Ever since the world was made privy to the sterling pioneering work of wonderful physicians like Edward Jenner and others like him more than two centuries ago regarding the development of vaccination for smallpox, the field of immunisation has become a significant boon to mankind. As individuals and as a people, many communities around the globe have without question had immense improvements in their lives made possible by this novel science. The routine practice of immunisation has benefited many and, prevented the mass outbreak of diseases and illnesses which despite an ever-increasing variety and complexity, has reduced disability and prevented deaths across the world.
Here at home, the enactment of the enabling laws that launched the Expanded Programme on Immunisation in 1976 radically altered the landscape for many children across Nigeria when a verifiable timetable for immunisation against the six most deadly childhood diseases began.
These diseases were tuberculosis, poliomyelitis, whooping cough, diphtheria, tetanus and measles. Within a generation, the infant mortality figures in Nigeria reduced from 209.1 in 1984 when the programme was re-launched to 104.3 per 1000 in 2016. While some of these deaths include babies who are still in the first four weeks of life, the vast majority are those children who are aged between two months and five years. It can be seen from the figures above that a lot of work has been done and plenty of progress made. There is still some way to go however. Immunisation is a process, or preventive medical treatment that needs not be feared. The original principles are very sound in that it involves the activation of the body’s own defence system against a specific disease condition.
What Edward Jenner did was to inoculate James Phipps with cowpox, a virus that is similar to smallpox. Smallpox was a lethal disease at the time and perhaps killed as many as 20 per cent of inhabitants in some cities and towns around Europe. Many years earlier, another English physician, John Fewster, had observed that people exposed to cowpox were immune to developing smallpox and documented his observations but it was Edward Jenner who took action based on what he had seen and read. That action, as seen above, led directly to the development of the world’s first vaccine, the one against smallpox, and one vaccine which today is being credited with saving perhaps more lives than any other. That is debatable but his pioneering work eventually led to the development of several vaccines against the six killer childhood diseases and many others besides, and continues to form the basis for the hopeful development of vaccines against malaria, HIV/AIDS and a host of other diseases.
Immunisation is therefore of great benefit to the society by essentially protecting the component individuals from contracting preventable diseases. As a consequence of this, it is noteworthy therefore, that individuals also have some obligations to the society they live in by ensuring that they are protected against communicable diseases which they might otherwise pass on to others in their communities. Immunisation is undeniably a medical treatment and like other forms of treatment in medicine, it is not without risks. However, the weight of the evidence available strongly supports the notion that where there are adverse reactions, these are few and far between and very unlikely to be serious. An individual accordingly has the right to refuse to have a particular form of immunisation. Such a decision may be motivated by fear, religious beliefs, and misinformation or as a result of some known risks associated with the vaccine. In extraordinary circumstances, particularly in the interest of the larger community, that right may be abrogated by a constituted authority.
Vaccines are usually made to the highest moral, ethical and scientific standards. As said earlier, it involves an effort to prime the body’s innate defence mechanisms to home in on a particular disease and protect the person against it. This is made possible by the development of a killed lookalike organism that is injected into a person to provoke that response or in some cases the same response is activated by injecting into qualified persons, weakened organisms that are sure to mimic the genuine disease. When either of these processes is set in motion, the immune system of our bodies are set in motion and they then produce in large numbers, the specific immune proteins that can fight that disease. When this happens, the person is protected for a long, long time from the offending infection or disease condition.
Another way of looking at it all is to assume that a mild form of the particular disease is being injected into the individual in order to avoid the bigger, more damaging, ailment from developing. The more serious disease can cause serious disfigurement and even death and should be worked against to the best extent available. Of recent, immunisation has been extended even beyond infections to include cancer prevention; a vaccine is available today against cervical cancer which is being administered to young female children and teenagers. They have generally been found to be safe. The continuing challenge for everyone must be to convince as many people as possible to make themselves available for these immunisation processes because their minor discomforts pale into insignificance in the light of their bigger challenges which often threaten life.
It is easy to appreciate the continuing impact of taking the hepatitis B vaccine, for example, among the general population. Nigeria is slowly going to be transformed from being one of the largest reservoirs of the hepatitis B virus in the world into one with a relatively virus-free youth population. This turn-around is made possible by the conscious addition of administering the Hepatitis B vaccine as part of the national programme on immunisation, as it is now called. The danger, as with all good things in Nigeria is that during the heady days soon after the programme was launched, the percentage coverage was much greater that what we now have. The nation has witnessed a level of 81.5 per cent of immunisation coverage for children in the 1990s to less than 30 per cent today. And all of this has happened despite the addition of Hepatitis B and Vitamin A in the national immunisation programme since 2004. Things are so dire now that we score only better than Sierra Leone in the entire West African sub-region. Yet, it must be clear that some of the previously eradicated diseases would stage a come-back if the level of commitment to the programme or the degree of surveillance should slacken.
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