Global health and U.S. health--inextricably linked.

Abstract

There have been many triumphs in public health during the last half-century; however, none have been more significant than the advancements in vaccines that have contributed to a dramatic decline in child mortality and infectious disease in the United States and many other parts of the world. As recently as 1967, an estimated 2 million people were dying each year from smallpox. With the development of an effective vaccine and worldwide immunization campaign, the disease was eradicated by 1980. A quarter-century ago, polio was endemic in 125 countries and paralyzing an estimated 350,000 children every year. In 2013, there were just three polio-endemic countries (i.e., countries that have never terminated indigenous poliovirus transmission) remaining—Nigeria, Pakistan, and Afghanistan—and 400 reported cases.1 In the U.S., vaccine-preventable diseases (VPDs) are at or near record lows,2 thanks to new or improved vaccines and immunization systems that protect children against 16 diseases.3,4 In the U.S., our commitment to immunizations is also an investment in our children. A recent study estimated that vaccination of each U.S. birth cohort with the recommended childhood immunizations prevents 42,000 deaths and 20 million cases of disease over the lifetime of the cohort, with a net savings of about $13.5 billion in direct costs and nearly $69 billion in direct and indirect societal costs.5 It is hard to argue with such numbers. Yet, worldwide, VPDs still account for one of every five deaths among children younger than 5 years of age.6 That burden falls most heavily on poor countries, but the potential spread of infectious diseases poses a significant public health threat to people in all 50 states and the District of Columbia. For example, although the number of polio cases worldwide remains near the record low, reported wild poliovirus cases in countries that had previously eliminated polio increased from six cases in 2012 to 256 cases in 2013. The increase is largely attributable to the difficulty of reaching children in areas of conflict and civil war.7 In the U.S. in 2013, there was a significant spike in measles cases, due almost entirely to people who brought the infection home after traveling overseas.8 Both examples are reminders that infectious diseases can strike people anywhere, and that U.S. health is inextricably linked to global health.