THE IMPACT OF ROUTINE IMMUNIZATION ON THE HEALTH SYSTEM
By: Ulimmachukwu Osele
The organization of health systems throughout the globe is distinct and the systems vary in the proportion of care delivered by both public and private enterprises, with emphasis on primary, secondary and tertiary care, the levels and sources of funding, the target population, the burden of disease in the community and the level of development of the human and technological infrastructure.
According to the World Health Organization (WHO), a health system comprises all organizations, people, and actions whose primary interest is to promote, restore, or maintain health. The goals of health systems are: improving health and health equity in ways that are responsive, financially fair, and making the best, or most efficient, use of resources. Health care systems face the challenge of being safe, timely, effective, equitable and patient-centered (STEEP) in order to achieve the following: an improved experience of care, improved health for a population, and reduced cost per capita. These three goal comprise the Triple Aim framework.
The immunization system is an integral part of the overall health system, with its focus on vaccine-preventable diseases. According to the World Health Organization, the immunization system has five elements viz, vaccine delivery, advocacy and communications, disease surveillance, logistics, and vaccine supply and quality (WHO 2000). Immunization systems largely share functions and resources with the overall health system. These include the time of multi-purpose health workers, the health infrastructure, logistical functions, and planning & management systems. The immunization system has dedicated parts that are still part of the health system but independent from other services, for example, the cold chain (largely), the vaccines, most immunization campaign functions and the time of single-purpose immunization staff (where they exist). Both immunization and health systems are active and interrelating. Changes and challenges of an immunization system can affect aspects of the overall health system and vice versa. Major changes in immunization programs are likely to have a greater impact on weak health systems than on stronger and supportive health systems where they achieve greater coverage.
The association between routine immunization and health systems is, therefore, complex and non-linear.
What has Vaccination Done for Us?
Over the years, vaccines have drastically reduced the incidence of several infectious diseases responsible for so much mortality and morbidity. The impact of vaccination has been demonstrated by the estimate that during the ‘vaccines for children era’ (1994–2013), the total number prevented by routine childhood vaccinations in the USA was over 322 million cases of infectious diseases, 21 million hospitalizations, and 731,700 deaths. Thus, vaccination has contributed substantially to the healthcare systems by reducing the burden of frequent infectious diseases and associated resource use. There is an increasing number of vaccines protecting against a range of infections affecting not just children but also adults and the elderly.
External genital warts (EGWs) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV) that infect teenagers and young adults early after their sexual debut. It has been estimated that, in Europe, almost 600,000 new cases of EGWs occur each year. The economic and human burden of EGWs is high. The average treatment cost and total annual direct cost of genital warts were estimated at €483 and €23 million, respectively, in France. The quadrivalent HPV vaccine protects against HPV types 16 and 18, and 6 and 11; these two latter types represent the causal pathogen for 90% of genital warts. A vaccination program is, therefore, expected to have a significant impact on the occurrence of genital warts and their associated treatment cost.
Using vaccines to prevent diseases in children, adults, and the elderly results in fewer medical visits, diagnostic tests, treatments, and hospitalizations, which lead to substantial savings in healthcare costs. Vaccines also contribute to reducing resource utilization by preventing nosocomial infections, such as rotavirus gastroenteritis, which can increase hospital stays by 4–12 days. Vaccination also has an important role in the prevention of cancers with, for example, human papillomavirus or hepatitis B vaccines. Since the financial impact of cancer is high for patients, healthcare systems, and the society any case prevented will reduce this impact. Newer vaccines, such as the herpes zoster vaccine, can provide an answer to unmet medical needs by preventing and reducing the severity of shingles and associated post-herpetic neuralgia, which are difficult conditions to treat. Thus, in increasing pressure on healthcare budgets, vaccination can contribute to the sustainability of healthcare systems through the reduced and more efficient use of healthcare resources.
Routine immunization also reduces pressure on Health care workers and Hospitals. During a disease outbreak, there is an increased number of patients with limited healthcare workers. There are not enough infrastructural provisions to accommodate these outbursts. We can see this case in the COVID-19 pandemic: healthcare workers work round the clock, they attend to patients out on the streets as there are no bed spaces in some of the hospitals. Routine immunization for a vaccine-preventable disease goes a long way in relieving this burden.
Routine vaccination has been shown to reduce the burden of vaccine-preventable diseases, reduce the physical and emotional pressure on health care workers, save cost and direct resources into other medical interventions. Health promotion and disease prevention are key factors for the long-term sustainability of health systems.
Pharm Ulimmachukwu Osele is the coordinator of the Public Health committee, Young Pharmacists Group, Lagos State, Nigeria. She is interested in global health pharmacy and is actively involved in global health projects in Lagos, Nigeria.
