Further, Faster, Fairer: reaching every last child with immunisation

19.4 million children under one year old globally are still missing out on immunisation – that’s one in seven children excluded from this critical health intervention. Today Save the Children launched a new report, Further, Faster, Fairer: Reaching every last child with immunisation, calling for accelerated action to achieve universal immunisation coverage.

Immunisation saves lives

Immunisation saves lives and is one of the most successful and cost-effective health interventions, with far-reaching benefits. Improved coverage has contributed to the impressive 50% drop in child deaths globally between 1990 and 2015, from 12.7 million deaths to 5.9 million. It’s estimated that 6.4 million deaths could be averted by immunisation between 2011 and 2020. The impact will be greatest among excluded communities, which typically have low access to healthcare and high vulnerability to disease, and where the financial burden of illness has a greater impact on household poverty. Save the Children estimates that closing the immunisation equity gap could save 800,000 more lives between now and 2020. However, immunisation has far reaching benefits – a mere $1 invested in immunisation can reap a $44 return in wider economic and social impacts.

Global progress, but not enough

Progress in the coverage of immunisation services over the past decade has been impressive, with 86% of children globally now receiving basic vaccinations. However, there is cause for concern. Progress has recently slowed and the 2011–2020 Global Vaccine Action Plan (GVAP) – endorsed by 194 member states – is off-track. Millions of children are still missing out.

There are huge disparities between countries, with basic immunisation coverage as low as 16% in Equatorial Guinea, compared with over 99% coverage in 29 countries. Twenty-two countries have coverage of 70% or less and five do not exceed 50% coverage. Nearly 60% of unimmunised children are in just ten countries – the Democratic Republic of Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, the Philippines, South Africa and Uganda.

Who is being left behind?

National data can mask inequalities in coverage within a country. To focus on the seventh child exposes the systematic exclusion that is going on within countries. Our new report shows that these excluded children are from the poorest households, certain ethnic groups, living in neglected areas, and affected by conflict and emergencies. They are concentrated in communities that are systematically excluded from progress.

Nigeria, Central African Republic, Pakistan, Ethiopia, Lao PDR, Cameroon, Guinea, DRC, Indonesia and Mali have the highest inequalities in coverage by household wealth (based on countries with recent available data). In Nigeria, a child from a wealthy household is 11 times more likely to be immunised than a child from a poor household. In Central African Republic and Pakistan, for every three children immunised from a wealthy household, only one child from a poorer household is immunised. In a number of countries, these inequalities are worsening.

In many cases it is whole communities – such as marginalised ethnic groups – that are neglected. In Nigeria, for example, coverage is nearly nine times higher among Igbo children than Fulani children. In Cameroon, twice as many Grassfields children are immunised compared with Biu-mandara children. Children living in rural and remote areas are also at a disadvantage – eg, a child in an urban area is more than twice as likely to be immunised as a child from a rural area in Nigeria and Central African Republic. In Ethiopia, coverage is nearly nine times higher in Addis Ababa than Afar, a region in the north east, while in the south east of Nigeria, coverage is nearly six times higher in the north west.

Conflict, natural disasters and disease outbreaks can exacerbate children’s exclusion from immunisation. Globally, two-thirds of all unimmunised children live in conflict-affected countries. When crises occur, immunisation coverage often plummets. In Syria, for example, immunisation coverage dropped by nearly 50% – from 80% in 2010 to 41% in 2015 – following the onset of conflict. In Liberia, progress on immunisation before the Ebola outbreak – which had seen coverage increase from 46% in 2000 to 80% in 2012 – was undone, with national coverage dropping to a mere 40% after the outbreak.

Reaching every last child with immunisation

Every child has the right to immunisation as part of their right to health. But unless we do things differently, we will continue to fail every seventh child and further entrench systematic inequalities that leave him or her behind. This injustice cannot continue. Breaking down the barriers that drive exclusion is possible – but requires renewed political leadership, commitment and investment. Actors at all levels have a responsibility to ensure that every last child can realise their right to immunisation.

At the midpoint of the GVAP, more must be done to accelerate action. We must go further, we must act faster and we must be fairer to ensure that every last child is reached with life-saving vaccination. Our new report calls for universal coverage of immunisation, putting forward recommendations for governments, development partners, the private sector and civil society to help drive this agenda forward.

Save the Children this year launched an ambitious new global campaign to help end exclusion and ensure that Every Last Child survives and thrives. The campaign calls on decision makers at the household, local, national and international levels to ensure barriers that exclude children from accessing life-saving services are eliminated. We must act now to make this a reality.

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