A Rationale for U.S. Participation in the CVI

Childhood immunization has led to remarkable declines in the incidence of sickness and death caused by vaccine-preventable diseases. This, in turn, has resulted in tremendous savings in costly and often long-term treatments.

Perhaps the greatest potential of immunization is the eradication of disease and the elimination of the need to vaccinate. The well-planned use of an effective vaccine made this goal a reality in the case of smallpox. By no longer having to vaccinate against this scourge, the United States alone is estimated to save $120 million per year. Hundreds of millions more are saved indirectly because of reductions in morbidity and mortality.

Polio is targeted as the next disease to be eradicated from the globe. Following an intensive vaccination campaign, there has not been a case of polio in the Americas since August 1991. Since the virus can be imported and spread from other parts of the world endemic for the disease, the United States and all countries in the Americas must be vigilant and continue to vaccinate against poliomyelitis. Vaccine-preventable diseases continue to occur in many nations of the world, often with a devastating impact on unimmunized segments of the population. There have been recent outbreaks of diphtheria in the Ukraine, measles in Somalia, and polio in Israel, to name but a few.

The United States has a long history of supporting immunization programs in other countries. Beyond the humanitarian underpinning of these efforts lies enlightened self-interest—it is in the United States' best interests to contribute to a world in which other nations are free from disease, disability, and their frequent correlate, poverty.

Vaccine-preventable diseases are an economic drain on developing countries. Developing countries that are able to sustain a healthy and productive work force—through effective disease prevention activities, including immunization—are more likely to become vibrant and full partners in the international community. As such, they not only are able to support a domestic economy but also provide a market for the goods and services of other countries. Currently, according to the U.S. Department of Commerce, almost a third of all U.S. exports go to the developing world, and this amount is likely to increase in the years to come.

Critics argue that vaccinating more of the world's children will lead inevitably to more people, more poverty, and a greater drain on finite natural resources. It is true that over 80 percent of births occur in so-

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