An old battle takes on new, worldwide urgency Universal immunization

Kurt Schmoke & Alfred Sommer

September 11, 1990|By Kurt Schmoke & Alfred Sommer

MORE THAN 70 heads of state -- presidents, prime ministers and kings -- will meet at the United Nations the end of this month to end a war. The battlefields will see no blood because the final struggles will be fought in classrooms, clinics and homes of the world.

The World Summit for Children will set forth a crusade to take our children into the 21st century with a mandate to be healthy, educated and productive.

Who will be the leaders? Every mayor of every town on Earth. Every public health professional in the field. Every parent, principal and day care worker. These armed forces will be mobilized by a moral commitment that makes children an international priority.

One of the major issues to be attacked is immunization. More than a decade ago, 1990 was chosen as the year to achieve universal immunization. Five years ago only 5 percent of the world's children had been vaccinated; in 1990, the immunization tally nears 80 percent. But the victory is incomplete.

Eight thousand children continue to die each day from diseases preventable by vaccines. Contrary to popular opinion, these children are not isolated in global backwaters unvisited by science. In fact, an analysis of present trends shows that in wealthier, industrialized societies, the number of under-immunized children has increased over the last decade, while in developing countries the percentage of vaccinated children is beginning to level off.

The task of universal immunization is complicated by the fact that today's vaccines require several doses, that they often must be administered through injections and that they have to be delivered to children at specific ages. Nonetheless, available vaccines and techniques already work, even while researchers around the world seek simpler, more practical approaches. The ultimate will be a vaccine that combats all major childhood diseases and that can be taken orally. It will produce life-long immunity when given as a single dose to newborns.

Even without this dream vaccine, vast strides can be made with current technology to help close the 20 percent gap in universal immunization.

The U.S. can't be excepted. Immunization has become increasingly erratic here. We are experiencing a revival of childhood diseases -- measles, mumps, rubella -- which were thought to be eradicated on North American soil. Since we possess the basic medical technology and know-how to prevent these diseases, we must ask ourselves why we're failing.

And the answer is fairly simple: We have not developed an effective strategy that pulls young parents and children into their local health-care systems. Health care is expensive, and over the last decade parents have tried to hold down costs by limiting visits to the doctor. As a result, children are not properly immunized.

Non-immunized children are a threat to themselves, their families and their schoolmates. Our response must be quick. We have what it takes to do the job; the U.S. has enough existing federally supported health-care clinics to administer free vaccines to every child in need. Hence, the challenge we face is to mobilize these resources and families.

To do this, Baltimore is staging a "Shots for Tots" immunization campaign from Sept. 21 to Sept. 24. Throughout the city, doctors and community clinics will serve all children ages 15 months to 5 years by providing free vaccines against childhood diseases. The campaign is being conducted by a partnership of the city, Johns Hopkins School of Public Health, the state, the federal Centers for Disease Control, UNICEF and local health care providers.

By timing the event in conjunction with the World Summit for Children, Baltimore hopes to encourage other cities across the nation to initiate similar programs. Through a combination of local efforts, a grassroots movement will inspire a new morality that will shift national priorities toward the prevention of disease, disability and death of our children.

Now is the time to redouble our efforts to finish the task set 10 years ago: universal immunization. Thousands of young lives depend on the commitment of responsible adults to back this cause. What could be more important?

Kurt Schmoke is mayor of Baltimore. Alfred Sommer is dean of the School of Public Health at Johns Hopkins University.

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