Why we vaccinate

I'm a huge proponent of vaccination. The last two generations of Americans have lived complacently without the spectre of childhood killers such as measles and polio. I always get irked by — and will challenge — suburban mothers who think homeopathy will protect their children from deadly epidemics. At the very least, they should be grateful to people like me who are willing to put their children at vaccine risk to provide the herd immunity that is the true protector for those too foolish to vaccinate. Why my rant? Because in third world countries, where childhood diseases are rampant, those mothers only wish they could have the protection available to American children:

Across the impoverished kingdom of Nepal, 50,000 mothers like Mrs. Gurung, most of them illiterate, are foot soldiers in one of the great unfolding public health triumphs of modern times: the global push to slash the number of children who die from complications of measles. Nepal's first national measles vaccination campaign last year cut by 90 percent the country's measles-related deaths in a year, usually about 5,000, the United Nations Children's Fund estimates.

But remarkable as it is, that tremendous success is overshadowed by the grievous toll measles continues to take in neighboring India. Experts estimate that more than 100,000 children a year still die there from complications of measles for want of a 15 cent vaccine.

The contrast between the countries highlights both the extraordinary promise of measles control, and the tragedy of its unfulfilled potential.

Nepal's campaign shows that quick, deep inroads can be made against measles with the proper financing and national will, as well as a tested strategy for winning public trust of vaccines.

"Vaccinating children against measles is the greatest return on investment for child health that we have," said Dr. Mark Grabowsky, who for five years was the adviser to the Red Cross for the Centers for Disease Control and Prevention. "It's the low-hanging fruit."

Still, measles kills 450,000 children worldwide each year. India, which has more measles-related deaths than any other country, has not made it a national priority, W.H.O. officials say.