Global immunization--a medical perspective.

The global community is close to achieving universal childhood immunization against a group of important childhood diseases--measles, tuberculosis, diphtheria, pertussis, tetanus and polio. In addition, polio has been targeted for eradication by the year 2000 and neonatal tetanus for elimination by 1995. There are targeted reductions in mortality and cases of measles by the same year. This paper addresses the difficult issue of how optimally to integrate these public health initiatives into local health care practices and beliefs. At the workshop on Global Immunization and Culture I presented the perspective of a physician who has worked with the Expanded Programme on Immunization and has understanding at a global level of the logistics of vaccine delivery. This paper serves as a counterpoint to others at the workshop by raising the question of whether routine vaccine delivery and special eradication efforts can be best carried out with a uniform, technologically based approach rather than extensive adaptation of the program to local conditions and beliefs. The reliance on a largely technological approach to control of these childhood diseases which occur in all societies independent of social behavior is contrasted with efforts to control HIV infection in which social structure and practices predict the occurrence of disease.