Importancia de las vacunas en salud pública: hitos y nuevos desafíos / The importance of vaccines in public health: milestones and new challenges

La creación del Programa de Inmunizaciones en el mundo ha sido una de las estrategias de salud pública más valorada y que contribuye a la equidad. Este programa fue lanzado por la Organización Mundial de la Salud en 1974, posteriormente en el año 1977 fue implementado por la Organización Panamericana de la Salud para los países de la región de América y en Chile fue a partir de 1979, poniendo a disposición un esquema contra 6 enfermedades inmunoprevenibles. Es un programa de Bien Público de cobertura nacional, gratuito para toda la población objeto para cada una de las vacunas, que cuenta con respaldo político, independiente de los cambios de gobierno y con financiamiento nacional en un 100%. Uno de los pilares de éxito de los programas es lograr altas coberturas de vacunación. En el caso de sarampión, dado la alta tasa de reproducción del agente y su condición de enfermedad en fase de eliminación, se requieren coberturas superiores a 95%. Aunque el principal indicador indirecto de desarrollo del programa es la tercera dosis de vacuna contra DFT (Difteria, Pertussis acelular, Tétanos). Aunque han transcurrido 45 años de existencia de los Programas de Inmunización, cinco de las Enfermedades Inmunoprevenibles forman parte de las 10 principales amenazas para la salud mundial. El presente artículo desarrolla parte de la historia del Programa Ampliado de Inmunizaciones de América y de Chile desde su génesis, destacando la importancia de los 12 componentes mínimos que forman parte de las actividades del programa y los hitos que han demostrado el valor, los beneficios de la vacunación, relatando ejemplos como viruela, poliomielitis, sarampión. Por último, se señalan las amenazas y posibles estrategias de superación.

The creation of the Immunization Program in the world has been one of the most valued public health strategies and one that contributes to equity. This Program was launched by the World Health Organization in 1974, later in 1977 it was implemented by the Panamerican Health Organization for the countries of the Americas region and in Chile since 1979, making available a scheme against 6 immunopreventable diseases. It is a program of Public Good of national coverage, free for all the target population for each of the vaccines, which has political support, independent of changes in government and 100% national financing. One of the corner stone of success of the programs is to achieve high vaccination coverage. In the case of measles, given the high rate of reproduction of the agent and its disease condition in the phase of elimination, coverage of more than 95% its needed. Although the main indirect indicator of program development is the third dose of DPT (Difteria, Acellular Pertussis, Tetanus) vaccine. Although 45 years of the existence of Immunization Programs have passed, five of the Immunopreventable Diseases are part of the 10 main risks to world health. This article develops part of the history of the Expanded Program of Immunizations of America and Chile since its genesis, highlighting the importance of the 12 limited components that are part of the activities of the program and the milestones that have experienced the value, benefits of vaccination, such as smallpox, polio, measles. Finally, the threats and possible strategies for overcoming them are pointed out.

The Smallpox Epidemics in America in the 1700s and the Role of the Surgeons: Lessons to be Learned During the Global Outbreak of COVID-19.

Today's COVID-19 pandemic offers many similarities with previous pandemics hitting our country. In particular, the smallpox epidemics during the 1700s threatened the lives of multitudes and created panic and fear in the society, similar to the situation caused by the coronavirus. Remedies that were instituted, especially inoculations, were met with opposition and even violence when first introduced. The newspapers were filled with headlines reflecting the disputes. There was a "six feet rule" during the smallpox epidemics, although it had a different meaning than today. Politicians and other leaders of the society were engaged in the war against the infection. Boston became involved in the fight against the smallpox by Dr. Zabdiel Boylston's and Rev. Cotton Mather's introduction of inoculations. When George Washington realized the benefits of the procedure and ordered mass inoculations of the Continental Army, it became an important factor in winning not only the fight against smallpox but the Revolutionary War as well. Looking back at history, realizing that we have survived previous outbreaks of devastating diseases, can provide hope during the current pandemic.

Smallpox vaccination in the German Empire. Vaccination between biopolitics and moral economy / La vacuna contra la viruela en el imperio alemán. La vacunación entre biopolítica y economía moral

After a smallpox epidemic in Germany in the early 1870s in the wake of the Franco-German War, smallpox vaccination became compulsory by Imperial Law in 1874. The act was hotly debated in parliament and in public and earlier resistance against vaccination developed into a political anti-vaccination movement. For this reason, the German government adopted a number of safety measures. The current article describes, firstly, vaccination practices, regulations and policies in the German states up to the 1870s and the biopolitical developments that led to the Imperial Law on compulsory smallpox vaccination in 1874. Secondly, the article sketches the public debate and critique regarding vaccination asking why compulsory vaccination succeeded in Germany. The article describes the measures implemented by the German government to promote compulsory vaccination and acceptance of the Imperial Law: initially, smallpox vaccines were manufactured by state-run production sites and supervised by local authori­ties. Empire-wide statistics were collated documenting the success of vaccination as well as related side-effects. From a government perspective, these precautions could be interpreted as a technology of trust

Después de una epidemia de viruela en Alemania a principios de la década de 1870 a raíz de la guerra francoalemana, la vacuna antivariólica se hizo obligatoria por Ley Imperial en 1874. La ley se debatió acaloradamente en el parlamento y en pú­blico, y la resistencia ya existente contra la vacunación se convirtió en un movimiento político antivacunas. Por ello, el gobierno alemán adoptó una serie de medidas de seguridad. El artículo actual describe, en primer lugar, las prácticas, regulaciones y políti­cas de vacunación en los estados alemanes hasta la década de 1870, y los desarrollos biopolíticos que llevaron a la Ley Imperial sobre la vacunación antivariólica obligatoria en 1874. En segundo lugar, se esbozan el debate público y la crítica sobre la vacunación, preguntando por qué la vacunación obligatoria tuvo éxito en Alemania. Se describen las medidas aplicadas por el gobierno alemán para promover la vacunación obligatoria y la aceptación de la Ley Imperial: inicialmente, las vacunas contra la viruela se fabricaban por centros de producción estatales supervisados por las autoridades locales. Se recopilaban estadísticas de todo el imperio que documentaban el éxito de la vacunación, así como los efectos secundarios relacionados. Desde la perspectiva del gobierno, estas precauciones podrían interpretarse como una tecnología de confianza

La vacunación: estrategia fundamental en la eliminación de la viruela en Cuba (1804-1923) / Vaccination: fundamental strategy in the elimination of smallpox in Cuba (1804-1923)

Las epidemias de viruela azotaron a Cuba desde 1522, produciendo elevada morbilidad y mortalidad. En 1804, se inició la estrategia de vacunación contra esta enfermedad que, con distintos avatares y fases en su desarrollo, tuvo como figura central a Tomas Romay. El objetivo del trabajo fue analizar los resultados de la estrategia de vacunación llevada a cabo en la eliminación de la viruela en Cuba y como se transformaron las instituciones en relación a los avances y producción de la vacuna en función del contexto científico, social y político del periodo estudiado. Las fuentes primarias utilizadas han sido diversas: fuentes de tipo epidemiológico y estadístico, documentos relacionados con los organismos puestos en marcha para la propagación y producción de la vacuna, informes institucionales y periodismo científico local. El trabajo reconstruye el papel jugado por la Junta Central de la Vacuna (1804), para planificar, ejecutar y expandir esta estrategia en el territorio, el Instituto de Vacunación Animal (1873) y el Centro General de la Vacuna (1883) en la producción de la misma. En el siglo XX, se convirtió en obligatoria por ley y junto a las estrictas medidas de aislamiento tomadas sobre los casos y los controles de focos, llevaron a la eliminación de la enfermedad a partir de 1923

The epidemics of smallpox lashed Cuba since 1522, producing high morbidity and mortality which with different ups and downs in its development, had as central figure Tomas Romay. The main aim of this paper is to analyze the results of the vaccination strategy performed in Cuba for the elimination of smallpox in Cuba and how the institutions were transformed in relation to the advances and production of the vaccine. The primary sources used have been diverse: epidemiological and statistical sources, documents related to organisms set up for to the spread and production of the vaccine, institutional reports and local scientific journalism. The work reconstructs the role played by the Central Vaccine Board (1804) emerged to plan, execute and expand this strategy in the territory, the Animal Vaccination Institute (1873) and the General Vaccine Center (1883) to produce it. In the twentieth century, it became mandatory by law and together with strict isolation measures taken on cases and spot checks, led to the elimination of the disease in 1923

Narrativas vacunales y políticas de vacunación contra la poliomielitis en el contexto de la provincia de Alicante (1963-1978) / Vaccine narratives and polio vaccination policies in the context of the province of Alicante (1963-1978)

El análisis a pequeña escala es una vía de abordaje historiográfico que abrió, en su momento, nuevos caminos en la investigación. La proximidad del objeto de estudio, permite profundizar en los determinantes propios y específicos y en las realidades y prácticas, por ejemplo, de las campañas de inmunización masiva contra la poliomielitis diseñada a nivel nacional pero implementadas localmente, como en el estudio de caso que abordamos. Utilizando como modelo el ámbito sanitario provincial de Alicante, el trabajo añade datos para completar la información de proximidad sobre estas campañas y de ese modo, completar una visión de conjunto y un análisis comparado tanto en un ámbito externo como en un ámbito interno interterritorial, nacional y provincial, así como el seguimiento de las directrices dadas por los organismos nacionales e internacionales. En segundo término, dotar de significado al conjunto de actividades llevadas a cabo por diferentes actores, instituciones y medios de comunicación, implicados en el proceso de implantación, cobertura y seguimiento de las campañas de vacunación contra la polio en el ámbito provincial alicantino. El uso de narrativas de personas afectadas por la enfermedad permite añadir elementos relevantes sobre experiencias personales en el contexto de las campañas vacunales

Small-scale analysis is a path of historiographical approach that opened, at the time, new paths in research. The proximity of the study object allows us to delve into our own and specific determinants and the realities and practices of, for example, mass immunization campaigns against polio, designed at the national level but implemented locally, as in the case study that we discuss. Using as a model the provincial sanitary area of Alicante, the work adds data to complete the proximity information on these campaigns and thus, complete an overview and a comparative analysis both in an external and in an internal interterritorial, national scope and provincial level as well as the follow-up of the guidelines given by the national and international organisms. Secondly, to give meaning to the set of activities carried out by different actors, institutions and media, involved in the process of implementation, coverage and follow-up of polio vaccination campaigns in the province of Alicante. The use of narratives of people affected by the disease allows to add relevant elements about personal experiences in the context of the vaccine campaigns

The Delay in the Licensing of Protozoal Vaccines: A Comparative History.

Although viruses and bacteria have been known as agents of diseases since 1546, 250 years went by until the first vaccines against these pathogens were developed (1796 and 1800s). In contrast, Malaria, which is a protozoan-neglected disease, has been known since the 5th century BCE and, despite 2,500 years having passed since then, no human vaccine has yet been licensed for Malaria. Additionally, no modern human vaccine is currently licensed against Visceral or Cutaneous leishmaniasis. Vaccination against Malaria evolved from the inoculation of irradiated sporozoites through the bite of Anopheles mosquitoes in 1930's, which failed to give protection, to the use of controlled human Malaria infection (CHMI) provoked by live sporozoites of Plasmodium falciparum and curtailed with specific chemotherapy since 1940's. Although the use of CHMI for vaccination was relatively efficacious, it has some ethical limitations and was substituted by the use of injected recombinant vaccines expressing the main antigens of the parasite cycle, starting in 1980. Pre-erythrocytic (PEV), Blood stage (BSV), transmission-blocking (TBV), antitoxic (AT), and pregnancy-associated Malaria vaccines are under development. Currently, the RTS,S-PEV vaccine, based on the circumsporozoite protein, is the only one that has arrived at the Phase III trial stage. The "R" stands for the central repeat region of Plasmodium (P.) falciparum circumsporozoite protein (CSP); the "T" for the T-cell epitopes of the CSP; and the "S" for hepatitis B surface antigen (HBsAg). In Africa, this latter vaccine achieved only 36.7% vaccine efficacy (VE) in 5-7 years old children and was associated with an increase in clinical cases in one assay. Therefore, in spite of 35 years of research, there is no currently licensed vaccine against Malaria. In contrast, more progress has been achieved regarding prevention of leishmaniasis by vaccine, which also started with the use of live vaccines. For ethical reasons, these were substituted by second-generation subunit or recombinant DNA and protein vaccines. Currently, there is one live vaccine for humans licensed in Uzbekistan, and four licensed veterinary vaccines against visceral leishmaniasis: Leishmune® (76-80% VE) and CaniLeish® (68.4% VE), which give protection against strong endpoints (severe disease and deaths under natural conditions), and, under less severe endpoints (parasitologically and PCR-positive cases), Leishtec® developed 71.4% VE in a low infective pressure area but only 35.7% VE and transient protection in a high infective pressure area, while Letifend® promoted 72% VE. A human recombinant vaccine based on the Nucleoside hydrolase NH36 of Leishmania (L.) donovani, the main antigen of the Leishmune® vaccine, and the sterol 24-c-methyltransferase (SMT) from L. (L.) infantum has reached the Phase I clinical trial phase but has not yet been licensed against the disease. This review describes the history of vaccine development and is focused on licensed formulations that have been used in preventive medicine. Special attention has been given to the delay in the development and licensing of human vaccines against Protozoan infections, which show high incidence worldwide and still remain severe threats to Public Health.

Measles and the Modern History of Vaccination.

The modern era of vaccination was heralded with the licensure of the first 2 measles vaccines in 1963. This new era was distinct from the preceding era of vaccination for 4 main reasons. First, federal leadership in support of immunization at the local level grew. Second, immunization proponents championed the required vaccination of children as the best means of ensuring a protected population. Third, immunization proponents championed the idea that mass vaccination would not only help manage infectious diseases but also eradicate them. Fourth, the focus of local and federally supported immunization initiatives began to extend to the "mild" and "moderate" diseases of childhood (eg, measles), so-called because they were seen as less severe than previous targets of mass vaccination, such as smallpox, polio, and diphtheria. This article follows the history of measles to explore immunization successes and challenges in this modern era, because measles was the first of the mild and moderate diseases to become the target of a federally supported eradication-through-vaccination campaign, one that relied heavily on the preemptive, required vaccination of children. Its story thus epitomizes the range of political, epidemiological, cultural, and communications challenges to mass immunization in the modern era of vaccination.

[The battle in Madrid over poliomyelitis vaccines (1963): science, ideology and power in the first mass immunization campaign in Spain]. / La batalla de Madrid por las vacunas antipoliomielitis (1963): ciencia, ideología y poder en la primera campaña de inmunización masiva en España.

Between 1958 and 1963, Spain witnessed the highest ever incidence of poliomyelitis (2000 cases and 200 deaths per year). Although Salk's inactivated vaccine had arrived in Spain in 1957, the government took no decisive action to administer it to the entire population at risk. Neither was Sabin's attenuated vaccine administered, available in Europe from 1960. While other countries adopted one or the other, in Spain rivalry arose over the two vaccines, with mixed results. The Salk vaccine was administered to a small percentage of the population at risk through the Compulsory Sickness Insurance scheme (Spanish initials: SOE), while at the same time a research team at the National School of Health led by Florencio Pérez Gallardo (1917-2006) carried out a model epidemiological study that demonstrated the superiority of the Sabin vaccine. In 1963, the SOE launched a national campaign with the Salk vaccine promoted by the paediatrician Juan Bosch Marín (1902-1995), a representative of the most conservative structure of the Franco regime. The dispute over which vaccine was best reached its peak in early 1963 at various scientific conferences in Madrid. Bosch Marín's group argued in favour of his campaign and the Salk vaccine, while Pérez Gallardo did the same for the oral vaccine, achieving a substantial impact by inviting Sabin himself to speak. By the end of the year, following a pilot study, the first mass oral vaccination campaign against polio was introduced in Spain.

Effect of vaccination programmes on mortality burden among children and young adults in the Netherlands during the 20th century: a historical analysis.

BACKGROUND: In the 20th century, childhood mortality decreased rapidly, and vaccination programmes are frequently suggested as a contributing factor. However, quantification of this contribution is subject to debate or absent. We present historical data from the Netherlands that allow us to quantify the reduction in childhood mortality burden for vaccine-preventable diseases in this period as a function of vaccination coverage. METHODS: We retrieved cause-specific and age-specific historical mortality data from Statistics Netherlands from 1903 to 2012 (for Dutch birth cohorts born from 1903 to 1992), and data for vaccination coverage since the start of vaccination programmes from the Dutch Health Care Inspectorate and the Dutch National Institute for Public Health and the Environment. We also obtained birth and migration data from Statistics Netherlands. We used a restricted mean life-time method to estimate cause-specific mortality burden among children and young adults for each birth cohort as the years of life lost up to age 20 years, excluding migration as a variable because this did not affect the results. To correct for long-term trends, we calculated the cause-specific contribution to the total childhood mortality burden. FINDINGS: In the prevaccination era, the contribution to mortality burden was fairly constant for diphtheria (1·4%), pertussis (3·8%), and tetanus (0·1%). Around the start of mass vaccinations, these contributions to the mortality burden decreased rapidly to near zero. We noted similar patterns for poliomyelitis, mumps, and rubella. The number of deaths due to measles around the start of vaccination in the Netherlands were too few to detect an accelerated rate of decrease after mass vaccinations were started. We estimate that mass vaccination programmes averted 148 000 years of life lost up to age 20 years (95% prediction interval 110 000-201 000) among children born before 1992. This corresponds to about 9000 deaths averted (6000-12 000). INTERPRETATION: Our historical time series analysis of mortality and vaccination coverage shows a strong association between increasing vaccination coverage and diminishing contribution of vaccine-preventable diseases to overall mortality. This analysis provides further evidence that mass vaccination programmes contributed to lowering childhood mortality burden. FUNDING: Dutch Ministry of Health, Welfare and Sport.

Las campañas de vacunación contra la poliomielitis en Jerez de la Frontera (1963-1965) / As campanhas de vacinação contra a poliomielite em Jerez de la Frontera (1963-1965) / Vaccination campaigns against polio in Jerez de la Frontera (1963-1965)

En el presente artículo nos hemos planteado como objetivo estudiar las dos fases de la campaña de vacunación contra la poliomielitis de los años 1963 y 1964, con la vacuna oral Sabin, en la ciudad de Jerez de la Frontera (Cádiz). Asimismo exponemos datos de la campaña de vacunación del año 1965 contra la poliomielitis, la difteria, la tos ferina y el tétanos en la referida ciudad. Hemos utilizado en nuestro estudio fuentes documentales originales del Archivo Municipal de Jerez y de otros archivos y bibliotecas de la provincia, así como prensa local, regional y nacional, que nos ofrecen información sobre las campañas de vacunación que han motivado nuestra investigación (AU)

Neste artigo temos que definir o objetivo de estudar as duas fases da campanha de vacinação contra a poliomielite em 1963 e 1964, com a vacina oral Sabin, na cidade de Jerez de la Frontera (Cádiz). Os dados também expor a campanha de vacinação contra a poliomielite em 1965, a difteria, coqueluche e tétano naquela cidade. Nós utilizado em nosso estudo fontes documentais originais Jerez Arquivos Municipais e outros arquivos e bibliotecas da província, bem como da imprensa local, regional e nacional, que nós fornecemos informações sobre as campanhas de vacinação que motivaram nossa pesquisa (AU)

The aim of this article is to study the two phases of the poliomyelitis’ vaccination campaign in the years 1963 and 1964, with the Sabin oral vaccine, in the city of Jerez de la Frontera (Cádiz). We also expound some data about the vaccination campaign in 1965 against polio, diphtheria, whooping cough and tetanus in the same city. We have used, in our study, original documents sources from Municipal Archives of Jerez, other archives and libraries of the province, as well as local, regional and national press, which have provided us some information on the mentioned vaccination campaigns (AU)

The Entangled History of Sadoka (Rinderpest) and Veterinary Science in Tanzania and the Wider World, 1891-1901.

Scholarship on the Tanzanian Rinderpest epizootic of the 1890s has assumed that German colonizers understood from the start that they were confronting the same disease that had afflicted Eurasia for centuries. Outward indicators of the epizootic, known locally as sadoka, especially wildlife destruction, were unknown in Europe, leading German veterinarians to doubt that the African disease was Rinderpest. Financial constraints and conflicting development agendas, especially tension between ranching and pastoralism, deterred early colonial applications of veterinary science that might have led to an early diagnosis. European veterinarians, guarding their authority against medical researchers, opposed inoculation therapies in the case of Rinderpest in favor of veterinary policing despite recent breakthroughs in vaccine research. The virus was not identified before reaching South Africa in 1896, but this breakthrough had little influence on policy in East Africa. Yet emergent international disease conventions directed at bubonic plague entangled with veterinary policy in East Africa.

'Fight TB with BCG': mass vaccination campaigns in the British Caribbean, 1951-6.

Based on a wide range of primary materials, including WHO reports and Colonial Office correspondence, this article examines the UNICEF/WHO-funded mass BCG campaigns that were carried out in seven Caribbean colonies between 1951 and 1956. It explores the reasons behind them, their nature and aftermath and also compares them to those in other non-European countries and discusses them within a context of decolonisation. In doing so, it not only adds to the scholarship on TB in non-European contexts, which had tended to focus on Africa and Asia, but also to the relatively new field of Caribbean medical history and the rapidly expanding body of work on international health, which has paid scant attention to the Anglophone Caribbean and the pre-independence period.

The contribution of vaccination to global health: past, present and future.

Vaccination has made an enormous contribution to global health. Two major infections, smallpox and rinderpest, have been eradicated. Global coverage of vaccination against many important infectious diseases of childhood has been enhanced dramatically since the creation of WHO's Expanded Programme of Immunization in 1974 and of the Global Alliance for Vaccination and Immunization in 2000. Polio has almost been eradicated and success in controlling measles makes this infection another potential target for eradication. Despite these successes, approximately 6.6 million children still die each year and about a half of these deaths are caused by infections, including pneumonia and diarrhoea, which could be prevented by vaccination. Enhanced deployment of recently developed pneumococcal conjugate and rotavirus vaccines should, therefore, result in a further decline in childhood mortality. Development of vaccines against more complex infections, such as malaria, tuberculosis and HIV, has been challenging and achievements so far have been modest. Final success against these infections may require combination vaccinations, each component stimulating a different arm of the immune system. In the longer term, vaccines are likely to be used to prevent or modulate the course of some non-infectious diseases. Progress has already been made with therapeutic cancer vaccines and future potential targets include addiction, diabetes, hypertension and Alzheimer's disease.

Vida, engenho e arte: o acervo histórico da Fundação Oswaldo Cruz / Life skill and art: the historical collection of the Oswaldo Cruz Foundation

Livro de fotografias sobre o acervo histórico da Fiocruz, formado em mais de um século por meio de expedições científicas, campanhas sanitárias e diversas atividades de pesquisa e ensino realizadas em seus laboratórios. Fotografias históricas de Joaquim Pinto somam-se às contemporâneas de Bruno Veiga para exibição deste amplo acervo de conhecimento, que encontra-se no campus de Manguinhos, no Rio de Janeiro, onde há um castelo mourisco, além de edificações centenárias em estilo eclético e modernista. Em breves artigos, historiadores e outros especialistas contextualizam a formação de cada tipo de acervo, revelando, também, aspectos da evolução da saúde pública no Brasil.

Benefits of lethal pandemics: direct impact of contagious diseases on public administration in Hungary (1867-1914).

The reconciliation of 1867 between Austria and Hungary brought great changes to Hungarian public administration: the way towards the building up of a modern public administration had been opened. Although there was a functioning public health system and a related legislation from the late 18th century, major issues - such as balanced geographical distribution of medical personnel, fair access to medical services even in the poorer regions of the country, and the effective protection against some contagious diseases - were not resolved for decades. During the reform work of public administration since the 1870s, the lawmakers touched repeatedly the framework and functioning of the public health as well. Although the general conditions of the domain depended traditionally on the municipalities and counties due to the national importance of the matter, the government made efforts to make the functioning of the public health more efficient through centralisation. The contagious diseases continuously endangered the population, revealing the weak points in the existing public health system, thereby giving a momentum to the reforms and helping the government in its organization of prevention and clearly contributing to the legislation work.