Opting In: The Value of Vaccines

A young boy in Pakistan receives an oral polio vaccine (OPV). Over the last 30 years huge progress has been made against polio and it is now only endemic in 2 countries, Afghanistan and Pakistan, with only 33 cases confirmed cases last year. Credit: Ashfaq Yusufzai/IPS

By Tharanga Yakupitiyage
UNITED NATIONS, May 1 2019 – Since the introduction of vaccines, diseases such as measles and polio were quickly becoming a thing of the past. However, the world’s progress on immunisation is now being threatened.

According to the World Health Organisation (WHO), 85 percent of the world’s children received basic vaccines, including the measles and diptheria-tetanus-pertussis (DTP) vaccines, which can protect them from infectious diseases that cause serious illness and even death.

In fact, measles immunisation resulted in an 80 percent drop in measles-related deaths between 2000 and 2017 worldwide.

Still, access to vaccines remain elusive for many out-of-reach communities.

In 2017, an estimated 20 million infants did not receive the DTP vaccine, 60 percent of whom live in just 10 countries, including Afghanistan, the Democratic Republic of the Congo, Iraq, and Nigeria.

A rising anti-vaccination movement is also threatening to dismantle progress.

In the United States, there are now more than 700 cases of measles across 22 states making it the highest figures the country has seen since 2000.

The phenomenon has prompted some states to not only make immunisation mandatory, but also to ban unvaccinated children from public spaces.

To mark World Immunisation Week, held during the last week of April, IPS spoke to WHO’s Coordinator of the Expanded Programme on Immunisation Dr. Ann Lindstrand on the challenges of immunisation and the way forward. Excerpts of the interview follow:

World Health Organisation’s Coordinator of the Expanded Programme on Immunisation Dr. Ann Lindstrand.

Inter Press Service (IPS): How is the overall global picture regarding immunisation, and why does immunisation matter? 

AL: Immunisation matters because it is one of the most effective health interventions that we have, and it has saved millions of lives. I don’t think there is any other health intervention that works that well, with such high coverage, worldwide.

Just looking back at what we have gained from immunisation—back in 1963 when we didn’t have any vaccine for measles, there were about 2.6 million deaths every year due to measles. Now, that figure has reduced by 95 percent. The last figures we have are from 2017 with an estimated 110,000 deaths—so there has been a tremendous health gain.

Same with polio—30 years ago, we had widespread polio crippling people but now its only endemic in two countries Afghanistan and Pakistan with only 33 cases confirmed cases last year.

Now the newer vaccines like HPV [human papillomavirus] will help us reduce numbers of cervical cancers and new vaccines on the horizon like the Ebola vaccine which is used in outbreaks in Africa right now has really played a critical role in stopping the spread of the current outbreak in the DRC.

Just this month, the first ever malaria vaccine is being piloted in routine immunisation programs in three countries.

We still need to reach more. We still need to reach the last 15 percent and we need to close equity gaps to reach those furthest away.

IPS: WHO and others have pointed to the anti-vaccination movement as one of the biggest health threats in the world. How concerning is the move away from vaccinations, and what does this mean for people around the world? Is this a new challenge for WHO? 

AL: It is an area of concern, yes.

But it is not the global picture. We do not have the data to say that hesitancy has increased but we have seen that with social media and the internet, misinformation is spread more widely and easily.

That’s something we are really worried about. In some areas, there is a resurgence of disease because of unacceptably low coverage rates or that people are refusing vaccines.

We need to see this in a historic perspective. Anti-vaccine messages have been around for just as long as vaccines have been around—these things come and they go.

But it worries us and we need to be right there to tackle to spread of vaccine misinformation. It is really important to put out the right messages.

I work as a paediatrician and I have talked to a lot of parents who have had these concerns and it takes a lot of effort.

At the heart of it, it is really the health worker who is sitting there with the [parent] who have concerns or have heard something on the internet or media, and they need to be able to respond to their questions and to listen and respect the concerns of parents.

And that those health workers actually have the capacity and time to respond, both with the social ability to listen to the parents’ real concerns and also provide the scientific evidence.

There is a lot of work in training healthcare workers which is ongoing and we need to keep doing that. We need to equip healthcare workers with the right methods, words, scientific evidence to reassure parents.

The bigger picture for us to improve health is for children everywhere to get vaccinated on time and every time. We need to increase access so that vaccine services are made convenient and welcoming so people want to go there, that we are good at putting out credible information from the beginning including what are the facts, what is the evidence.

IPS: Some U.S. states are enacting mandatory immunisation laws or even barring those who have not received vaccines from certain public spaces. Do you agree with these steps, or does more need to be done? 

AL: The only disease where WHO actually recommends mandatory proof of vaccination applies to yellow fever and for international travellers in certain countries.

Beyond that, it is up to every country to make decisions based on existing disease epidemiology, their laws and regulations, and if it is the best way to go.

Many countries have achieved high immunisation coverage without mandatory immunisation.

It is a complex area—how do you sanction parents? How far do you go to enforce laws when they are in place?

That is a conversation that every country needs to have before even considering any of the mandatory vaccinations.

I think it is important to encourage countries to invest in and protect their individuals and communities from vaccine-preventable diseases and then remove barriers—have few access barriers when it comes to cost and convenience.

Make it simple and easy. Make the choice of vaccines the social norm.

IPS: In light of World Immunisation Week, what is your message for people around the world regarding the importance of immunisation?  

AL: Immunisation is a fantastic health intervention. It is a right for all children, and it is also a shared responsibility.

As we have seen with the recent outbreaks, no country and no individual can afford to be complacent about vaccines. It is important that we look at not just putting out fires or responding to outbreaks after they have happened—that’s expensive, ineffective and it costs lives.

What is more important is to have sustainable prevention, thinking and ensuring that everyone everywhere is vaccinated at the right time with the right vaccines and throughout their life course.

It also important to see that vaccines is not just for saving lives, it helps children to learn, grow, keep them in school instead of sick, avert disabilities and long-term consequences. It reduces the health care costs for a country, and protects families and communities from sliding into poverty.

There is no debate to have on the benefit or the risk between vaccines and the vaccine-preventable diseases.

We need to continue to protect people also in the future, and we really need to invest in trust in vaccines and in our healthcare system.

Are Migrant Workers Humans or Commodities?

By Thalif Deen
UNITED NATIONS, May 1 2019 – The United Nations has estimated a hefty $466 billion as remittances from migrant workers worldwide in 2017—and perhaps even higher last year.

These remittances, primarily from the US, Western Europe and Gulf nations, go largely to low and middle-income countries, “helping to lift millions of families out of poverty,” says UN Secretary-General Antonio Guterres.

But most of these migrant workers are known to pay a heavy price, toiling mostly under conditions of slave labour: earning low wages, with no pensions or social security, and minimum health care.

As the United Nations commemorated Labour Day on May 1, the plight of migrant workers is one of the issues being pursued by the Geneva-based International Labour Organization (ILO), a UN agency which celebrates its centenary this year promoting social justice worldwide.

In a December 2018 report, the ILO said: “If the right policies are in place, labour migration can help countries respond to shifts in labour supply and demand, stimulate innovation and sustainable development, and transfer and update skills”.

However, a lack of international standards regarding concepts, definitions and methodologies for measuring labour migration data still needs to be addressed, it warned.

But much more daunting is the current state of the migrant labour market which has been riddled with blatant violations of all the norms of an ideal workplace.

Ambassador Prasad Kariyawasam, a member of the UN Committee on Migrant Workers, told IPS rising populist nationalism world over is giving rise to rhetoric with unfounded allegations and irrational assessments of the worth of migrant workers to economies of many migrant receiving countries in the world.

Since migrant workers remain voiceless without voting or political rights in many such receiving countries, they are unable to mobilize political opinion to counter assertions against them, he said.

“And migrant workers are now being treated in some countries as commodities for import and export at will, not as humans with rights and responsibilities,” said Ambassador Kariyawasam, a former Permanent Representative of Sri Lanka to the United Nations.

Unless these trends are reversed soon, he warned, not only human worth as a whole will diminish, but it can also lead to unexpected social upheavals affecting economic and social well-being of some communities in both sending and receiving countries of migrant workers.

At a UN press conference April 10, ILO Director-General Guy Ryder said the ILO Centenary is a time to affirm with conviction that the mandate and standards set by the Organization remain of extraordinary importance and relevance to people everywhere.

He called for a future where labour is not a commodity, where decent work and the contribution of each person are valued, where all benefit from fair, safe and respectful workplaces free from violence and harassment, and in which wealth and prosperity benefit all.

Tara Carey, Senior Content & Media Relations Manager at Equality Now told IPS poverty and poor employment opportunities are a push factor for sex trafficking.

There are many cases in which women and girls in African countries are promised legitimate work and are then trafficked into prostitution. This happens within countries, across borders, and from Africa to places in Europe and the Middle East, she pointed out.

And recently, the police in Nigeria estimated 20,000 women and girls had been sold into sexual slavery in Mali:

“The new trend is that they told them they were taking them to Malaysia and they found themselves in Mali. They told them they would be working in five-star restaurants where they would be paid $700 per month.”

The number of migrants is estimated at over 240 million worldwide. And an increasingly large number of countries, including Saudi Arabia, Qatar, Kuwait, Bahrain and the United Arab Emirates (UAE), are home to most migrant workers from Asia.

In a background briefing during a high-level plenary meeting of the General Assembly in April, the ILO said conditions of work need to be improved for the roughly 300 million working poor – outside of migrant labour — who live on $1.90 a day.

Millions of men, women and children are victims of modern slavery. Too many still work excessively long hours and millions still die of work-related accidents every year.

“Wage growth has not kept pace with productivity growth and the share of national income going to workers has declined. Inequalities remain persistent around the world. Women continue to earn around 20 per cent less than men.”

“Even as growth has lessened inequality between countries, many of our societies are becoming more unequal. Millions of workers remain disenfranchised, deprived of fundamental rights and unable to make their voices heard”, according to the background briefing.

In its 2018 review of Human Rights in the Middle East & North Africa, the London-based Amnesty International (AI) said there were some positive developments at a legislative level in Morocco, Qatar and the UAE with respect to migrant labour and/or domestic workers.

But still migrant workers continued to face exploitation in these and other countries, including Bahrain, Jordan, Kuwait, Lebanon, Oman and Saudi Arabia, in large part due to kafala (sponsorship) systems, which limited their ability to escape abusive working conditions.

In Morocco, the parliament passed a new law on domestic workers, entitling domestic workers to written contracts, maximum working hours, guaranteed days off, paid vacations and a specified minimum wage.

Despite these gains, the new law still offered less protection to domestic workers than the Moroccan Labour Code, which does not refer to domestic workers, AI said.

In Qatar, a new law partially removed the exit permit requirement, allowing the vast majority of migrant workers covered by the Labour Law to leave the country without seeking their employers’ permission.

However, the law retained some exceptions, including the ability of employers to request exit permits for up to 5% of their workforce. Exit permits were still required for employees who fell outside the remit of the Labour Law, including over 174,000 domestic workers in Qatar and all those working in government entities.

In the UAE, the authorities introduced several labour reforms likely to be of particular benefit to migrant workers, including a decision to allow some workers to work for multiple employers, tighter regulation of recruitment processes for domestic workers and a new low-cost insurance policy that protected private sector employees’ workplace benefits in the event of job loss, redundancy or an employer’s bankruptcy, according to AI.

Meanwhile, as the ILO pointed out in a report in May 2017, current sponsorship regimes in the Middle East have been criticized for creating an asymmetrical power relationship between employers and migrant workers – which can make workers vulnerable to forced labour.

Essential to the vulnerability of migrant workers in the Middle East is that their sponsor controls a number of aspects related to their internal labour market mobility – including their entry, renewal of stay, termination of employment, transfer of employment, and, in some cases, exit from the country, the report noted.

Such arrangements place a high responsibility – and often a burden – on employers. To address these concerns, alternative modalities can be pursued which place the role of regulation and protection more clearly with the government.

This report demonstrates that reform to the current sponsorship arrangements that govern temporary labour migration in the Middle East will have wide-ranging benefits – from improving working conditions and better meeting the needs of employers, to boosting the economy and labour market productivity.

Meanwhile, in its ”Century Ratification Campaign”, ILO has invited its 187 member States to ratify at least one international labour Convention in the course of 2019, with a commitment to apply a set of standards governing one aspect of decent work to all men and women, along with one political commitment supporting sustainable development for all.

The writer can be contacted at thalifdeen@ips.org