Whooping cough is on the rise globally, and there are significant challenges in controlling the disease. Here, Susie Barnes – SVP, Global Medical Affairs, Vaccines at GSK – explains why immunisation is one of the most cost-effective interventions available, and how, through ongoing prevention, we can protect our health and productivity throughout our lives.
Pertussis is an infectious respiratory disease known more commonly as ‘whooping cough’ because of the whooping sound some patients make when they gasp for air between breaths.
It can affect anyone, though the risk of hospitalisation is highest for infants, people with chronic respiratory conditions like COPD or asthma and adults over 65. Parents often don’t realise how dangerous it can be for babies, who can develop severe breathing difficulties and severe complications like apnoea, pneumonia, convulsions and brain dysfunction.
Thankfully, pertussis is vaccine-preventable and would be less prevalent were it not for one leading, critical barrier – a steady reduction in vaccine uptake across the life course. Because the effectiveness of pertussis vaccines wane and regular boosters are needed, outbreaks continue to occur in cycles. Right now, we’re in the middle of a global outbreak. Cases in China in the first four months of 2024 were 45 times higher than for the whole of 2023. Australia is heading for a whooping cough epidemic with 41,000 cases confirmed this year up to November 2024, the highest number of cases in 30 years.
England has seen nearly 14,000 cases between January and September 2024, eclipsing the 858 reported cases for the whole of 2023. And in Europe, the Czech Republic is experiencing its worst pertussis outbreak in 60 years.
Such high numbers of cases mean that the chance of a newborn, a young child, or a chronically ill person becoming infected with the disease us far greater, and a rise in pertussis-related deaths could become more likely.
So how did we get here?
During the pandemic, pertussis infections were reduced as social distancing measures to stop the spread of COVID-19 also successfully reduced the impact of other respiratory diseases.
In addition, life course vaccination against diseases other than COVID-19 declined as global childhood immunisation levels dropped. A recent report found that adults also missed 100 million potential vaccine doses during this period.
Population immunity wanes over time when there are a high number of people are not protected against vaccine-preventable diseases.
So, as we navigate this resurgence of pertussis, the stakes are high. Without action, high rates of disease transmission and low rates of vaccination puts lives, especially of newborns, at risk.
One of the best ways to prevent pertussis deaths and complications is to increase maternal vaccination rates and booster vaccines. Booster vaccinations help to protect adolescents, older adults, and people of any age with underlying respiratory disease. To protect more people, pertussis vaccination guidelines should be clearer, driven by robust national immunisation programmes to promote vaccines equitably. A centralised primary care system should offer multiple opportunities to educate patients and caregivers – and ensure up-to-date immunisations as a standard of care.
It is predominantly through sustained efforts to vaccinate children that we have almost wiped out several infectious diseases that used to be more prevalent, such as polio.
What needs to happen next?
Adult immunisation, however, faces enormous structural and societal challenges.
One of the biggest barriers to progress we see in the world today is limited awareness about the benefits of vaccination for adults – and vaccine hesitancy.
There are complex reasons behind why people choose not to vaccinate, including a combination of complacency, difficulty accessing vaccines and a lack of confidence. This gap in knowledge risks poor decision-making and could even lead to the disinvestment of much needed adult vaccine programs, potentially leaving millions without access to preventative treatments that could save their lives.
Declining trust in healthcare institutions is also an issue. To counter that, we need transparent communication with the public that present the benefits and risks clearly.
There are important social and economic benefits for vaccinating populations, too. Recent data shows that every $1 invested in adult immunisation generates up to $19 back to the health system and society. Another potential upside is a healthier older population who experience less years lived with disability or health complications.
In the case of pertussis, it also means curbing morbidity and mortality in newborn infants, providing essential protection, and eliminating loss of life.
Meeting the needs of an ageing society and increasing healthcare costs is not a challenge that is going away.
Governments can and must do more to counter these issues and make vaccination throughout the life course the new standard of care. It just doesn’t make sense not to.
SVP and Head of Global Medical Affairs for Vaccines at GSK
