Introduction

A: Introduction to the committee:

World Health Organization is a specialized agency of the United

Nations which was established 71 years ago, on 7 April 1948. Its main

purpose is to support countries to obtain better health regarding the

United Nations Sustainable Development Goals of 2030. The

organization’s priorities are SDGs, antimicrobial resistance, universal

health coverage, disease outbreaks and emergencies, climate change,

women’s health, communicable diseases, non-communicable diseases,

mental health and WHO reform. World Health Organization had declared the ten threats to

global health of 2019 which are: air pollution and climate change, non-communicable diseases,

global influenza pandemic, fragile and vulnerable settings, antimicrobial resistance, Ebola and

other high-threat pathogens, weak primary health care, vaccine hesitancy, dengue and HIV. In

Ekin JMUN 2020 this committee will work with two agenda items: “Combating Vaccine

Hesitancy and Revising Universal Health Coverage”

B: Introduction to the topic:

Since the invention of the vaccine back in 1798, vaccine hesitancy has been a huge problem

even though the proved fact that vaccines reduce childhood morbidity, mortality and disease

outbreaks. Lately, there has been an increase in the vaccine hesitancy with the anti-vaxxer

movement of 1999 in US, claiming that vaccines caused health problems. The problem then

became a widespread issue. The main reasons of the problem are the false information or the

negative experiences on internet, especially on social media; the lack of education; the

religional and personal beliefs, and the community mistrust among in healthcare systems and

governments. Despite the possibility of prevention of 1.5 million lives each year by routine life

saving immunizations in order to avert vaccine-preventable diseases, there are millions of

vaccine hesitant and delayed vaccines, besides the people who don’t have the opportunity to

get vaccinated. As this issue is one of the ten threats to global health, declared by the World

Health Organization in 2019; and as Ethan

Lindenberger, a vaccine advocate who was once an

unvaccinated child, stated “People who believe in

vaccine hesitancy are not bad people, let’s not

demonize them and build a wall, but rather extend a

hand and build the bridges.” , this committee will be

discussing and finding solutions to the vaccine

hesitancy issue regarding the human rights and its

violation.

Definition of Key Terms

Vaccine Hesitancy: Vaccine hesitancy is the reluctance and the refusal of vaccinations in spite

of the opportunity to maintain vaccines and to get vaccinated. Since it has caused a lot of

deaths, especially in developing countries, it was determined to be one of the ten threats to

global health by WHO in 2019.

Immunization: The inoculation of a substance into a human or an animal body that produces

antibodies, the proteins who fight with diseases in blood, so as to protect the person or the

animal and to prevent disease outbreaks.

Anti-Vax(xer): The person who is against

vaccination because of particular reasons, who

delay the vaccination dates or rejects to ever get

vaccinated.

Healthcare system: It is the system which

provides a set of services in hospitals and

primary care clinics for the hospitalization of

physically and mentally ill by the governments.

Every country has its own healthcare system

with its own rules respecting universal health coverage.

Vaccine-preventable diseases: The infectious diseases which could be treated by an effective

preventive vaccine which leads to a vaccine-preventable death if not-hospitalized. The main

vaccine-preventable diseases targeted by the exocrine pancreatic insufficiency are tubercle

bacillus, poliovirus, diphtheria, tetanus, pertussis, measles virus, hepatitis B virus, rotavirus,

Haemophilus influenza type B (Hib), pneumococcal infection and yellow fever virus, declared

by WHO.

General Overview

Vaccination is one of the most successful and effective health interventions and it has saved

numerous lives all around the world ,conjointly, has improved the quality of life and wellbeing

all around the world. However; it should be bare in mind that vaccines can only be useful,

improve health and prevent diseases if they are implemented. To prevent the vaccine-

preventable diseases and deaths associated with it, the immunization programs ought to be

able to obtain and sustain high vaccine uptake rates.

Vaccine hesitancy dates back to the 19th century, the first vaccine ever, introduced by Edward

Jenner. Regardless of the scientific growth of the society, vaccine hesitancy has never receded.

Vaccine hesitancy had become a huge extensive problem and became worldwide after the anti-

vaxxer movement in 1999. The movement was commenced by a group of vaccine-hesitant

people, insisting that vaccines caused health

problems. With the article of the Lancet journal

on the correlation between the measles vaccine

and autism, the movement has made a

breakthrough. However, the paper was reacted,

in 2011, after it was proven that the information

were not factual. Nevertheless, by that point of

time, the movement has already gained a lot of

followers, thus every 1 in 10 people are anti-

vaxxer. EU Health Commissioner Vytenis

Andriukatis once stated in an international

health conference, “We have become the victims of our own success.”

Vaccine hesitancy is an increasingly important issue for both local and global reasons. It is a

major problem for the country immunization programs and it provokes the disease outbreaks.

Furthermore, it is not only a problem for the LEDCs (Less Economically Developed Countries)

but also a complex problem for the MEDCs (More Economically Developed Countries). For

instance, the 33% of the France population, one of the most economically developed countries

of EU, is hesitating vaccination, on the other hand, less than 1% of the population of Egypt is

vaccine-hesitant. Moreover, the global level of vaccine hesitancy had increased by 30%

between 2016-2017. 7 countries all around the world, including 3 from Europe have lost their

measles-free status in the past seven years and in 2019 the global cases of measles have surged

to alarmingly high levels with Albania, Czechia, Greece and the UK losing their status. Likewise,

this issue was decided to be one of the 10 threats to global health in 2019 by WHO.

The main reasons of the problem are the false information or the negative experiences on

internet, especially on social media; the lack of education; the religion and personal beliefs; the

community mistrust among in healthcare systems and governments.

Since we are in the “post-truth era” where everyone has access to and uses regularly internet

for not only to search some information, as on health-related topics, but also for creating their

own content which leads every fact to be seem to be an “object of debate”. This facilitates the

sharing of both true and false information, which a large number of audiences could reach.

There are numerous authentic articles on vaccination on internet which people could indeed

believe in its accuracy. The messages on social media

on vaccine hesitation are often composed of

misinformation with negative experiences since the

main benefit of immunization, the absence of the

disease, is more difficult than to discern the negative

experiences. This had lead us to inevitable injurious

consequences; to the increase of disbelief of vaccine

efficacy co-occurred with the mistrust in the

pharmaceutical companies, as a result, the

consecutive acceleration of the incidence of vaccine

hesitancy all around the world.

As stated before, vaccine hesitancy is a phenomenon for both high-income and low-income

countries. The mistrust in the healthcare system, the government and the pharmaceutical

companies leads the high-income nations to be anti-vaxxers. On the other hand, the lack of

access to essential health services contributes to vaccine hesitancy in low-income, underserved

countries. Citizens of those countries are often suspicious when a new vaccine initiative is

introduced, comprehending the vaccine as something promulgated by the outsiders of the

agenda, thus, the language when introducing a vaccine have to be drafted carefully so as to gain

the trust of the communities, specifically in underserved countries where people have low

access to healthcare.

It is mentioned that lack of education is one of the main factors of vaccine hesitancy ,but,

contrarily, a higher level of education doesn’t always ensure vaccine acceptance. The experts

have noted that some studies identify higher education as a threat to vaccine acceptance, as a

result of the mistrust in the healthcare

systems and governments.

It is explained by the World Health

organization that vaccine hesitancy can

also be caused by negative religional

and personal beliefs based on myths

which is an outcome of lack of

education. For instance, in some

African countries people believe that

the vaccination of women causes

infertility which is an authentic misinformation and, as well, an example of mistrust in the

healthcare system. As reported by who, “Effective communication is key to dispelling fears,

addressing concerns and promoting acceptance of vaccination.” thus, for the sustainability of

the solution education is vital.

Major Parties

United Nations Children’s Fund (UNICEF)

UNICEF is a United Nations agency established in 1946 in

order to provide humanitarian and developmental aid to

children all around the world who has now working across

190 countries to build a better world for the children. Since

vaccine hesitancy essentially refers to children, UNICEF has

organized a high-level event with the help of the Permanent

Mission of Japan at the United Nations in New York in 28 June

2019 so as to unite technical experts, governments, NGOs (Non-Governmental Organizations)

for discussing the misinformation on immunization. This was the first event of its kind that

takes place in a United Nations office to be organized, focused on the question of vaccine

hesitancy. UNICEF has also released a brief on the factors of vaccine hesitancy (based on the

past four years).

World Health Organization Europe

Besides that it is an office of the World Health Organization,

WHO/Europe has released a Guide to Tailoring Immunization

Programmes (TIP) that is consisted of methods to identify the

communities susceptible to vaccine-preventable diseases, to

diagnosticate supply and side barriers and enablers for immunization

and to propose evidence-based responds to enhance and sustain

immunization uptake.

Strategic Advisory Group of Experts (SAGE)

SAGE is the principal advisory group of the World Health Organization on immunization and

vaccine hesitancy. SAGE had developed a profound review on the issue and recommended

suggestions on how to address vaccine hesitancy and its principles. SAGE had directed its final

recommendations to WHO, the public health community and to WHO member states in

October 2014 dividing into three categories: (1) those focused on the need to increase the

understanding of vaccine hesitancy, its determinants and the rapidly changing challenges in

entails; (2) those focused on dealing with the structures and organizational capacity to

decrease hesitancy and increase acceptance of vaccines at the global, national and local levels;

(3) those focused on the sharing of lessons learnt and effective practices from various

countries and setting as well as the development, validation and implementation of new tools

to address hesitancy.* The first category is focused on to the increase of the understanding of

vaccine hesitancy, its determinants and the rapidly changing challenges entails. The second

category is related to the need of the organizational capacity to decrease vaccine hesitancy and

increase its acceptance in global, national and local levels. The third and the last category is

focused on the allocation of the lessons learnt from the experiences based on various countries.

Countries Involved

India

As the second most populated country in the world,

India has eluded a lot of disease outbreaks throughout

the history. Since the lack of education is one of the

factors of the vaccine hesitancy, India has implemented

mandatory vaccinations in schools to combat with

vaccine hesitancy. Although it has succeeded at some

point, some parents objected to the immunization of

their children without their permission by stalling the

campaign court during the measles and rubella

vaccination campaign of India.

Rwanda

During the HPV vaccination campaign of Rwanda, the country achieved its goals following a

good strategy which was targeted parents to explain them the need of the immunization. For

instance, the healthcare workers wandered

door to door so as to explain the profits of

the HPV vaccine. They explained the people

that the immunization prevented cancer,

they prepared female reproductive system

diagrams. Since the campaign was tailored

to the community, the healthcare workers

dispelled rumours that cervical cancer was

more likely to cause infertility than

vaccines as the most common reasons for

to hesitate vaccination are based on

religious beliefs.

Malaysia

A research has been made in Malaysia to test the reliability of the Parent Attitudes about

Childhood Vaccines (PACV) to demonstrate the prevalence of vaccine hesitancy among parents.

As the results, 11.6% of the parents turned out to be vaccine hesitant. It was noted that the

anti-vax parents were majorly the unemployed, younger and non-Muslim parents. Pregnant

women expecting the first child were four times more likely to be vaccine hesitant compared

with the pregnant women who had already had other children.

The United States of America

In the USA mandatory immunization laws for school entrance were legislated so as the

government could control the vaccine-preventable disease outbreaks, conversely, particular

exemptions are tolerated to school entrance immunization such as the exemptions for medical,

philosophical, personal and religious beliefs. All states authorize the medical exemptions. The

religious belief exemptions are accepted by all states except Mississippi and West Virginia

when the philosophical or personal belief exemptions are accepted in only 20 states. In

addition, vaccine hesitancy affects a quarter to a third of US parents which had lead to a

significant economic burden estimated to be 2.7 to 5.3 million US dollars.

Timeline of Events

1796 The first vaccine ever was invented by a British physician named Edward Jenner. It was the first successful smallpox vaccine ever to be developed.

1867 The Vaccination Act of 1867 was developed by extending the age requirement of the Vaccination Act of 1853 by 11 years; by extending it to 14 years from 3 years. The Act had also required penalties for vaccine refusal.

July 1999 The United States Anti-Vaccination Movement was started. The movement was composed of some ex-doctors, semi-celebrities who don’t have a medical background and some anti-governmental US citizens.

September 11, 1999 The Lancet Journal published an authentic article claiming the correlation between the measles vaccine and autism. The publishment of the paper lead to the boost of the US Anti-Vax Movement. The paper was reacted in 2011, twelve years later with the proof that it was misinformed but it was then too late by that point of time.

August 14, 2013 To encourage the WHO member states to better diagnose the factors of the vaccine hesitancy, WHO/Europe released the Guide to Tailoring Immunization Programmes (TIP) which was consisted of methods and tools to identifying and diagnosing the vaccine hesitancy; enhancing the sustainability of vaccine acceptance.

October 21-23, 2014 The World Health Organization’s primary advisory group on vaccine hesitancy and immunization SAGE issued its recommendations on the issue to WHO, WHO

member states and public health community.

January 18, 2019 The World Health Organization announced a list containing the ten threats to global health of the year 2019, which included vaccine hesitancy.

June 28, 2019 UNICEF and the Permanent Mission of Japan hosted a high-leveL event at UN New York Office in order to make technical experts, governments, NGOs discuss on the issue. The event was also the first event of its kind to be held in a United Nations Office

Possible Solutions

The solutions on this issue must be found regarding the main reasons of the problem. Since the

lack of education is one of the main factors of the problem, the education should be improved

by the mandatory lessons about health and healthcare from the elementary school. The

communities’ awareness on the issue should be increased with the help of the WHO, WHO sub-

committees, NGOs by advertisements, newspapers, televisions. A regulation in the universal

health coverage should be made, including the obligatory vaccination of particular or all

vaccine-preventable diseases.

B: Introduction to the topic:

For many years communities and individuals are suffering from financial hardship while

receiving the health service they need. Universal Health Coverage (UHC) ensures people t get

the primary health care they need including a full spectrum of essential and quality health

services, from health promotion to prevention, rehabilitation, treatment and palliative care.

There is always a risk when it comes to the financial consequences of paying for health

services. This risk includes poverty in case of any unexpected illness since it requires people to

use up their life savings or sell assets. However, UHC does not mean people can get free

coverage for all possible health interventions, as no country can provide all services free of

charge on a sustainable basis.

Definition of Key Terms

Health: State of complete mental, social and physical well-being and not merely the absence of

infirmity or disease.

Primary Health Care: It is an associate approach to health and well-being centred on wants

and circumstances of families, people and communities. It addresses the health and well-

being of comprehensive and reticulate physical and social health. Primary health care isn't

simply treating a group of specific diseases however additionally providing whole-person

take care of health wants throughout life. Receiving comprehensive care, starting from

promotion and bar treatment, rehabilitation and palliative care as shut as possible to folks’

everyday atmosphere is what primary health care ensures to people.

Mental Disorder: Mental disorders affect individuals’ functioning, results being emotional

suffer and diminished quality of life, stigma, alienation and discrimination. There might be

serious economic and social consequences when these burdens of individuals extend with the

community and society.

Promotion and Prevention: Promotion is about improving health and well-being while

prevention is concerned with avoiding disease

Palliative Care: Palliative care is medical care for people living with serious illness. The main

idea of palliative care is providing relief from the symptoms and stress of illness.

General Overview

Universal health coverage has a direct impact on the population’s health. Being able to access

health services enables communities to be more productive and active contributors to their

countries. Universal health coverage is thus a very critical component of poverty reduction and

sustainable development. Moreover, it is the hallmark of a government’s commitment to

improving the well-being of all its citizens.

Ensuring that all people obtain the health services they need without suffering from financial

hardship when paying for them is one of the goals of universal health coverage. Still millions of

people cannot access services they need due to the

costs. Even over 800 million people receive poor quality

of services even they use at least 10% of their

household budgets out-of-pocket expenditures. To

prevent people from being pushed into poverty,

financial risk protection is the key element.

However, poverty isn’t the only problem. Governments

are finding it increasingly difficult to respond to the

ever-growing health needs and increasing costs of

health services especially in countries where health

services have traditionally been accessible. Strengthening health systems in all countries is a

big step for moving towards universal health coverage. But strengthening health systems

cannot be achieved only by solving financial hardship. Health systems only function with

qualified health workers. Their availability, accessibility, acceptability and quality are

important because they affect improving health system coverage and realizing the right to the

enjoyment of the highest attainable standard

of health.

A projected shortfall of eighteen million

health workers by 2030 has been estimated

by the World Health Organization, mostly in

countries with low- and lower-middle income.

In some countries, public sector absorbs the

supply of health workers due to budgetary

constraints, which also cause challenges in

universal access to health workers.

Timeline of Events

12 December 2012

the United Nations General Assembly endorsed a resolution on Global Health and Foreign Policy urging countries to expedite the progress toward universal health coverage

June 2015

WHO and the World Bank Group prepared

First global monitoring report to measure

health service coverage and financial

protection to appraise countries’ progress

towards universal health coverage.

25 September 2015 the resolution on Transforming Our World: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including access to quality essential health-care services, financial risk protection, and access to safe, effective, quality and affordable essential medicines and vaccines for all.

12 December 2017

the UN passed a third resolution on Global Health and Foreign Policy: addressing the health of the most vulnerable for an inclusive society, which called on Member States to promote and strengthen their dialogue with other stakeholders, including the private sector, academia and civil society, in order to maximize their engagement in and contribution to the implementation of health goals and targets through an intersectoral and multi-stakeholder approach.

Major Parties

International Labour Organization (ILO): ILO is an organisation which

works for setting labour standards, developing policies and delivering

programmes promoting decent work for all women and men. Poverty which

occurs because of financial hardship caused by health service costs or

unemployment of health workers are the

issues interests ILO.

The Organisation for Economic Co-operation and

Development (OECD): Their goal is establishing international

norms and finding evidence-based solutions to a range of

economic, environmental and social challenges. One of their core mission is to promote policies

to improve the social and economic well-being of people around the world. In order to sustain

and achieve universal health coverage, they bring much relevant experienced supporting

countries.

The World Bank: The World Bank Group is a unique global

partnership with its five institutions working for reducing poverty

and building shared prosperity in developing countries with their

sustainable solutions. Supporting countries to build healthier, more

equitable societies, as well as to improve their fiscal performance

and country competitiveness are the aims of the WBG, while the path

to UHC is specific to each country.

United Nations Children’s Fund (UNICEF): Every child has the right to access primary health

care and health service. With WHO, UNICEF ensures these rights in UHC.

Possible Solutions

1. Since strengthening health systems in all countries can only be done with financial

structures, robust them is a key factor.

2. One of the possible cornerstones for achieving UHC around the world can be investing

in the quality of primary health care.

3. Good governance, the supply of medicines, sound system procurement, well-functioning

health information systems and health technologies ar other critical elements.

4. Contracting and payment arrangements can be improved in order to employ more

health-workforce and make them more efficient.

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