Redouble efforts to vaccinate every child
Vaccines save lives. Every year vaccinations avert 2 to 3 million infant deaths globally from deadly diseases such as diphtheria, hepatitis B, measles, mumps, pertussis, polio and tetanus. At the same time, however, 1 in 5 children, an estimated 21.8 million infants worldwide, are still missing out on basic vaccines. Of them, 9 million infants, more than one-third, live in WHO’s South-East Asia Region.
Nearly 40 million children are born in the region every year. Only about 75 percent of them get all three doses of the diphtheria-pertussis-tetanus vaccine, which provides protection from infectious diseases that can cause serious illnesses, disabilities and fatalities. Those children, who miss out on the vaccine for measles, are susceptible to a highly infectious viral disease that can cause serious complications, including blindness, encephalitis and pneumonia. In 2013 about 26 percent of the global measles deaths, amounting to almost 38,000, occurred in South-East Asian countries. India accounted for 27,500 deaths alone.
These grim statistics underscore the need to intensify efforts at protecting children with lifesaving vaccines. Why should children continue to die of diseases that can be prevented? We must close these gaps with the timely delivery of vaccinations.
Our success against smallpox historically and more recently in stopping poliovirus transmission in the region has demonstrated that we have the capacity to reach a large majority of children with vaccines. Lessons learnt from these major public health victories, especially polio, need to be emulated. Routine immunization must reach underserved children living in remote areas and in deprived urban settings – to ensure equity with vaccines.
Disparities in vaccination coverage usually result from resource crunch, competing health priorities, poor management of health systems, inadequate monitoring and supervision and low awareness levels among parents on the benefits of immunization. We must address these concerns continuously to improve the quality and the reach of immunization services.
It is encouraging to see the efforts being made by member countries. India, with the biggest birth cohort of 26 million, has been applying lessons and best practices from the polio eradication programme to strengthen routine immunization. It has launched a campaign focusing on 201 districts that have the highest number of partially vaccinated and unvaccinated children, for intensified efforts to increase immunization coverage in these districts. Bangladesh is focusing its efforts in 32 priority districts. Bhutan has mapped its hard-to-reach pockets with floating population across the country for targeted interventions. Indonesia is prioritizing immunization activities in 36 districts across seven provinces and Thailand is focusing on three of its southern provinces.
Member countries are also adding more vaccines to the immunization schedule such as rubella vaccine and the pneumococcal conjugate vaccine (PCV). The Inactivated Polio Vaccine (IPV) which is injectable is being included in the routine immunization programme as part of the Polio Eradication & Endgame Strategic Plan. While the introduction of new vaccines is an opportunity to improve immunization services, increasing vaccination coverage is critical for the meaningful introduction of any new vaccine.
However, not only should coverage be increased, but it needs to be sustained to reap the benefits of immunization. Linking vaccines to the delivery of other health interventions can ensure sustainability. At the core, however, we must strengthen our health care systems to increase and sustain immunization coverage. We know from our recent experience with Ebola and other public health emergencies in the past the role strong health systems play in rolling out timely and adequate responses.
Vaccination is a known cost-effective health intervention. Increasing vaccination coverage will accelerate control of vaccine-preventable diseases and reduce death and diseases among children. A vaccination programme is also a shared responsibility. Collective efforts are required by the government, its partner agencies, health professionals, academia, civil society, media, private sector and the community itself. And all of the above should be steered by a continued political commitment and backed with financial resources.
With concerted efforts, WHO South-East Asia Region aims at maternal and neonatal tetanus elimination this year; measles elimination and rubella and congenital rubella syndrome (CRS) control by 2020; sustaining the victory over polio until the disease is eradicated globally; increasing immunization coverage to > 90 percent at the national level and to >80 percent at the district level with the three doses of diphtheria-pertussis-tetanus vaccines.
Every child has the right to lead a healthy life. In 2015, the focus will be on closing the immunization gap and establishing equity in immunization levels with renewed efforts.
(The author is Regional Director, WHO South-East Asia Region)