Vaccination is the single most cost-effective public health intervention that has decreased childhood mortality as well as illness and disability in the last forty years. According to the United Nations report, [i]childhood vaccination contributed significantly to the achievement of the fourth Millennium development goal, i.e., two –third reduction of childhood mortality between 1990 and 2015, and is also a leading health-related goal in post-2015 sustainable developmental goals.
World Health Organization (WHO), conforming to its mandate to provide member states with technical guidance in health matters, established an advisory group on immunization-SAGE (Strategic Advisory Group of Experts) that recommends vaccination guidelines for different age groups including childhood immunization. However, quite expectedly these guidelines are not identical and universal for all countries as there exist a complex mix of individual, demographic, behavioral, social, and structural factors that influence the uptake of various vaccinations. WHO realizes these differences amongst countries and explicitly advises that these recommendations are not to be directly used by healthcare providers. But they are intended for use by “national immunization managers and key decision-makers, chairs and members of national advisory committees on immunization, and partner organizations, including industry”[ii] to assist them in formulating a country-specific immunization policy taking in account all the factors mentioned above.
How a country decides about its vaccination policy is not a simple task; instead, it follows a rigorous process of consultations and deliberations. They consider incidence of various diseases as well as the disease burden, in terms of its mortality, morbidity and disability, and the cost of the disease burden is paralleled to that of the vaccine to assess its cost-effectiveness. Other important considerations are the effectiveness and safety profile of the vaccines including their potential for producing adverse effects.
The difference in vaccination schedules amongst developed and developing countries stems from the difference in disease patterns, and it also reflects the disparities in their economic power. The most devastating diseases in developing countries might be rare or non-existent in developed countries. In developing countries, communicable diseases still attribute to 56% of disease burden, which is as low as 6% in developed countries. Even in case of presence of similar diseases, the strains of causative organisms are sometimes different in developed and developing countries, requiring different vaccines. Moreover, the process of storage, handling, and distribution of vaccines also varies amongst nations and developing nations especially need vaccines that can be produced and stored more economically.
Few examples of the differences in vaccination schedules amongst developed and developing countries are; developing countries use Live Oral polio vaccine, while in developed countries inactivated virus vaccine is used, either as a subcutaneous or intramuscular injection. Similarly, for pertussis, wealthy countries use acellular vaccine contrary to the use of live attenuated vaccine in poor or emerging economies. Several vaccinations which are routinely used in most of the developed countries such as Chickenpox, Hepatitis –B, MMR, Meningococcal, and Rotavirus are not part of the public-sector Immunization program in developing countries and available only to affluent segments of the society through private health entities.
[i] UN (United Nations). 2015. “UN Millennium Development Goals: Child Health.” UN, New York. http://www.un.org/millenniumgoals/childhealth.shtml.