Vaccine Delivery Struggles

Vaccines and vaccination are often in the news – perhaps never more than in the last four years, as the world found its way through the COVID pandemic.

They were high on the agenda of the recent World Health Assembly, held last month in Geneva, with encouraging stories of vaccination campaign successes, and frustrating stories of vaccination obstacles and unrealized hopes.

The success stories of vaccination are well known to the world’s healthcare community: the immense global health benefits that vaccines and vaccination programs have achieved worldwide, and their future potential.

The “frustration stories” are equally familiar. Two particular examples have been in the news recently -- specifically, unmet needs for vaccinations against HPV and cholera. These two examples offer sharper insights into the precise nature of the obstacles to increased immunization.

First, the HPV vaccine stands as one of the most prominent examples of inequitable access to care. There are variations in uptake of vaccines for this sexually transmitted infection due to cost, health infrastructure, lack of awareness, and cultural barriers. Overcoming these hurdles will require multistep, multidisciplinary approaches that consider country and community contexts. 

Second, cholera is a prime example of a disease of poverty. It has been virtually eradicated from high-income countries (HICs), yet still takes thousands of lives in low- and middle-income countries (LMICs). Because of the massive improvements in HICs, research has slowed, allowing cholera to continue to run rampant in LMICs. There exists an oral cholera vaccine that could be distributed and significantly reduce the mortality surge caused by cholera. Instead, we see shortages across the regions most affected. Even with a predicted global production capacity of 37-50 million doses, this will likely not be enough.   

What causes this shortage?  

Cholera vaccines are developed on a ‘needs basis’, causing a delay in production, as opposed to being readily available to distribute. This is in large part as a result of the lack of funding for the production of cholera vaccines. 

There are also challenges regarding the packaging of oral cholera vaccines. Schanchol (one of the WHO pre-qualified doses) is delivered in a single dose vial with a rubber top and sealed with an aluminum strip. Vaccine delivery campaigns could benefit from easier administration methods such as the plastic droppers used for oral polio vaccines. 

In conflict settings particularly, vaccine delivery teams experience their biggest challenge. Countries in turmoil are repeatedly left behind when it comes to healthcare.

High-income countries continue to see amazing technological advancements such as personalized melanoma vaccines, while low-income countries continue to struggle to achieve access to basic immunizations.  

Economic disparities between wealthy and LMIC economies are not going away anytime soon. But staying on message, continuing the dialog, and never letting people forget the critical importance of universal immunization, remain powerful tools. The vigorous, ongoing deployment of these tools is sure to be a vital factor in eventually solving the world’s immunization dilemmas.