Mass vaccination is a public policy effort to vaccinate a large number of people, possibly the entire population of the world or of a country or region, within a short period of time. This policy may be directed during a pandemic, when there is a localized outbreak or scare of a disease for which a vaccine exists, or when a new vaccine is invented. Under normal circumstances, vaccines are provided as part of an individual's medical care starting from birth and given as part of routine checkups. But there are times when there is a need to quickly vaccinate the population at large and provide easy access to the service. When this occurs, temporary clinics may be established around communities that can efficiently handle the many people within at once. Challenges of a mass vaccination effort include vaccine supply, logistics, storage, finding vaccinators and other necessary staff, vaccine safety and public outreach.
Historic mass vaccinations
Measles Measles is a viral infection known for its highly contagious properties. Infection with measles is transmitted through the respiratory tract and can manifest as fevers, the "three C's of measles": cough, coryza (runny nose), conjunctivitis(red/watery eyes), and a maculopapular rash. Prevention can be achieved with vaccination, as a single dose is 93% effective against measles and both doses of the two-shot series provides 97% effectiveness against measles. Management of measles, not prevention of measles, can be accomplished with vitamin A supplementation.
Measles History Measles was first described by physicians in the 9th century. In the centuries after, as explorers traveled from their borders and encountered new populations, these previously unexposed groups were acutely effected by measles. It wasn't until 1757 that Francis Home discovered the cause of measles to be as a result of infection from a pathogen. Deaths from measles dropped by the 20th century due to advances in medicine and standards of living, though this improvement was largely seen in developed nations. Globally, there is still a documented yearly occurrence of 2 million deaths from 30 million cases.
Vaccine Development John Franklin Enders developed a live measles vaccine which underwent testing from 1958 to 1960, followed by public licensing in 1963. The vaccine used in the United States since 1968 was a vaccine developed by Maurice Hilleman, which is a weaker live vaccine and showed increased efficacy, leading to a more effective measles vaccine. In 1971, the Measles vaccine began to be produced as a combined vaccine with two other newly developed vaccines: mumps and rubella (MMR Vaccine). In 1989, the two-dose regimen of the MMR vaccine began due to improved immunity developed from two doses rather than one.
Measles Eradication Efforts Under the Vaccination Assistance Act of 1962, President John F. Kennedy directed federal money to states in an effort to provide affordable and effective vaccinations to children and the broader population. By 1965, President Lyndon B. Johnson worked with Congress to extend the Vaccination Assistance Act to cover Measles. In 1967, Johnson and the CDC set out to eradicate measles and saw a drop in weekly measles cases from 1,000 to 200. Cases of measles dropped in 1968 with 22,000 cases compared to 450,000 cases per year prior to the advent of the vaccine. Following an uptick in cases in the early 1970s President Jimmy Carter set a goal for 90% vaccination, achieved partly through school mandates. This found success, with 96% of school children being vaccinated by the end of his term in 1981 and a record low number of cases: 2,600. Through the 80's and early 90's, vaccination hesitancy picked up steam. This was met by President Bill Clinton with the Comprehensive Child Immunization Act of 1993. By 2000, the last full year of his second term, the United States officially declared measles had been eradicated.
Barriers to Efforts As with any mass vaccination effort, vaccine-hesitancy remains a major barrier to maintaining low levels of measles cases. A key cause of this challenge was a research article written in 1998 in "The Lancet" claimed to show a link between autism and the MMR vaccine. In the wake of the article, negative news coverage of the MMR vaccine increased along with vaccine skepticism. "The Lancet" retraced the paper in 2010 for incorrect data resulting from the study and for unethical treatment of the children in the study. Due to the high infectivity rate of measles, the vaccination level to reach 'herd immunity' is 95%. However, anti-vaccination campaigns and misinformation has caused the vaccination level to dip below the threshold, leading to a rise in measles cases in the USA. Despite previously declaring measles had been eliminated in the US, there is now a Measles resurgence in the United States.
Smallpox
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