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CONGRATULATIONS! INOCULATIONS! THE ECONOMIST COMMENTS ON THE CHINESE VACCINATION PROGRAM

Wednesday, 30th of July 2014

CONGRATULATIONS! INOCULATIONS!

From The Economist online; best viewed at

http://www.economist.com/news/china/21608799-world-health-organisation-gives-china-glowing-report-its-lowering-infant-and-maternal?fsrc=scn/fb/wl/pe/congratulationsinoculations

FANS of the China model frequently say that, for all the disadvantages of a one-party state, there are also benefits. Enforcing basic health care is one—and by no means a small one. Last year the China mortality rate for children under five years old was just one-fifth the rate it was in 1991, down from 61 deaths per 1,000 live births to 12. The maternal mortality rate has also dropped substantially—by 71%—since 1991. In 1992, one in ten Chinese children under five contracted hepatitis B. Today fewer than one in 100 of them carry the disease.

 

Chinese advances have not gone unnoticed. Last month a group of four international bodies, including the World Health Organisation (WHO) and the World Bank, said China was one of ten countries to have made exceptional progress in reducing infant and maternal mortality (see chart). Not all of the ten—which included Egypt, Peru, Bangladesh and Vietnam—are one-party states.

Chinese improvement lies in two basic, connected areas: better care at birth and countrywide immunisation. Since 2000 the government has offered subsidies to mothers who give birth in hospitals, thereby reducing health dangers from complications—especially the risk of neonatal tetanus. The scheme also brought hard-to-reach people and groups into contact with the health-care system.

From 2001 to 2007, the share of births that took place in hospitals rose by 46%, making it easier to give a hepatitis B vaccine immediately. China now has one of the highest usage rates of the birth dose of the vaccine in the world: 96% of Chinese babies receive it on their first day of life. In 2012 the WHO commended China for a “remarkable” public-health achievement. That year it declared China free of maternal and neonatal tetanus.

Margaret Chan, the WHO director-general, this month said that Chinas regulatory system for vaccines had passed the WHOs evaluation with outstanding results. Dr Chan says she has “full confidence” in the safety of vaccines made in China. Last year the WHO approved one for the first time for use by UNICEF. (That has not dispelled suspicions within China itself, however, about the safety of Chinese vaccines.) China and the WHO claim that about 95% of children are vaccinated for measles, rubella and polio. In 2008 the government added eight new vaccines, including hepatitis A and meningitis, to its national programme. All are administered to children free of charge. Just as important has been the mobilisation of a network of health-care workers, at provincial, county and township levels.

That does not guarantee effectiveness. In 2010 the government ran a huge vaccination campaign against measles, inoculating 103m children. Though the scheme reportedly achieved a coverage rate of 98%, outbreaks of measles in 2013 and again this year showed that many children must have missed their scheduled doses.

Part of the problem is the growing number of rural migrant children. They are tied to their hometown through the household-registration, or hukou, system and do not qualify for free health services, such as routine immunisation, outside it. Another hurdle is the complexity of administering so many vaccines in such a large, developing country. There are still occasional cases of poorly stored or outdated vaccines causing ill health, or even death. As a result, says Chen Taoan, a former official at the China Centre for Disease Control and Prevention, trust in the immunisation system is eroding, even though the quality of vaccines remains—mostly—high. When 17 infants died after receiving a hepatitis B vaccination last year, immunisation rates dropped by a third across the country in a month. The drop was even greater in urban areas (where parents have better access to media). Coverage rates fell for other vaccines, too, by an estimated 15%. The batches were recalled for tests. International organisations confirmed they were safe and that the deaths were not related to the vaccines. But parental confidence was dented.

Wang Yuedan, a professor of immunology at Peking University, says that, for all its successes, the Chinese approach to immunisation is still stuck in the 1960s. When the incidence of infectious disease was high, a blanket approach made sense. But that carries with it risks for the vulnerable or weak, who may have adverse reactions to vaccinations. Now that many diseases have been eradicated, screening infants for suitability before they receive a vaccine is preferable, says Mr Wang. The ineffectiveness of the measles vaccinations in 2010 is a case in point.

Many Chinese vaccines, including those for Japanese encephalitis and polio, are the live attenuated sort (which limits the virulence of a microbe but keeps it alive). In the case of polio, these are favoured in poor countries where disease is rampant because they are cheap and require fewer boosters. But they must be stored properly, and carry health risks for those with a weakened immune system. The WHO has urged China now to shift to an inactivated polio vaccine (in which the microbe has been killed). In April Sinovac, a Chinese firm, said it would produce the countrys first such vaccine.

That China is now at a stage where it needs a more sophisticated and targeted immunisation programme is testimony to its success, however. It is a sign that 1.4 billion people have taken another step up the ladder of good health.