Over 80 students, doctors, nurses and reporters gathered at the Johns Hopkins School of Public Health  last week to hear international activists and Baltimore health experts discuss the universal problem of immunization and describe how Baltimore’s progress makes it a public health model to be emulated globally.

In the 1990s — when Baltimore faced a mini-outbreak of several hundred kids falling ill with mumps and measles–then-health commissioner Peter Beilenson and then-Mayor Kurt Schmoke responded to the problem by pressuring parents through school and legal enforcement.The result? Over a three-month period in 1996, the percentage of immunized children in Baltimore city increased from 62% to 99.7%. In the decade since, Baltimore has seen only six or seven cases of measles and mumps, total.

“We had immunization clinics on street corners…we got the school system to enforce the law and put kids out, if they were not fully immunized,” said Peter Beilenson during the  event, organized by GAVI (the Global Alliance for Vaccines and Immunization.)

“The state’s attorney sent letters to threaten parents whose kids were missing school,” Beilinson recalled.

Anne Bailowitz, the Acting Chief Medical Officer of the Baltimore City Health Department, explained why the pressure translated into action: “When a child cannot enter school that is a compelling force for parents to get their children immunized.” Bailowitz also emphasized the effectiveness of a data-driven approach in increasing the immunization percentages.

The Baltimore Immunization Registry Program (BIRP) “has offered us not only a repository very valuable for schools and city service agencies where accurate immunization record is critical, but it also allows us to step back and see what we’re doing and what we’re not doing, as well as what points we have to improve upon,” explained Bailowitz.

Acknowledging the difficulty of translating “public health efforts into political will” in impoverished countries, Beilenson insisted nevertheless that it can be done, as seen here in Baltimore.

Joining Beilenson, Bailowitz and others as panel speakers were Robert E. Black, the Edgar Berman Professor and Chair of the Department of International Health and Director of the Institute for International Programs of the Johns Hopkins Bloomberg School of Public Health, and Helen Evans, the Deputy Chief Executive Officer of GAVI.

While internationally well-established, GAVI is relatively unknown in the United States, prompting Evans and other GAVI members to coordinate the event.

“Baltimore is outstanding in terms of immunization,” successfully “reversing the stereotype that inner cities have higher rates than the rest of the state,” said Susan Swift, GAVI’s Director of Strategic Marketing and Communications.

GAVI decided to spread the word about its goals and work by joining forces with  local immunization efforts, highlighting Baltimore’s model program made sense.

Following the panel discussion, Evans, Susan Swift and a few other GAVI members joined public health students and nurses for a brief tour of the Harriet Lane Clinic, the Eastern District Health Clinic and the House of Ruth.  Visitors were walked through the various clinics’ immunization efforts.

At the House of Ruth, for example, a shelter serving abused women and their children, nurses use Maryland Immunet to keep track of children’s immunization records. Kate Schuettinger, one of the three nurses working at House of Ruth, said that as mothers came through bringing in their kids to be checked for colds, she would discuss immunization with them.

“There are so many problems with a population that’s so transient,” Schuettinger said. “Kids get immunized from a lot of clinics and immunization can be confusing.” Once a child has been put into Immunet, however, regardless of where they went for immunizations and where they go afterwards, the doctors and nurses will have access to their records.

The Harriet Lane Clinic not only uses Immunet but is also testing a new computer algorithm-based program that automatically flags children who are missing immunizations. The information is distributed to residents who in turn reach out to the families.

Tracey King, Harriet Lane Clinic’s Assistant Medical Director, also impressed the GAVI representatives, explaining the clinic’s other services. Besides social workers there is also a “full-time attorney that works in the clinic and a family resource desk staffed by Hopkins undergraduates who identify families’ problems in food, housing and job training” and then work with them to link the families to services, King said.

Baltimore also has the TIKE (To Immunize Kids Everywhere) van, which is equipped with vaccinations and travels throughout the city, stopping at locations such as the Eastern District Health Clinic for families to bring their children to get vaccinated.

While Baltimoreans may not need to worry about their children dying from pneumococcal disease thanks to the city’s immunization efforts, one doesn’t need to travel to Africa to be exposed to the devastation a lack of immunization can wreak. Just outside of Baltimore in Prince George County immunization is still a huge challenge.

Nurses Aldene Ault and Sharon Doughty said, that like GAVI, they came to Baltimore and attended the event to learn what they could to apply to their neighborhood. “We know that Baltimore has done a great job,” Ault said.

Ault identified one of the major problems in Prince George County as the lack of an immunization data system. “It’s very hard for families to remember immunizations and the problem is that entering into Immunet takes staffing and time,” she explained.

The GAVI representatives agreed Baltimore was lucky having the combination of public health interest and resources coupled with political impetus for positive change.

Having a world-class public health institution in your backyard doesn’t hurt either, Ault observed:  “Hopkins does so much.”