{{Short description|Administration of a vaccine to large populations}} {{Vaccination}} '''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.<ref name=":0">{{Cite news | vauthors = Florio J, Shapiro O |date=2020-12-18 |title=How New York City Vaccinated 6 Million People in Less Than a Month |language=en-US |work=The New York Times |url=https://www.nytimes.com/2020/12/18/nyregion/nyc-smallpox-vaccine.html |access-date=2022-08-04 |issn=0362-4331}}</ref>
==Historic mass vaccinations== === Measles === Measles is a viral infection known for its highly contagious properties.<ref name=":32">{{Cite journal |last=Moss |first=William J |date=December 2017 |title=Measles |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673617314630 |journal=The Lancet |language=en |volume=390 |issue=10111 |pages=2490–2502 |doi=10.1016/S0140-6736(17)31463-0|pmid=28673424 |url-access=subscription }}</ref> 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.<ref name=":32" /> 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.<ref>{{Cite web |last=CDC |date=2025-01-17 |title=Measles Vaccination |url=https://www.cdc.gov/measles/vaccines/index.html?CDC_AA_refVal=https://www.cdc.gov/vaccines/vpd/mmr/public/index.html |access-date=2025-03-18 |website=Measles (Rubeola) |language=en-us}}</ref> Management of measles, not prevention of measles, can be accomplished with vitamin A supplementation.<ref name=":32" />
====Measles History====
Measles was first described by physicians in the 9th century.<ref name=":03">{{Cite journal |last=Conis |first=Elena |date=March 2019 |title=Measles and the Modern History of Vaccination |journal=Public Health Reports |language=en |volume=134 |issue=2 |pages=118–125 |doi=10.1177/0033354919826558 |pmid=30763141 |pmc=6410476 |issn=0033-3549}}</ref> In the centuries after, as explorers traveled from their borders and encountered new populations, these previously unexposed groups were acutely effected by measles.<ref name=":03" /> It wasn't until 1757 that Francis Home discovered the cause of measles to be as a result of infection from a pathogen.<ref name=":03" /> 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.<ref name=":03" /> Globally, there is still a documented yearly occurrence of 2 million deaths from 30 million cases.<ref name=":03" />
==== Vaccine Development ==== John Franklin Enders developed a live measles vaccine which underwent testing from 1958 to 1960, followed by public licensing in 1963.<ref name=":03" /> 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.<ref name=":12">{{Cite web |last=CDC |date=2024-05-20 |title=History of Measles |url=https://www.cdc.gov/measles/about/history.html |access-date=2025-03-12 |website=Measles (Rubeola) |language=en-us}}</ref> In 1971, the Measles vaccine began to be produced as a combined vaccine with two other newly developed vaccines: mumps and rubella (MMR Vaccine).<ref name=":12" /> In 1989, the two-dose regimen of the MMR vaccine began due to improved immunity developed from two doses rather than one.<ref name=":12" />
====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.<ref name=":03" /> By 1965, President Lyndon B. Johnson worked with Congress to extend the Vaccination Assistance Act to cover Measles.<ref name=":03" /> In 1967, Johnson and the CDC set out to eradicate measles and saw a drop in weekly measles cases from 1,000 to 200.<ref name=":03" /> Cases of measles dropped in 1968 with 22,000 cases compared to 450,000 cases per year prior to the advent of the vaccine.<ref name=":03" /> Following an uptick in cases in the early 1970s President Jimmy Carter set a goal for 90% vaccination, achieved partly through school mandates.<ref name=":03" /> 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.<ref name=":03" /> Through the 80's and early 90's, vaccination hesitancy picked up steam.<ref name=":03" /> This was met by President Bill Clinton with the Comprehensive Child Immunization Act of 1993.<ref name=":03" /> By 2000, the last full year of his second term, the United States officially declared measles had been eradicated.<ref name=":12" />
====Barriers to Efforts====
As with any mass vaccination effort, vaccine-hesitancy remains a major barrier to maintaining low levels of measles cases.<ref name=":22">{{Cite web |title=World Health Organization (WHO) |url=https://www.who.int/ |access-date=2025-03-12 |website=www.who.int |language=en}}</ref> 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.<ref name=":22" /> In the wake of the article, negative news coverage of the MMR vaccine increased along with vaccine skepticism.<ref>{{Cite journal |last1=Motta |first1=Matthew |last2=Stecula |first2=Dominik |date=2021-08-19 |editor-last=Useche |editor-first=Sergio A. |title=Quantifying the effect of Wakefield et al. (1998) on skepticism about MMR vaccine safety in the U.S. |journal=PLOS ONE |language=en |volume=16 |issue=8 |article-number=e0256395 |doi=10.1371/journal.pone.0256395 |doi-access=free |bibcode=2021PLoSO..1656395M |issn=1932-6203|pmc=8376023 }}</ref> "The Lancet" retraced the paper in 2010 for incorrect data resulting from the study and for unethical treatment of the children in the study.<ref>{{Cite journal |last=Eggertson |first=L. |date=2010-03-09 |title=Lancet retracts 12-year-old article linking autism to MMR vaccines |journal=Canadian Medical Association Journal |language=en |volume=182 |issue=4 |pages=E199–E200 |doi=10.1503/cmaj.109-3179 |pmid=20142376 |issn=0820-3946|pmc=2831678 }}</ref> Due to the high infectivity rate of measles, the vaccination level to reach 'herd immunity' is 95%.<ref name=":22" /> 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.<ref name=":22" /> Despite previously declaring measles had been eliminated in the US, there is now a Measles resurgence in the United States.<ref name=":03" />
=== Smallpox === ==== Early successes in eradication (prior to 1950) ==== In 1947, after a man traveled from Mexico to New York City and developed smallpox, Dr. Israel Weinstein announced to the residents of New York the need to get vaccinated. Vaccine clinics were established throughout the city and within less than a month, 6,350,000 residents were vaccinated.<ref name=":0" /> This was enabled by improvements in vaccine production and storage. Prior to new developments, transportation represented a major issue and hindered mass vaccinations.<ref name="Belongia_2003">{{cite journal | vauthors = Belongia EA, Naleway AL | title = Smallpox vaccine: the good, the bad, and the ugly | journal = Clinical Medicine & Research | volume = 1 | issue = 2 | pages = 87–92 | date = April 2003 | pmid = 15931293 | pmc = 1069029 | doi = 10.3121/cmr.1.2.87 }}</ref> Because smallpox vaccination requires a live virus, it originally required a sample to be transferred from person-to-person or animal-to-person directly.<ref name="Belongia_2003" /> The creation of a liquid vaccine stored in capillary tubes marked a major advancement for the smallpox vaccine.<ref name="Fenner_1988">{{Cite book |title=Smallpox and its eradication |date=1988 |publisher=World Health Organization | vauthors = Fenner F |isbn=92-4-156110-6 |location=Geneva |oclc=19521677}}</ref> This method involved the use of glycerol as a preservative and was significant for storage and transportation.<ref name="Fenner_1988" /> In addition to these benefits, it enabled mass production through the use of animals, and ensured long term viability at temperatures below freezing.<ref name="Fenner_1988" /> However, this method was insufficient to enable widespread vaccination in tropical regions of the world, and thus was largely restricted to temperate countries.<ref name="Fenner_1988" /> Compulsory vaccinations were used throughout the beginning of the 20th century in a most of these countries, which led to the decline of smallpox.<ref name="Fenner_1988" /> For countries such as the United States, Canada, the United Kingdom, and some other European countries, outbreaks were quickly shut down by strong public health policies.<ref name="Fenner_1988" /> Soon, the more deadly Variola Major smallpox variant steadily declined, and endemics were only brought on by travelers from countries that lacked control over smallpox outbreaks.<ref name="Fenner_1988" /> It's important to note that the milder Variola Minor smallpox variant remained prevalent until the mid-20th century, as it often didn't warrant hospital visits or was misdiagnosed.<ref name="Fenner_1988" /> The success of health policies in controlling and eliminating smallpox by the 1950s in many countries led some to believe that the world eradication of smallpox would be possible.<ref name="Fenner_1988" />
==== Interest in worldwide eradication (1950-1959) ==== The creation of a heat stable, freeze-dried vaccine occurred in the 1950s.<ref name="Belongia_2003" /> Further improvements in freeze-drying technology allowed for the mass production of the vaccine at a commercial level.<ref name="Fenner_1988" /> The Health Assembly, a group within the World Health organization (WHO), began discussing the possibility of eliminating smallpox between 1950 and 1955.<ref name="Fenner_1988" /> The idea was ultimately rejected, as many viewed it an impossible task to take on. In 1958, a professor from the USSR, acting as a Health Assembly delegate, once again pushed the idea of smallpox being an issue for all countries, whether or not endemics are still occurring.<ref name="Fenner_1988" /> He presented a report to the Eleventh World Health Assembly, which argued that world eradication of the disease is possible, as shown by the success of countries that managed to eliminate it through health policy.<ref name="Fenner_1988" /> This was particularly significant as the professor, Viktor Zhdanov, had come to the conclusion on his own, without knowledge of arguments from previous World Health Assemblies. In this Zhdanov Report, he used the USSR as an example, arguing that the success of mandatory vaccinations throughout his country proves that it's possible to eliminate it in any country.<ref name="Fenner_1988" /> Zhdanov offered the support of the USSR, and backed the legitimacy of the report through the donation of millions of vaccines and previous offers of support to central-Asian countries.<ref name="Fenner_1988" /> The method of eradication would that was proposed involved the use of the newly developed freeze-dried vaccinations and mandatory vaccination.<ref name="Fenner_1988" /> Surveillance containment programs was also mentioned, which actually came to dominate in the later years of the eradication campaign.<ref name="Fenner_1988" /> Over the course of the next year, resolutions coordinating the start of the program, as well as to ensure the success of it, were made.<ref name="Fenner_1988" /> During the Twelve World Health Assembly in 1959, the proposal of an eradication campaign for smallpox was voted for successfully.<ref name="Fenner_1988" />
==== Smallpox eradication program (1960-1966) ==== The eradication of smallpox seemed to be easier and less costly than other previously eradicated diseases.<ref name="Fenner_1988" /> Smallpox had no vectors, as humans were the only reservoirs carrying the disease. Furthermore, the elimination of the disease would be mostly on mass vaccination and did not require vector control.<ref name="Fenner_1988" /> Directed by Donald Henderson, this first effort involved the use of mass vaccinations with a goal to have 80% of every country's population immunized.<ref name="Belongia_2003" /> Although the program was brought forth by WHO, implementation would largely depend on individual governments. WHO would be responsible for supporting the programs through vaccine production, and training of staff.<ref name="Fenner_1988" /> Each country would be required to cover most of the costs and actual functions of the program. A lack of universal commitment from countries hindered this campaign allowing smallpox to remain prevalent almost a decade later.<ref name="CDC_Smallpox_History">{{Cite web |date=2021-02-21 |title=History of Smallpox {{!}} Smallpox {{!}} CDC |url=https://www.cdc.gov/smallpox/history/history.html |access-date=2022-07-25 |website=www.cdc.gov |language=en-us}}</ref> This was particularly a problem in developing countries.<ref name="Belongia_2003" /> The WHO was not designed to provide considerable material support and close collaboration between countries on a wide scale.<ref name="Fenner_1988" /> Over the first few years of the program's initiation, a lack of donations of vaccines and money hindered the success of the program.<ref name="Fenner_1988" /> The WHO created the Expert Committee on Smallpox in 1964 due to the lack of progress. A report was released giving a more clear strategy to be implemented, in the form of different phases.<ref name="Fenner_1988" /> Based on outbreaks that occurred in India in regions that claimed to have more than 80% vaccination rates, the committee determined that 100% of the population would need to be vaccinated in the first mass vaccination phase. After this, they would focus on stopping subsequent cases and investigating them.<ref name="Fenner_1988" /> This was not well received during the Seventeenth World Health Assembly, in which many express doubts over the success especially with extreme vaccine shortages following a lack of donations.<ref name="Fenner_1988" /> It wasn't until 1965 that the USA increased commitment to the cause, yet not out of interest but because they were already starting a measles eradication campaign and felt this could be added on.<ref name="Fenner_1988" /> This along with continued support from the USSR led the WHO to develop an intensified program for smallpox eradication, however many members still lacked confidence in this new program's success.<ref name="Fenner_1988" />
==== Intensified smallpox eradication program (1967-1980) ==== From 1967, the Intensified Smallpox Program now called for surveillance reporting and investigation in addition to mass vaccination.<ref name="Fenner_1988" /> Teams were directed to find alternative or unique solutions in their regions.<ref>{{cite journal | vauthors = Bhattacharya S | title = The World Health Organization and global smallpox eradication | journal = Journal of Epidemiology and Community Health | volume = 62 | issue = 10 | pages = 909–912 | date = October 2008 | pmid = 18791049 | doi = 10.1136/jech.2006.055590 | pmc = 2602749 }}</ref> In the years following the initiation of this plan, the WHO saw an increase in qualified volunteers, contributions from countries and participation in their campaign.<ref name="Fenner_1988" /> They worked on increasing training of staff and publicizing the program worldwide. Improvements in procedures and technology had a significant effect on advancing the program.<ref name="Fenner_1988" /> Particularly, the invention of the bifurcated needle made administration of vaccines in the field more practical than the previously used jet-injectors.<ref name="Fenner_1988" /> The number of outbreaks, instead of the percent of population vaccinated, became the new focus.<ref name="Fenner_1988" /> By 1973, smallpox only remained a problem in five countries. Improved methods of surveillance and containment, as well as a large increase in support, was a critical part of finally eradicating smallpox.<ref name="Fenner_1988" /> The regions would contain the spread out smallpox through vaccinating anyone exposed to an infected person; this was the method of ring vaccination.<ref>{{Cite web |title=Disease Eradication |url=https://cpp-hov.netlify.app//vaccines-101/what-do-vaccines-do/disease-eradication |access-date=2022-08-01 |website=cpp-hov.netlify.app |language=en}}</ref> It would not be until May 8, 1980, during the World Health Assembly that smallpox was announced as officially eradicated.<ref name="Strassburg_1982">{{cite journal | vauthors = Strassburg MA | title = The global eradication of smallpox | language = English | journal = American Journal of Infection Control | volume = 10 | issue = 2 | pages = 53–59 | date = May 1982 | pmid = 7044193 | doi = 10.1016/0196-6553(82)90003-7 }}</ref>
==== Criticism of mass vaccination ==== Vaccination policies were not met without resistance, as countries that had mandatory vaccination policies saw a rise in antivaccination movements.<ref name="Fenner_1988" /> In Brazil, compulsory vaccination was met with riots.<ref name="Fenner_1988" /> The lack of control led to large outbreaks and many deaths.<ref name="Fenner_1988" /> Other countries had more success in vaccination, which led to Variola Minor replacing Variola Major as the cause of smallpox outbreaks in these countries.<ref name="Fenner_1988" /> Antivaccinationists rejected vaccination policy more, as this more mild form was not seen as significant.<ref name="Fenner_1988" /> This was particularly an issue in the United States as only some states had compulsory vaccination, while others banned or lacked laws for it.<ref name="Fenner_1988" /> ----
===Polio=== thumb|360x360px|A young Indian girl receiving a dose of oral polio vaccine by a trained healthcare worker. Poliomyelitis is a disease which causes lower body paralysis through the damage of motor neurons caused by three strains of the poliovirus.<ref name="Baicus_2012">{{cite journal | vauthors = Baicus A | title = History of polio vaccination | journal = World Journal of Virology | volume = 1 | issue = 4 | pages = 108–114 | date = August 2012 | pmid = 24175215 | pmc = 3782271 | doi = 10.5501/wjv.v1.i4.108 | doi-access = free }}</ref> Only 1% of polio cases actually result in paralysis.<ref name="Baicus_2012" /> In 1916, the United States experienced a polio epidemic which paralyzed over 27,000 people and lead to 6,000 deaths.<ref name="Baicus_2012" /> These outbreaks gradually became worse and worse as it spread throughout the Americas and to Europe.<ref name="Baicus_2012" /> Jonas Salk developed the first inactivated polio vaccine (IPV) in 1953 which was tested in a clinical trial that enrolled 1.6 million children in Canada, Finland and the United States.<ref name="Baicus_2012" /> With the distribution of Salk's vaccine, cases decreased from 13.9 to 0.8 cases per 100,000 in a period of only 7 years from 1954 to 1961.<ref name="Baicus_2012" /> By 1956, Albert Sabin had created the live-attenuated vaccine also known as the oral polio vaccine (OPV) which contained three types of wild polio strains.<ref name="Baicus_2012" /> After almost two decades in 1972, Sabin decided to donate his vaccine strains to the World Health Organization (WHO) which greatly increased the distribution and accessibility of the vaccine across the world.<ref name="Baicus_2012" />
In the years following the development of the vaccines from 1977 to 1995, children who had been fully vaccinated with all three doses of OPV had risen from 5% to 80%.<ref name="Baicus_2012" /> In 1988, the World Health Assembly decided to make efforts to completely eradicate polio by the year 2000 with a large amount of the progress occurring before the target date.<ref name="Bahl_2018">{{cite journal | vauthors = Bahl S, Bhatnagar P, Sutter RW, Roesel S, Zaffran M | title = Global Polio Eradication - Way Ahead | journal = Indian Journal of Pediatrics | volume = 85 | issue = 2 | pages = 124–131 | date = February 2018 | pmid = 29302865 | pmc = 5775388 | doi = 10.1007/s12098-017-2586-8 }}</ref> This effort was titled the Global Polio Eradication Initiative and has seen wild success with a decrease in 99% of cases worldwide by 2018.<ref name="Ahmad_2020">{{cite journal | vauthors = Ahmad T, Khan M, Musa TH, Hui J | title = Polio vaccination campaign in Pakistan: a step towards eradication or still a challenge in hand? | journal = Human Vaccines & Immunotherapeutics | volume = 16 | issue = 6 | pages = 1444–1445 | date = June 2020 | pmid = 32208950 | pmc = 7482792 | doi = 10.1080/21645515.2020.1717152 }}</ref> When the global campaign began in 1988, there were over 125 polio-endemic countries compared to only 20 by the year 2000.<ref name="Bahl_2018" /> Wealthier countries with better infrastructure were able to use more resources and introduce better health strategies to achieve herd immunity early on.<ref name="Bahl_2018" /> The WHO Region of the Americas declared themselves to be polio free in 1994.<ref name="Ahmad_2020" /> Following this enormous achievement, other WHO regions quickly followed with the Western Pacific Region declared polio free in 2000, the European Region in 2002 and South-East Asia Region in 2014.<ref name="Ahmad_2020" />
Mass vaccination strategies such as National Immunization Days were key to the success of the oral polio vaccine (OPV).<ref name="Minor_2014">{{cite journal | vauthors = Minor P | title = The polio endgame | journal = Human Vaccines & Immunotherapeutics | volume = 10 | issue = 7 | pages = 2106–2108 | date = 2014 | pmid = 25608050 | pmc = 4370356 | doi = 10.4161/21645515.2014.981115 }}</ref> In South America, transmission rates severely declined in the mid-1980s following the invention and widespread use of the OPV.<ref name="Minor_2014" /> With such an incredibly high amount of vaccinations within a short time frame, the overall incidence of Polio was decreased.<ref name="Minor_2014" /> Other countries such as India, were able to vaccinate over 120 million children in large scale vaccination days which became a regular occurrence.<ref name="Minor_2014" />
==== Polio campaigns in America ==== Several famous Americans helped pave the way for the acceptance of the polio vaccine in the United States. Franklin D. Roosevelt, one of the most famous polio patients in the world, created the National Foundation for Infantile Paralysis in 1938 which eventually became known as March of Dimes.<ref name="marchofdimes">{{Cite web |title=A history of the March of Dimes |url=https://www.marchofdimes.org/mission/a-history-of-the-march-of-dimes.aspx |access-date=2022-07-26 |website=www.marchofdimes.org |language=english}}</ref> The March of Dimes funded a large portion of the polio research all throughout the epidemic and eventually resulted in the development of the vaccine by Jonas Salk.<ref name="marchofdimes" /> Following the years after its invention and distribution, polio cases decreased from tens of thousands to only a handful per year.<ref name="marchofdimes" /> With the help of Elvis Presley, who took the vaccine publicly, the acceptance of the polio vaccine increased even further.<ref>{{Cite web | vauthors = Sick C |date=2020-12-15 |title=Polio vs. COVID-19, the history of mass vaccination campaigns |url=https://dayton247now.com/news/coronavirus/polio-vs-covid-19-the-history-of-mass-vaccination-campaigns |access-date=2022-08-04 | archive-url = https://web.archive.org/web/20210627205313/https://dayton247now.com/news/coronavirus/polio-vs-covid-19-the-history-of-mass-vaccination-campaigns | archive-date = 27 June 2021 |website=WRGT |language=en}}</ref> This act embodied three of the most important pillars of a behavioral change campaign: social influence, social norms and examples.<ref name="Hershfield_2021">{{Cite web | vauthors = Hershfield H, Brody I |date=2021 |title=How Elvis Got Americans to Accept the Polio Vaccine |url=https://www.scientificamerican.com/article/how-elvis-got-americans-to-accept-the-polio-vaccine/ |access-date=2022-07-26 |website=Scientific American |language=en}}</ref> Elvis Presley used his social influence to normalize getting the polio vaccine, which increased vaccination rates among American youth to over 80% in just under 6 months.<ref name="Hershfield_2021" /> These types campaigns were the heart of the mass vaccination efforts in America.<ref name="Hershfield_2021" />
==== Barriers to eradication ==== Despite the global efforts to vaccinate and eradicate polio, the virus still causes outbreaks every year.<ref name="Bigouette_2011">{{cite journal | vauthors = Bigouette JP, Wilkinson AL, Tallis G, Burns CC, Wassilak SG, Vertefeuille JF | title = Progress Toward Polio Eradication - Worldwide, January 2019-June 2021 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 70 | issue = 34 | pages = 1129–1135 | date = August 2021 | pmid = 34437527 | pmc = 8389387 | doi = 10.15585/mmwr.mm7034a1 }}</ref> As of 2021, only wild polio virus type 1(WPV1) affects the world and are localized in Afghanistan and Pakistan.<ref name="Bigouette_2011" /> The circulating vaccine-derived poliovirus (cVDPV) caused outbreaks in 32 countries in 2020.<ref name="Bigouette_2011" /> The cVDPV is a result of live oral poliovirus vaccine becoming infectious after extended circulation.<ref name="Bigouette_2011" /> This prompted an update to the Global Polio Eradication Initiative (GPEI) Strategy for the years 2022–2026.<ref name="Bigouette_2011" /> With the most recent update in August 2020, the WHO African Region was declared polio free leaving only one of the six WHO regions with polio.<ref name="Bigouette_2011" /> The GPEI's new initiatives focused on eradicating the WPV1 in both Afghanistan and Pakistan while also combating the new outbreaks of cVDPV.<ref name="Bigouette_2011" /> The difficulty arises when the world must not only eliminate the wild type polio virus but also the vaccine-derived form, making eradication even more complex.<ref name="Chumakov_2021">{{cite journal | vauthors = Chumakov K, Ehrenfeld E, Agol VI, Wimmer E | title = Polio eradication at the crossroads | language = English | journal = The Lancet. Global Health | volume = 9 | issue = 8 | pages = e1172–e1175 | date = August 2021 | pmid = 34118192 | doi = 10.1016/S2214-109X(21)00205-9 | s2cid = 235417843 | doi-access = free }}</ref> While both the live and inactivated polio vaccines were wildly successful in saving the world from the historic endemic, there still are drawbacks with each of the vaccines.<ref name="Chumakov_2021" /> The OPV vaccine was reverted to an infectious strain which led to the rise of the cVDPV.<ref name="Chumakov_2021" /> While the inactivated polio vaccine (IPV) protected the host, it was not strong enough to generate intestinal mucosa immunity and therefore did not prevent the transmission of the virus.<ref name="Chumakov_2021" /> These weaknesses suggest that more innovative vaccines or a combination of the two is needed to completely eradicate polio.<ref name="Chumakov_2021" /> ----
===Swine flu vaccination=== In 1918, the deadly H1N1 influenza virus which infected approximately 500 million people around the world and resulted in the deaths of 50 to 100 million people (3% to 5% of the world population).<ref>{{cite book |title=StatPearls |vauthors=Jilani TN, Jamil RT, Siddiqui AH |date=2022 |publisher=StatPearls Publishing |place=Treasure Island (FL) |chapter=H1N1 Influenza |pmid=30020613 |access-date=2022-07-26 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK513241/}}</ref> New York City had created two major mass immunization programs, the first was the smallpox immunization program initiated in 1947 and the second was the swine flu influenza program in 1976.<ref name="Minor_2014" />
For the first mass immunization campaign in 1947, the New York City Department of Health maintained the outbreak within a period of 29 days and vaccinated 6.35 million people successfully.<ref name="Minor_2014" /> Weinstein and colleagues established vaccination clinics at many locations such as at the Department of Health's 125 Worth Street headquarters, at the 21 district health centers, 60 child health clinics, and 13 municipal hospitals in order to accommodate for the high demand of people requesting for a vaccination.<ref name="Minor_2014" /> The smallpox vaccination effort was announced to be officially terminated on May 3, 1947.<ref name="Minor_2014" /> In which case, it was rather surprising to see that the second mass immunization campaign in 1976, which was a national immunization effort, was only able to accomplish vaccinating 639,000 against swine influenza over a period of 60 days.<ref name="Minor_2014" /> It was also noted that in 1976, the mass swine flu vaccination programme was discontinued after 362 cases of Guillain–Barré syndrome were identified among 45 million vaccinated people.<ref name="Minor_2014" /> The vast differences between the number of people vaccinated in 1947 versus 1976, despite the outbreaks, are reflected mainly by the public's skeptical perception of the minimal severity and low threat of swine flu.<ref name="Minor_2014" />
Swine flu, also known as H1N1 influenza A virus, is a type of infectious respiratory disease that has caused high economical and medical burden every year around the world.<ref name="He_2021">{{cite journal | vauthors = He W, Zhang W, Yan H, Xu H, Xie Y, Wu Q, Wang C, Dong G | display-authors = 6 | title = Distribution and evolution of H1N1 influenza A viruses with adamantanes-resistant mutations worldwide from 1918 to 2019 | journal = Journal of Medical Virology | volume = 93 | issue = 6 | pages = 3473–3483 | date = June 2021 | pmid = 33200496 | doi = 10.1002/jmv.26670 | s2cid = 226989536 }}</ref> There are important lessons to be learned from the recent 'Swine Flu' pandemic. Improving techniques are necessary in trying to decrease the spread of infection-both in the community and within our hospitals would mean improving infection control and hygiene, and the use of masks, alcohol hand rubs and so on.<ref>{{cite journal | vauthors = Collignon P | title = Swine flu: lessons we need to learn from our global experience | journal = Emerging Health Threats Journal | volume = 4 | page = 7169 | date = July 2011 | pmid = 24149036 | pmc = 3168221 | doi = 10.3402/ehtj.v4i0.7169 }}</ref>
A worldwide study was conducted which comprehensively analyzed adamantanes resistance in H1N1 influenza viruses from 1918 to 2019 and showed 77.32% H1N1 influenza variants demonstrating resistance to adamantanes.<ref name="He_2021" /> This study emphasizes the importance of global surveillance, especially in many third-world countries, as well as the evolution of drug-resistant H1N1 influenza variants in an effort to prevent another pandemic.<ref name="He_2021" />
==Contemporary usage== ===COVID-19=== The introduction of multiple COVID-19 vaccines throughout the pandemic such as Pfizer, Moderna, Johnson and Johnson, and the newly approved Novavax vaccine have helped allow large amounts of the population to get vaccinated.{{citation needed|date=July 2023}}
When COVID-19 was identified in December 2019 there were no vaccines readily available to vaccinate mass populations.<ref name="Solis-Moreira_2021" /> By December 2020, the Pfizer vaccine was the first to receive emergency use approval by the Food and Drug Administration.<ref name="Solis-Moreira_2021" /> Vaccines under normal circumstances can take up to 10–15 years to be made and approved.<ref name="Solis-Moreira_2021" /> Without worldwide collaboration, funding for research, and rigorous guidelines for clinical trials there would not have been a quickly developed vaccine.<ref name="Solis-Moreira_2021">{{Cite web | vauthors = Solis-Moreira J | veditors = Guildford A |date=2021-11-13 |title=COVID-19 vaccine: How was it developed so fast? |url=https://www.medicalnewstoday.com/articles/how-did-we-develop-a-covid-19-vaccine-so-quickly |access-date=2022-07-26 |website=www.medicalnewstoday.com |language=en}}</ref> thumb|COVID-19 Vaccines The type of vaccines that are available are messenger RNA, vector, and protein subunit. Messenger RNA vaccines work by giving cells specific instructions to make the S protein found on the surface of the COVID-19 virus.<ref name="Mayo_COVID_how_vaccines_work" /> It does not infect recipients of the vaccine with the virus but allows for the body to detect and fight the COVID-19 virus.<ref name="Mayo_COVID_how_vaccines_work" /> Both Pfizer and Moderna COVID-19 vaccines fall in to the messenger RNA category.<ref name="Mayo_COVID_how_vaccines_work" /> Vector vaccines also deliver instructions on how to make the S protein found on the surface of the virus.<ref name="Mayo_COVID_how_vaccines_work" /> It also does not cause the recipient to become infected with the virus after vaccination.<ref name="Mayo_COVID_how_vaccines_work" /> The Johnson & Johnson vaccine falls into the vector category.<ref name="Mayo_COVID_how_vaccines_work" /> Lastly the subunit vaccine only contains a part of the virus needed to create an immune response.<ref name="Mayo_COVID_how_vaccines_work" /> The S protein is the harmless subunit that will allow for an immune response when the COVID-19 virus is detected.<ref name="Mayo_COVID_how_vaccines_work" /> The Novavax vaccine falls into the subunit protein category.<ref name="Mayo_COVID_how_vaccines_work">{{Cite web |title=How do different types of COVID-19 vaccines work? |url=https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/different-types-of-covid-19-vaccines/art-20506465 |access-date=2022-07-26 |website=Mayo Clinic |language=en}}</ref>
When vaccinating large populations an action plan must be created to organize which groups will receive the vaccination first.<ref name="cdph_plan" /> The California Department of Public Health created an action plan to vaccinate by population group.<ref name="cdph_plan" /> First immunocompromised groups, second unvaccinated or not fully vaccinated, third under 12 populations, fourth boosters for those 65 and older, and lastly boosters for ages 12–64.<ref name="cdph_plan">{{Cite web |date=2022-07-25 |title=COVID-19 Vaccine Action Plan |url=https://www.cdph.ca.gov/programs/cid/dcdc/cdph%20document%20library/covid-19/vaccine-action-plan.pdf |website=California Department of Public Health}}</ref>[[File:Salisbury Mass Vaccination Site - 51053268081.jpg|thumb|right|A mass vaccination site at a stadium in Salisbury, Maryland|360x360px]]
As well as mass vaccination centers being established at many locations, such as stadiums led to many people getting vaccinated.<ref>{{cite web | vauthors = Otte J | url = https://www.theguardian.com/world/2021/jun/19/london-stadiums-host-super-saturday-of-mass-rapid-covid-vaccinations | title = London stadiums host 'super Saturday' of mass rapid Covid vaccinations | date = 19 June 2021 | access-date = 28 February 2022 | work = The Guardian }}</ref>
In the United States, NFL commissioner Roger Goodell offered the league's 30 stadiums as mass vaccination sites.<ref>{{Cite web |title=NFL Commissioner Roger Goodell writes to President Biden offering all stadiums as vaccine sites |url=https://www.nfl.com/news/roger-goodell-president-joe-biden-offering-stadiums-vaccine-sites |access-date=2022-08-04 |website=NFL.com |language=en-US}}</ref> As of April 2021, NFL stadiums have administered more than 2 million doses.<ref>{{Cite web |title=NFL stadiums, facilities hit 2 million COVID-19 vaccines administered |url=https://www.nfl.com/news/nfl-stadiums-facilities-hit-2-million-covid-19-vaccines-administered |access-date=2022-08-04 |website=NFL.com |language=en-US}}</ref> By December 2021, more than 100,000 people had received vaccinations at Indianapolis Motor Speedway.<ref>{{cite news | vauthors = Horrall Z |date=December 29, 2021 |title=No. 3: IMS works with Indiana to vaccinate over 100,000 |website=IMS.com |publisher=IMS LLC |url=https://www.indianapolismotorspeedway.com/news-multimedia/news/2021/12/29/ims-biggest-moments-mass-vaccination-clinic-2021 |access-date=May 20, 2022}}</ref>
Pharmacist have also played an important role in getting mass populations vaccinated since they are a skilled and trained workforce able to help increase vaccination rates.<ref>{{cite journal | vauthors = Lee L, Peterson GM, Naunton M, Jackson S, Bushell M | title = Protecting the Herd: Why Pharmacists Matter in Mass Vaccination | journal = Pharmacy | volume = 8 | issue = 4 | article-number = E199 | date = October 2020 | pmid = 33114654 | pmc = 7712642 | doi = 10.3390/pharmacy8040199 | doi-access = free }}</ref> Many people can turn to drug or convenience stores to get vaccinated since it can be a quick and easy place to access.<ref name="Noguchi_2021" /> Pharmacies have played a large roll in mass vaccination now more than ever due to the pandemic.<ref name="Noguchi_2021" /> Some states prior to the pandemic did not allow pharmacist to vaccinate or administer flu vaccines.<ref name="Noguchi_2021" /> Now, pharmacies are contracting with state and federal governments since they have become key players in vaccinations.<ref name="Noguchi_2021">{{Cite news | vauthors = Noguchi Y | date = January 22, 2021 |title=Mass Vaccination Efforts Thrust Pharmacies To Center Of COVID-19 Fight |language=en |work=NPR |url=https://www.npr.org/2021/01/22/959700130/mass-vaccination-efforts-thrust-pharmacies-to-center-of-covid-19-fight |access-date=2022-07-28}}</ref> Without the involvement of pharmacies mass vaccination would be difficult to achieve.<ref name="Noguchi_2021" /> in most communities 90% of people live within five miles of a pharmacy.<ref name="Noguchi_2021" /> Pharmacist can oftentimes be the quickest access to a healthcare provider, making it a desirable option for the public to come and get vaccinated.<ref name="Noguchi_2021" />
Not only have pharmacist been involved in COVID-19 vaccinations but pharmacy technicians as well.<ref name="DeMarco_2022" /> Pharmacy technicians have helped alleviate the workload on pharmacist with the large increase in demand for vaccinations.<ref name="DeMarco_2022" /> They also can create more opportunities to interact with people who are hesitant in getting the COVID-19 vaccines.<ref name="DeMarco_2022">{{cite journal | vauthors = DeMarco M, Carter C, Houle SK, Waite NM | title = The role of pharmacy technicians in vaccination services: a scoping review | journal = Journal of the American Pharmacists Association | volume = 62 | issue = 1 | pages = 15–26.e11 | date = 2022-01-01 | pmid = 34663566 | doi = 10.1016/j.japh.2021.09.016 | s2cid = 239027949 | doi-access = free }}</ref> Pharmacy technicians can support pharmacist which will allow more vaccination services to be accommodated efficiently and safety.<ref name="DeMarco_2022" /> These efforts will allow for an increase in vaccinations and help vaccinate large groups at a time.<ref name="DeMarco_2022" />
During the pandemic pharmacist have had a fundamental roll in sharing information about COVID-19 vaccines.<ref name="Terrie_2021" /> Pharmacist are a quick resource for information and can help relieve some common concerns about reactions or misinformation to the vaccines.<ref name="Terrie_2021">{{Cite journal | vauthors = Terrie YC |title=The Role of the Pharmacist in Overcoming Vaccine Hesitancy | journal = US Pharm | date = 2021 | volume = 45 | issue = 4 | pages = 28–31 |url=https://www.uspharmacist.com/article/the-role-of-the-pharmacist-in-overcoming-vaccine-hesitancy |access-date=2022-07-28 |language=en}}</ref> They are also advocates for getting vaccinated since they are educators and vaccine administrators.<ref name="Terrie_2021" /> Sharing information to the public about COVID-19 vaccines can help increase vaccinations rates.<ref name="Terrie_2021" /> Since pharmacist are easily accessible in the community setting they can help motivate or encourage getting vaccinated helping decrease preventable infections or diseases such as COVID-19.<ref name="Terrie_2021" />
Mass vaccination of COVID-19 vaccines is important to help stop the spread of the coronavirus and eventually end the pandemic.<ref name="CRF_2022" /> Individual governments have been allocating billions of dollars to increase production of vaccines to help with the current global manufacturing need of vaccines.<ref name="CRF_2022">{{Cite web |title=A Guide to Global COVID-19 Vaccine Efforts |url=https://www.cfr.org/backgrounder/guide-global-covid-19-vaccine-efforts |access-date=2022-07-29 |website=Council on Foreign Relations |language=en}}</ref> Countries such as the United States, Canada, and Australia were able to receive many vaccines early on due to them being wealthier countries.<ref name="CRF_2022" /> They were able to receive many doses enough to vaccinate their own countries but this left other lower-income countries with limited supply of the vaccines.<ref name="CRF_2022" /> With some countries receiving more vaccines than others this leads to inequitable distribution and can increase the risk of new outbreaks.<ref name="CRF_2022" /> Without proper global vaccine distribution it will make it more difficult to end the pandemic and allow for mass vaccination as a global effort.<ref name="CRF_2022" /> Amid the new strains of the coronavirus such as the omicron variant, scientist and healthcare officials have raised concern about reduced effectiveness of available vaccines.<ref name="CRF_2022" /> In response to a concern about vaccines having reduced effectiveness countries have encouraged booster shots for most of their population.<ref name="CRF_2022" /> The World Health Organization would like to prioritize unvaccinated people over booster doses so more of the population will have received their initial dose.<ref name="CRF_2022" />
== References == {{reflist}}
Category:Vaccination