This is a special week in Global Health.
The World Health Organisation recognises a total of 14 "World Health Days" every year. The usual suspects of HIV/Aids, TB, and malaria are there, but you probably didn't know that fully half of these days - a full week - make up World Immunisation Week. You read that right: immunisation is so important that the WHO gives it entire week.
Anyone who was working in global health back in the eighties will know why. Immunisation is responsible for saving more lives than almost any other health intervention, and the rollout of the Expanded Programme on Immunisation in the 1980's under Jim Grant made such a positive impact that it is the stuff of legend.
In many ways it makes sense to celebrate the power of vaccines and our historic successes against vaccine-preventable diseases in the last week of each April. We should feel proud.
But... this is not why we have World Immunisation Week.
Immunisation has given us one of the most colossal successes we have had in global health but progress has stalled. Routine immunisation rates have barely changed in the last five years, with only a 1% increase since 2010.
Today, 18.7 million children missed out on basic immunisation. Eight countries in the world immunise less than half their children.
Stagnant progress on immunisation coverage is compounded by unchanged, or increasing, levels of inequity. In Nigeria for example, children from wealthy households are 11 times more likely to be immunised than children from poorer households. This gap has increased by over 20% since 2008.
Unfortunately, in too many countries, there is simply no data available to even understand which children are being missed or if inequality is falling or increasing.
- In 22 out of 75 low and middle income countries in the scorecard, national immunisation coverage has worsened between 2010 and 2014. More than half of the countries are yet to reach 90% coverage; a key target in the Global Vaccine Action Plan.
- 35 countries have no published, disaggregated data to identify which children are being left behind. Of the countries that do produce data, 20 countries in the scorecard have not made any progress in closing the coverage gap between the richest and poorest households. In 7 of these countries the gap is actually widening. On the other hand, 18 countries are making progress in closing the gap.
The Sustainable Development Goals (SDGs) which were agreed by world leaders last September have an explicit target on achieving universal immunisation ("vaccines for all") by 2030. The scorecard shows us we are a long way from reaching those targets.
However, "vaccines for all" is a target in the SDGs precisely because it is achievable.
Let's take polio as an example. Polio is an infectious disease that has almost been eradicated. A reduction in cases from over 350,000 in 1998 to 74 in 2015 has only been possible through a concerted effort from multiple stakeholders to ensure that all children, no matter where they live, are immunised.
No more so is this the case than in India where children that had slipped through the net for years have been caught by the dedicated polio workers and volunteers who focused on locating and reaching marginalised communities like migrants and slum-dwellers. Work with community influencers such as imams and religious leaders helped create levels of previously unknown trust which allowed health workers to reach communities they had previously been unable to reach. This is the level of dedication and local knowledge that must similarly be applied to the implementation of routine immunisation programmes if we are to tackle stalling progress and consistent inequalities.
A focus on immunisation alone can only go so far, as it is often much wider systemic issues that need to be addressed to reach children with the full set of WHO recommended vaccines throughout the first few years of life. It will be of little surprise to you that children who miss out on immunisation are more likely to miss out on all health interventions. Routine immunisation systems can provide a solid base for a primary health care system to be built on, often strengthen the whole system and increase equitable access to all health services.
Therefore it is important to acknowledge, we need to simultaneously do more to support increased domestic and international financing which strengthens immunisation and health systems if we are to achieve universal immunisation.
There are some inequities in the world that we know will take a long time to overcome, but we can do something right now to stop children all around the world dying from preventable diseases. That every day an estimated 8,000 families lose sons and daughters from diseases that we can stop, and from infections that we can avoid, should be a reason for further, faster, and fairer efforts to reach every last child.
So is World Immunisation Week really important? And do we really need a week? Yes, it is. And it will remain so until not a single child dies from a disease that we can prevent.
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