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Opinion

Baltimore's vaccine example

This week, Baltimore is privileged to host an international conference sponsored by the preeminent global immunization advocacy organization, the GAVI Alliance. Launched in 2000 at the star-studded gathering of the World Economic Forum in Davos, Switzerland, the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation) was founded by the Bill and Melinda Gates Foundation, the World Health Organization, UNICEF and the vaccine industry, among others.

Pneumococcal disease and rotavirus, a virulent form of diarrhea, are the top two killers of children in the 70 or so most impoverished countries in the world — those where the average income is less than $3 per day. It has traditionally taken 10 to 15 years for vaccines we in America take for granted to reach people in these most impoverished places, with a particularly huge death toll in children under 5 — more than 2 million each year.

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The United States government, Baltimore's own Johns Hopkins University, and organizations like the GAVI Alliance are hastening the introduction of vaccines where they are needed most. In its first decade, for example, GAVI support has enabled 250 million children to be vaccinated and has averted 5 million early deaths.

But the effort needs to be broadened to curtail completely preventable death and disease in the globe's most vulnerable children. How? By increasing public health pressure on political authorities. And we have an example of just that here in Baltimore.

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Not long ago in this country — before immunizations became widely available — thousands of children and teenagers would die or suffer significant long-term consequences each year from infectious diseases: 15,000 from diphtheria, 3,000 from measles. More than 20,000 babies were born blind, deaf, or mentally retarded from rubella, each year; 15,000 were paralyzed and 1,000 killed by polio.

These deaths are history. And Baltimore has written an important recent chapter in the fight against childhood mortality. You may have seen the billboard of the cute child with his proud mother beside the Russell Street exit off I-95. It congratulates Baltimore for "giving kids a shot." Baltimore was recently named one of six American cities that have been the most successful in improving childhood immunization rates. But it wasn't always the case.

In the mid-1990s, then-Vice President Al Gore came to town extolling "Lessons without Borders" — an effort to help American cities to share in the lessons that the Agency for International Development (AID) had learned from its work with aid programs in poor countries. Putting that principle in action, one of my colleagues in the Baltimore City Health Department visited Kenya to learn how a developing nation had immunized more than 90 percent of its children, while Baltimore's school-age immunization rate had barely topped 60 percent. No wonder we had mini-epidemics of measles and mumps affecting hundreds of Baltimore kids and families in those years.

I remember, as a relatively new health commissioner, huddling with then-Mayor Kurt Schmoke as we walked down Ashland Street and saying, "This is ridiculous. We know the problem is lack of enforcement of state law by the school system." His support was unequivocal, and with the collaboration of then-Superintendent of Schools Walter Amprey (in enforcing automatic exclusion of un-vaccinated students) and State's Attorney Pat Jessamy (threatening prosecution of parents whose kids were not in school), combined with holding massive citywide immunization clinics, within a matter of months Baltimore's school-age immunization rate topped 99.5 percent.

The 99.5 percent figure is not just another meaningless statistic. It signifies that we have complete immunity and (as long as such high rates are maintained) won't have outbreaks of serious diseases that can maim or damage or kill children like we did as recently as 18 years ago.

These gains have been maintained through strong immunization programs. Baltimore has added community-based centers and outreach vehicles like the TIKE (To Immunize Kids Everywhere) mobile van to make sure even the hardest-to-reach children of all ages get a chance at a healthy start.

In short, Baltimore put in place the important equation implied earlier: Public health pressure plus political leadership equals immunization coverage — which equals healthy kids.

As one of 24 local health officers in the state, I continue, along with my colleagues, to keep a close watch on child fatalities. Throughout Maryland, we still have challenges related to prematurity and low birthweight, and to child abuse. But the bottom line is that you can see the value of immunizations by simply looking at childhood mortality rates. Today, as long as a baby lives past his or her first birthday — and aside from motor vehicle accidents — there's virtually no significant cause of death among children ages 1 to 15. In contrast, when my dad was a youngster, the childhood death rate was drastically higher because of the prevalence of infectious diseases.

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In other words, the childhood death rate in Maryland and most states is blessedly minuscule. If only that were so for children not much different from ours in the 70 countries where people earn just $3 per day.

Dr. Peter Beilenson is the Howard County health officer. His e-mail is pbeilenson@howardcountymd.gov.


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