Immunisation for All: No child left behind

by Kirsten Mathieson and Lara Brearley, Save the Children One in five children—those from the poorest families, the most remote areas, and marginalized groups—are still denied their right to immunisation and other essential health services. Save the Children’s new report, Immunisation for All: No child left behind, calls for equitable progress towards universal access to immunisation, integrated with other essential health services, and identifies proven strategies at the country level to reach these children. Strengthening routine immunisation is key to achieving and sustaining high and equitable immunisation coverage. While immunisation campaigns have been very successful, this report argues that if we are to achieve and sustain high and equitable immunisation coverage, more comprehensive systems are required. This includes, for example, investing in frontline health workers, engaging and empowering communities to demand immunisation and shape delivery mechanisms, and fostering the development of new innovations to strengthen supply chains and service delivery. Strengthened vaccine supply systems are needed to overcome distribution challenges in low-resource settings and are vital to routine immunisation and the delivery of health services, for example, where there are long distances between health facilities and unstable power supplies. Ensuring adequate supply and functional equipment at all levels of the health system will enable vaccinators to reach the children who need them the most—in particular in hard-to-reach rural and remote communities. Save the Children’s report explores initiatives that are addressing these issues, including project Optimize. The report reflects on the potential of immunisation programs to bring otherwise excluded children into thereach of other essential health services. Where immunisation coverage is both higher and more equitable than that of other health services, using vaccination services to deliver a broader package of interventions will help to narrow inequalities for a wider set of health services. Furthermore, embedding immunisation services within an integrated primary health care system can be a more efficient use of resources and will provide sustainable access to essential health services. At the global level, the report identifies how donors, the private sector, and other institutions can do much more to support countries to achieve and sustain universal immunisation coverage. This involves vaccine research and development agendas that respond to the needs of the poor and most vulnerable, and it includes technologies and packaging that work in low-income contexts. It also requires sustainable access to sufficient supplies of vaccines at affordable prices. The report looks at opportunities to increase competition, to provide technology transfers, and to realize the potential for pooled procurement. With more of the world’s poor living in low- and middle-income countries, affordable and sustainable access to vaccines is more urgent than ever. The fact that one in five children remains without basic vaccination is inexcusable. We know what needs to be done, and we must seize the opportunity to achieve and sustain universal access to the full benefits of immunisation. This report is a call to action for this Decade of Vaccines to ensure that inequalities in immunisation are addressed so that no child dies from preventable or treatable causes. Save the Children calls on the following groups to rise to the challenge of ensuring immunisation for all. Governments The report calls on governments to develop and implement strategies to address inequalities in immunisation that are integrated into national health plans and strengthen health systems. It urges governments to empower communities and engage them meaningfully as strategies are developed, implemented, and monitored. GAVI Alliance The report calls on the GAVI Alliance to make equity a top priority in their next business plan and to urgently realize their commitment to allocate 15 to 25 percent of their budget to cash-based support for health system strengthening and promoting synergies across the continuum of care. It also urges GAVI to use their market shaping with pharmaceutical manufacturers to encourage price transparency and reductions and to collaborate with partners to encourage tiered pricing and pooled procurement for graduating countries. Development partners The report calls on development partners to champion equity as the priority agenda within the Decade of Vaccines and the opportunity of immunisation to promote equity across primary health care. It calls on bilateral donors to ensure sufficient funding for countries to strengthen health systems, including immunisation as part of the essential basic package of services, and for continued investment in and commitment to vaccine research and development, including building regulatory capacities in emerging markets. It calls on the World Health Organization and the United Nations Children’s Fund to ensure meaningful civil society representation in the monitoring and accountability framework for the Global Vaccine Action Plan (GVAP). Private sector The report calls on the private sector to prioritize research and development that responds to the burden of disease and the contexts in which the poor and marginalized live. It also calls on the private sector to support capacity-building of emerging market suppliers through untied technology transfers and efforts to strengthen regulatory capacity. It urges pharmaceutical companies to increase transparency about vaccine prices and pricing mechanisms and to be open to opportunities for pooled purchasing and tiered pricing by income level, particularly for low- and middle-income countries. Civil society The report calls on civil society to empower local civil society to actively participate in immunisation and health systems and to engage in the GVAP monitoring and accountability framework with all key stakeholders at local, country, regional, and global levels.