World Immunisation Week 2015: Closing the Immunisation Gap

As World Immunisation Week commences, WHO is calling for renewed global efforts to end disability and deaths caused by vaccine-preventable diseases.

World Immunisation Week 2015 campaign focuses on closing the immunisation gap.
Photograph courtesy of: RIBI image library/Flickr

The World Health Organisation is calling for renewed efforts by the global health community to vaccinate marginalised children, in order to bridge the immunisation gap.

“One in five children are still missing out on routine life-saving immunisations that could avert 1.5 million deaths each year from preventable diseases,” said WHO in a statement.

“In 2013, an estimated 21.8 million infants did not receive lifesaving vaccines.”

“We need to look at vaccine-preventable communicable diseases as a global public health issue now rather than a national issue. This will require all nations to prioritise the delivery of immunisation programmes and a collective, global effort to fund and coordinate this”, said Dr Janine Arnott, Research Fellow in Health and Social Care at the University of Central Lancashire.

Immunisation is widely recognised as one of the most successful and cost-effective health interventions, according to the UN body.

“Vaccination is a very potent tool for the prevention of diseases as it enhances the immune system,” said  Deputy Principal Medical Officer, Air Commodore CS Thakur, in Nagpur, India.

Apart from preventing diseases such as polio, measles and diphtheria, the vaccines also protect children against pneumonia and rotavirus diarrhoea, two of the biggest killers of children under the age of five.

Despite improvements in global vaccine coverage during the past decade, there continue to be regional and local disparities, said the WHO. Reasons range from the insufficient supply of vaccines, poor health services to inadequate political and financial support and improper monitoring and supervision.

“There is no one centralised approach that can ensure vaccines are delivered and administered to each child,” said Director of Immunisation, Vaccines and Biologicals at WHO, Dr Jean-Marie Okwo-Belé. “Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” she added in the statement.

Some developing countries have started to make efforts at the grass-root level.

Guinea, Liberia and Sierra Leone have started a campaign to vaccinate more than three million children against diseases such as measles and polio in UNICEF-supported campaigns. This is the first nationwide immunization campaign by the three countries that were worst-hit by Ebola.

The outbreak had damaged the already poor health system, by disrupting routine health check-ups.

A child about to receive her measles vaccination, in Ethiopia's Merawi province. Photograph courtesy of: UK Department for International Development/Flickr

In the South Pacific Ocean nation of Vanuatu, the ’10,000 in 10’campaign is underway. Launched on 18 March, the initiative aims to vaccinate 10,000 children between six to five years of age, in 21 villages over a span of 10 days. The ambitious project provides immunisation to children against measles and rubella.

In Pakistan, Farrukh Hussain of Budha village has dedicated his life to vaccinating children in the region.

The Basic Health Unit vaccinator travels on his motorbike, with a vaccine carrier on the back, to the remotest communities of the Nankana Sahib district, in Pakistan’s Punjab province.

The district has a population of around 1.6 million, with nearly 58,000 live births annually.

“Pakistan is the world’s sixth largest population, with the biggest birth cohort,” said Dr Saadia Farrukh, UNICEF Health Specialist, in a report. “Each year, more than 350,000 children do not live to celebrate their fifth birthday; one of the major causes of these deaths is vaccine-preventable diseases,” she added.

In India, the immunisation programme has been strengthened as new vaccines targeting pneumonia, rotavirus along with the pentavalent vaccine have been introduced.

Recently, the Indian government has launched ‘Mission Indradhanush’ with the objective of preventing vaccine-preventable diseases (Diphtheria, Whooping cough, Tetanus, Polio, Tuberculosis, Measles and Hepatitis B) by 2020, in India.

 According to the WHO, there are still 65 countries where immunisation against diphtheria, tetanus and whooping cough (DTP3) is not provided to every child. Moreover, maternal and neonatal tetanus is a major health concern in 24 countries. While Afghanistan, Nigeria and Pakistan still remain polio endemic.

Polio eradication is one of the first milestones that the campaign aims to achieve.

The WHO also added that 16% of all children are not being immunised against measles. While half of all children do not receive the rubella vaccine. Rubella is a viral disease, the infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can damage vital organs like the brain, eyes and heart.

To bridge the immunisation gap, simplifying vaccination procedures, improving vaccination delivery and affordability are some of the crucial operational needs that need to be addressed.

“To strengthen the vaccine delivery system, paramedics chain at the peripheral level need to be strengthened,” said Dr Thakur.

“Maintenance of the cold storage is also important to preserve the efficacy of the vaccines,” he added.

In the Central African Republic (CAR), the vaccination system is fraught with logistical challenges. Most vaccines are stored in kerosene fridges. Volunteers walk or cycle their way to the remote pockets of the ravaged region to vaccinate children.

Every month, the team from a local clinic travels for more than an hour in a wooden canoe to vaccinate children living in villages along the river. The mothers walk to the clinic, carrying their children on their backs.

The UN body also stressed that strengthening vaccine supply chains and training more health workers are part of the challenge as well.

In conflict-hit nations, the scale of difficulties is even higher.

In Syria, immunisation rates across the country fell from 99% to just 52% since the conflict began in 2011. Lack of access and severe damage to health infrastructure being the key factors. UNICEF estimates that over 230,000 children in hard-to-reach areas across the country will likely miss out vaccination due to the ongoing conflict.
Currently, a 10-day measles immunisation campaign is underway since 19 April in Syria.  The campaign is aimed at children between six months to five years of age. The vaccination is being provided in 1,209 health centres.

UNICEF estimates there are more than 3.8 million children internally displaced across the country, many of whom were missed out in previous measles campaigns. About 646,000 of those are under the age of five.

“Attention must also be given to challenging myths and superstition around the safety of vaccines at local and national level. Improving public education does, therefore, also need attention and funding,” said Dr. Arnott.

In the United States, anti-vaccine advocates had made a claim that the MMR vaccine might “trigger” autism in children who are already susceptible to it. Researchers have dismissed the claim and the health workers are now trying to dispel the fear stemming from the reports. The public health workers are also dealing with a measles outbreak in the country.

“We need a global commitment from governments and pharmaceutical companies to fund and deliver immunisation programmes.,” she added.

In 2012, all 194 WHO Member States endorsed the Global Vaccine Action Plan (GVAP) at the World Health Assembly. The Global Vaccine Action Plan aims to provide universal access to vaccines for people in all communities by 2020. It set 6 targets for 2015.However, vaccines are not being delivered equitably or reliably, according to an independent assessment report by Strategic Advisory Group of Experts on Immunisation (SAGE) on GVAP.  Only 1 of the 6 key vaccination targets for 2015 is currently on track – the introduction of underutilised vaccines, the report revealed.

 Providing vaccination to adolescents and adults is also part of the initiative. There are new and sophisticated vaccines that are now available to protect against life-threatening diseases like influenza, meningitis, and cervical and lung cancer.

World Immunisation Week is celebrated in the last week of April (24-30) each year to promote the importance and usage of vaccination. The event is celebrated by UNICEF along with immunisation partners, governments and civil society organisations around the world.