World Immunization Week takes place during the last week of April each year. The World Health Organization (WHO) and its partners sponsor the event to promote global vaccination practices as the most effective way to protect people from disease.
The 2020 theme, #VaccinesWorkforAll, celebrates the frontline medical professionals who develop and administer vaccines, along with the citizens who get vaccinated. WHO also designated 2020 as the International Year of the Nurse and the Midwife to highlight accolades for their vaccine delivery.
Read on for 10 facts about vaccines and the roles of nurses.
1. Vaccine development began in the 18th century.
Known as the pioneer of immunization, British physician Edward Jenner observed that people who contracted cowpox, a disease similar to smallpox, were immune from the disease once they recovered. He used that knowledge to contribute to the development of a smallpox vaccine. In Jenner’s time, more than 3,500 people died of smallpox in London alone. Globally, outbreaks of the disease spanned 3,000 years, killing an average of three out of 10 people who contracted it. Due to vaccination programs around the world, WHO declared smallpox eradicated in 1980.
After the development of the smallpox vaccine, others followed, including:
- Cholera in 1885
- Rabies in 1885
- Typhoid in 1896
- Diphtheria in 1923
- Yellow fever in 1936
- Pertussis in 1939
- Influenza in 1945
- Polio in 1960
- Measles in 1963
- Mumps in 1967
- Rubella in 1969
- Hepatitis B in 1986
- Hepatitis A in 1995
- Chickenpox in 1996
- Human papillomavirus in 2006
2. Nurses have long played a prominent role in delivering and advocating for vaccines.
Throughout the early 20th century, public health nurses in eastern U.S. cities made house calls and began staffing immunization clinics. These efforts saved many people from contracting diseases like polio and tuberculosis, the latter of which was the biggest killer of U.S. citizens in 1900. Nurses also saved many lives during the 1918 influenza outbreak, along with the 2009 H1N1 epidemic, by administering vaccines at public immunization clinics.
Nursing organizations also advocate for increased access to and awareness of immunization, including the 317 Coalition, which lobbies the federal government to invoke Section 317 of the Public Health Service Act to provide more funding for immunization of uninsured Americans. In 2017, the American Nurses Association (ANA) included its signature on a letter to the U.S. President presenting evidence of vaccine safety and citing the importance of continuing immunization programs, given such events as the 2014 measles outbreak at Disneyland.
3. Vaccines prevent disease.
Vaccines artificially activate the immune system by injecting the same germs that cause illness. Vaccines mildly infect people so they don’t get sick, but instead develop immunities that prevent them from getting sick. WHO reports that vaccines prevented 10 million deaths worldwide from 2010-2015.
Immunization success stories include an 80% drop in measles cases in the U.S., between 1980 and 1981. In 1994, polio was declared eradicated from the Americas, followed by Europe in 2002. As of 2017, polio remains in only three countries due to the development of a new and more effective vaccine in 2010.
Pandemics are still a serious challenge, with the current coronavirus crisis and recent influenza outbreaks at the forefront. The 1918 flu pandemic killed an estimated 50 million people, none of whom were vaccinated as one did not yet exist. Today, flu vaccines reduce illness by 40%-60%. During 2017-2018, immunization prevented an estimated 5,700 deaths from influenza.
4. The timing of a COVID-19 vaccine remains uncertain.
Progress on a COVID-19 vaccine will surely be a prominent topic during World Immunization Week. In Washington state, where the first U.S. cases appeared, Kaiser Permanente Washington Health Research Institute, with funding from the National Institute of Health, initiated a clinical trial this March in Seattle. The six-week trial will enroll 45 healthy adults to test for immune responses from an investigational vaccine. The vaccine development harkens to studies on SARS and MERS, even though people cannot yet receive vaccinations against those two viruses.
Current estimates indicate a 12-18 month timeframe to release the vaccine for widespread use. Even then, scientists and physicians fear that the vaccine will not undergo full testing for safety. As the number of cases rises across the globe, vaccine development in research labs and pharmaceutical companies continues in China, Hong Kong, Australia, Canada, England, and the U.S.
5. Lack of vaccinations can result in outbreaks.
As we suffer through the coronavirus crisis, it remains clear that the largest outbreaks of highly contagious diseases tend to occur before a vaccine has been developed — and also return during times of low vaccine rates.
From 1989-1991, measles resurged in the U.S. primarily in areas where as few as 50% of children had been vaccinated. A total of 123 people died, 90% of whom were not vaccinated. Measles returned in 2008, with more than 90% of cases occurring in those who were not vaccinated or with unknown immunization status.
- In 2010, California’s health department reported a 418% increase in pertussis cases compared to the previous year, with 89% in infants too young for immunization.
- From 2010-11, cholera killed 4,787 in Haiti after the earthquake due to logistical problems administering vaccinations.
- In 2013, due to war and immunization disruption, Syria reported an outbreak of polio, which had not appeared there since 1999.
6. Nurses staff the front lines of immunization.
Nurses, especially registered nurses (RNs) and nurse practitioners (NPs), routinely deliver vaccines as part of their job duties. They also provide patients with evidence-based information about vaccine safety, potential side effects, and the importance of immunization. In some countries, nurses administer all vaccinations.
A challenge for nurses and others in healthcare lies in convincing reluctant patients to become vaccinated. If people don’t see people sick from the disease, they don’t believe it poses a danger. Nurses must often advise that remaining unvaccinated can affect both patients and their families.
Nurses often fill the gap between patients and doctors. In rural areas, a shortage of primary care providers can mean that communities look to nurses for immunization advice and administration. School nurses also play a significant role in advising students and families about vaccine requirements, while organizations, such as the National Association of School Nurses, recommend implementing school-based vaccination programs.
7. Nurses can access vaccine safety information to stay up to date.
Nurses must stay informed about clinical practices, vaccine availability, regulations, and other topics concerning safe immunization. The Centers for Disease Control (CDC) monitors vaccine safety and offers online resources to help healthcare professionals communicate accurate information to their patients. These resources include links to websites with reports, data, and inquiry portals.
Examples of available CDC information include immunization schedules, lists of current shortages and delays, and instructions for reporting adverse effects. WHO offers a wealth of international immunization information, such as standards, programs, news briefs, publications, position papers, and statistics.
Nurses can access ANA continuing education resources such as recommendations, guidelines, and applicable law compliance summaries; books and journal articles; resources on vaccines for specific diseases; and fact sheets. The CDC website offers webinars, modules, online and self-study training courses, conference calls, a video and guide on obtaining continuing education credit, and quality improvement projects for certification renewal.
8. Not all nurses can prescribe vaccines.
The International Council of Nurses conducted a survey of nursing associations in 15 unidentified Office of Economic Cooperation and Development (OECD) countries. The OECD includes 36 countries worldwide, including the U.S. Survey results revealed that just 33% of nurses can prescribe vaccines. All states, excluding Arkansas, Michigan, and New Mexico, permit NPs to prescribe vaccines under the supervision of a physician. However, only 18 states allow NPs to prescribe vaccines on their own authority. RNs can prescribe under supervision only in Florida, Minnesota, Oregon, and Texas.
The inability of nurses to independently prescribe the vaccines they regularly administer ranked among the OECD countries surveyed as the greatest barrier to nurses’ roles in immunization. There are currently ongoing attempts to change regulations to allow nurses to prescribe vaccines. Countries that allow nurses to prescribe cited additional professional requirements, such as specific practice experience and prescription education, along with supervised training and mentoring.
9. Nurses need vaccines themselves.
Along the same lines of the adage, “doctors make the worst patients,” nurses sometimes neglect their own health. Medical professionals focus entirely on other people’s health day after day and can forget about their own wellness amid their busy schedules. Nurses’ exposure to infectious diseases makes it all the more important for them to receive regular vaccinations. It keeps them and their families healthy, along with reducing the risk to their patients of contracting viruses.
First and foremost, nurses need a flu shot every fall. All nurses, but particularly those who work with infants, need a tetanus, diphtheria, and pertussis vaccine. Other important immunizations include hepatitis B, meningococcal, varicella, measles, mumps, and rubella. To keep nurses and their patients safe from influenza, the ANA strongly recommends urging their family members and coworkers to become immunized; practicing thorough handwashing; and using safety needles and standing orders for vaccine administration.
10. Nurses work tirelessly in the fight to prevent and contain diseases.
All over the world, nurses work long hours protecting patients and fighting diseases, often risking their health to help others. The current novel coronavirus pandemic highlights the sacrifices nurses make each day. While the race to develop a COVID-19 vaccine continues, nurses work in testing centers and treatment facilities. Once a vaccine becomes available, it will surely fall to nurses to administer it to thousands of people.
In the meantime, nurses and other medical professionals maintain close contact with highly contagious and severely ill patients without proper protection, due to a shortage of face masks. To rectify this situation, nurses, healthcare staff, and volunteers sew and fashion homemade masks out of craft and hardware store materials.
Across Spain, citizens confined to their homes step onto their balconies each night to applaud doctors and nurses. Their heroic efforts deserve recognition and celebration, especially during the Year of the Nurse.