Protecting every child from diseases preventable by vaccine

Vaccines have proven to be the most cost effective way to prevent childhood diseases and deaths. And yet millions of children remain un-vaccinated. WHO estimates that in 2012, more than eight million children under one year of age in WHO’s South-East Asia Region did not receive third dose of DTP containing vaccines.

In India, an estimated seven million children were left unimmunized which left them vulnerable to preventable diseases such as polio, diphtheria, tetanus, pertussis, measles and Rubella. Why are we failing these children?

Millions of children born each day depend on an efficient and functional health system to protect them from vaccine preventable diseases. High immunization coverage is an indicator of development. However despite considerable economic progress in South-East Asia, why are we unable to vaccinate all our children?

Routine immunization programs cast a protective net over all children by providing a set of vaccines. A robust routine immunization program can help us control, eliminate and eventually eradicate major diseases like polio, measles and rubella. With unprecedented global support for the eradication of polio from the face of earth, we are closer to that goal than ever before.

But these gains are fragile. We need to put in place strong routine immunization services and systems to ensure continued high coverage. This must be backed with efficient and sensitive surveillance systems including functioning laboratory networks for detecting the spread and source of vaccine preventable diseases.

At the 66th targeting 2020 for measles elimination and rubella/congenital rubella syndrome (CRS) control.

This goal cannot be achieved without a strong routine immunization programme. What can countries do to bridge the gap and reach the unreached children? Even in the countries where the overall coverage is high, there are pockets of ‘high risk’ or difficult to reach populations that are under-served and therefore, children in these areas are deprived of their basic human right to health.

India’s success with Polio eradication was achieved through a combination of routine immunization services and specially focused drives and days. 

India targeted 400,000 sites with low immunization coverage and reached out to them using lessons learnt from their Polio eradication initiative. These sites have mobile, underserved, hard to reach populations. India utilized successful mechanisms from the Polio eradication initiative to map and track children that were chronically missed by the routine system. The country strengthened micro-planning, monitoring and accountability mechanisms at all levels of routine immunization.

WHO Regional Committee Meeting in New Delhi, countries adopted a resolution. Approximately five million children were reached through special immunization weeks in targeted low-performing districts in 2012/13.  The establishment of an Immunization Technical Support Unit (ITSU) to support programme operations, monitoring vaccine supply chain, generating demand for vaccines in communities helped India improve immunization coverage.

The country also increased surveillance for vaccine preventable diseases and any adverse events following immunization. A web enabled mother and child tracking system was developed. Providing additional incentives to ASHA workers for ensuring full immunization of children also improved immunization in India.

Low performing

While the countries like Nigeria are benefitting from India’s successful polio eradication program, countries like Bangladesh and Nepal have many best practices that the low performing countries in the Region can learn from. In Nepal, the practice of conducting “appreciative enquiries” to empower communities with information and create demand for immunization and efficient delivery has helped increase coverage.
Bangladesh adopted several best practices such as efficient reporting, extension of services deep into remote areas and annual coverage evaluation surveys to help reach the unreached.

Many countries in South-east Asia have introduced more than one new vaccine into their national immunization programme in the last decade. All countries need to have a robust immunization programme that can introduce new vaccines. The plan to introduce new vaccines must address programmatic challenges such as cold chain capacity, vaccine storage and management and other delivery challenges.

Additionally, countries will need to put in place measures to ensure the financial sustainability of their immunization programme to benefit from other new and available vaccines such as cholera, Japanese Encephalitis (JE), pneumococcal, rotavirus, and human papillomavirus vaccines.

Immunization attracts strong donor support through substantial funds to countries. Access to these funds has enabled countries to reach and immunize children in the poorest parts of the world with vaccines that until now were only available to children in developed countries. For instance in Bangladesh, the measles-rubella (MR) combination vaccine was introduced in 2012 and the country plans to introduce pneumococcal vaccine. Also Bangladesh plans to introduce rotavirus vaccine to prevent diarrheal diseases in the coming years. Maldives introduced the measles-mumps-rubella (MMR) vaccine in 2007, Sri Lanka in 2011 and in Bhutan, the human papilloma virus (HPV) vaccine was introduced in 2010 to prevent cervical cancer.

Countries need to realign their public health policies and strategies to take advantage of the potential benefits of vaccines given that more and more diseases, both communicable and noncommunicable, are becoming vaccine preventable.

Countries also need to ensure that routine immunization is well integrated into their health delivery system. In the end political will and targeted delivery of vaccines will make the difference between life and death for millions of our children.

(The writer is regional director of WHO, SEARO)