Childhood Immunization Combatants Face Friendly Fire

Appallingly, some of the fiercest battles in international public health are between those who want to save lives one way and those who want to save them a different way. Energies that should be focused squarely and collectively to combating disease instead are devoted to internecine bickering. Nowhere is that more apparent than in the world of childhood immunization, which after a long period of resource scarcity is now benefiting from new money and attention, but still seems unable to break out of an old mindset of competition and tunnel-vision advocacy. In a front-page article in the Sunday New York Times, Celia Dugger looks at measles immunization in Nepal and India, and manages to subtly capture two of the current skirmishes in the childhood immunization wars: In one fight, those pushing measles campaigns complain that they are stymied by an overemphasis on polio eradication. In another conflict, the proponents of stronger routine immunization programs fear that measles campaigns will undermine efforts to build up clinic-based services. Surely there must be a way out of this mess - a way that will lead to fewer brickbats thrown and more lives saved. Part of that “way out” has to involve some hard rethinking about how to make each valuable effort - polio eradication, measles campaigns, routine immunization - genuinely reinforce the others. There are ways for this to happen, and we’ve seen them in Latin America, as campaigns have been used as stimulants to energize routine programs and to invest in better epidemiologic surveillance systems. Those who fund campaign-style approaches have to demand that the designers and implementers demonstrate how they are contributing to long-term systemic improvements - and be given the resources to do it. The other part of the “way out” is to follow the lead of those who work on HIV/AIDS; there, a permanent ceasefire has been called between the “prevention” supporters and the “treatment” advocates. Those who are pushing for more funding for prevention programs take every opportunity to state that more access to treatment is essential to the success of their efforts; advocates of expanded treatment programs habitually voice messages of support for prevention. If this sort of détente can be achieved in the overheated world of HIV/AIDS, surely the immunization folks can combine forces to fight needless child deaths, rather than each other.