PHO Rounds: Congenital Rubella Syndrome Prevention and the “Paradoxical Effect”

This Public Health Ontario (PHO) Rounds describes the position that was recently made for introducing universal rubella vaccines. It is a case study in using new evidence to address inequity through policy change. The key elements to achieving change in many public health systems are common, requiring scientific evidence from observational data and mathematical modeling complemented by the action of a strong global alliance able to navigate the policy arena.
Congenital rubella syndrome (CRS) is caused by infection with rubella virus early in pregnancy and causes devastating damage to infants. CRS has been eliminated from Canada but remains a major inequity and ongoing risk in countries without access to rubella vaccine, where 32,000 children with CRS are born annually. Barriers to accessing rubella vaccine have included a World Health Organization (WHO) policy that countries should reach at least 80% immunization coverage either through routine immunization or campaigns, designed to avoid the risk of the “paradoxical effect”.
By the end of this session, participants will be able to:
• Describe inequity in countries’ access to rubella vaccine and the implications for the global burden of congenital rubella syndrome and rubella elimination
• Define the “paradoxical effect” as it applies to immunization coverage
• Outline the key elements needed to change global immunization policy
• Apply the global case study to the elements needed to strengthen local public health policy development
Presenter(s): Dr. Natasha S. Crowcroft
The presentation can be found here: www.publicheal...