infections are preventable everywhere. Lancet 349: 1186–1187PubMedCrossRefGoogle Scholar
  69. 68.
    de Andrade AL, de Andrade JG, Martelli CM, e Silva SA, de Oliveira RM, Costa MS, Laval CB, Ribeiro LH, Di Fabio JL (2004) Effectiveness of Haemophilus influenzae b conjugate vaccine on childhood pneumonia: a casecontrol study in Brazil. Int J Epidemiol 33: 173–178PubMedCrossRefGoogle Scholar
  70. 69.
    Gessner BD, Sutanto A, Linehan M (2005). Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomized vaccine-probe trial. Lancet 365: 43–52PubMedCrossRefGoogle Scholar
  71. 70.
    World Health Organization (2006) Conclusions and recommendations from the Strategic Advisory Group of Experts to the Department of Immunization, Vaccines and Biologicals. Wkly Epidemiol Rec 81: 2–11Google Scholar
  72. 71.
    Kane MA, Clements J, Hu D (1993) Hepatitis B. In: DT Jamison, WH Mosley, AR Measham, J Bobadilla (eds): Disease Control Priorities in Developing Countries. Oxford University Press, New York, 321–330Google Scholar
  73. 72.
    Van Damme P, Kane M, Meheus A (1997) Integration of hepatitis B vaccination into national immunization programmes. BMJ 314: 1033–1037PubMedGoogle Scholar
  74. 73.
    Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, Liang DC, Shau WY, Chen DS (1997) Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl J Med 336:1855–1859PubMedCrossRefGoogle Scholar
  75. 74.
    Margolis HS, Alter MJ, Hadler SC (1991) Hepatitis B: evolving epidemiology and implications for control. Semin Liver Dis 11: 84–92PubMedGoogle Scholar
  76. 75.
    Chen HL, Chang MH, Ni YH, Hsu HY, Lee PI, Lee CY, Chen DS (1996) Seroepidemiology of hepatitis B virus infection in children: Ten years of mass vaccination in Taiwan. JAMA 276: 906–908PubMedCrossRefGoogle Scholar
  77. 76.
    World Health Organization (2006) Progress in the control of yellow fever in Africa. WHO Wkly Epidemiol Rec 80: 50–54Google Scholar
  78. 77.
    World Bank (1993) World development report 1993: investing in health. Oxford University Press, New YorkGoogle Scholar
  79. 78.
    Monath TP, Nasidi A (1993) Should YF vaccine be included in the expanded program of immunization in Africa? A cost-effectiveness analysis for Nigeria, Am J Trop Med Hyg 48: 274–299PubMedGoogle Scholar
  80. 79.
    Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C (2002) Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2: 25–32PubMedCrossRefGoogle Scholar
  81. 80.
    Madhi SA, Peterson K, Madhi A, Wasas A, Klugman KP (2000) Impact of human immunodeficiency virus type 1 on the disease spectrum of Streptococcus pneumoniae in South African children. Pediatr Infect Dis J 19: 1141–1147PubMedCrossRefGoogle Scholar
  82. 81.
    Fedson DS, Musher DM (2004) Pneumococcal polysaccharide vaccine. In: S Plotkin, W Orenstein (eds): Vaccines, 4th edn. Saunders, Philadelphia, 529–588Google Scholar
  83. 82.
    Whitney CG, Farley MM, Hadler J (2003) Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348: 1737–1746PubMedCrossRefGoogle Scholar
  84. 83.
    Centers for Disease Control and Prevention (CDC) (2005) Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease: United States, 1998–2003. MMWR Morb Mortal Wkly Rep 54: 893–897Google Scholar
  85. 84.
    Ray GT, Whitney CG, Fireman BH, Ciuryla V, Black SB (2006) Cost-effectiveness of pneumococcal conjugate vaccine: evidence from the first 5 years of use in the United States incorporating herd effects. Pediatr Infect Dis J 25: 494–501PubMedCrossRefGoogle Scholar
  86. 85.
    Salo H, Sintonen H, Kilpi T, Linna M, Nohynek H, Verho J, Nuorti PJ (2005) Economic evaluation of pneumococcal conjugate vaccination in Finland. Scand Infect Dis J 37: 821–832CrossRefGoogle Scholar
  87. 86.
    Dagan R (2004) The potential of pneumococcal conjugate vaccines to reduce antibiotic resistance. Adv Expe Med Biol 549: 211–219Google Scholar
  88. 87.
    Cutts FT, Zaman SM, Enwere G (2005) Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 365: 1139–1146PubMedCrossRefGoogle Scholar
  89. 88.
    Ray GT, Whitney CG, Fireman BH, Ciuryla V, Black SB (2006) Pneumococcal vaccination in developing countries. Lancet 367: 1880–1882CrossRefGoogle Scholar
  90. 89.
    Schmitt HJ, Booy R, Weil-Olivier C, Van Damme P, Cohen R, Peltola H (2003) Child vaccination policies in Europe: a report from the Summits of Independent European Vaccination Experts. Lancet Infect Dis 3: 103–108PubMedCrossRefGoogle Scholar
  91. 90.
    Baltimore RS (2006) Recent trends in meningococcal epidemiology and current vaccine recommendations. Curr Opin Pediatr 18: 58–63PubMedCrossRefGoogle Scholar
  92. 91.
    Centers for Disease Control and Prevention (CDC) (2005) Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 54(RR-7): 1–21Google Scholar
  93. 92.
    World Health Organization (2005) World Health Report 2004. WHO, GenevaGoogle Scholar
  94. 93.
    Baseman JG, Koutsky LA (2005) The epidemiology of human papillomavirus infections. J Clin Virol 32S: S16–S24CrossRefGoogle Scholar
  95. 94.
    Parikh S, Brennan P, Boffetta P (2003) Meta-analysis of social inequality and the risk of cervical cancer. Int J Cancer 105: 687–691PubMedCrossRefGoogle Scholar
  96. 95.
    Jansen KU, Shaw AR (2004) Human papillomavirus vaccines and prevention of cervical cancer. Annu Rev Med 55: 19–31CrossRefGoogle Scholar
  97. 96.
    Fine PE (1995) Variation in protection by BCG: implications of and for heterologous immunity. Lancet 346: 1339–1345PubMedCrossRefGoogle Scholar
  98. 97.
    Kaufmann SH (2006) Envisioning future strategies for vaccination against tuberculosis. Nat Rev Immunol 6: 699–704PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Verlag Basel/Switzerland 2007

Authors and Affiliations

  • Rudolf H. Tangermann
    • 1
  • Hanna Nohynek
    • 2
  • Rudolf Eggers
    • 1
  1. 1.World Health OrganizationGenevaSwitzerland
  2. 2.Department of VaccinesNational Public Health InstituteHelsinkiFinland

Personalised recommendations