Shaping the immunisation landscape – getting it right for 20 million children

The next year will be critical for shaping the global immunisation landscape. The potential impact on the nearly 20 million children still not receiving vaccinations globally is huge.

The post-2020 global immunisation vision for the next decade is being crafted this year. Simultaneously, Gavi, the Vaccine Alliance, is developing its next five-year strategy – which will guide its support to eligible countries (traditionally low-income countries with gross national income per capita less than or equal to US$1,580) – and is gearing up for its third replenishment to ensure sufficient funding to deliver on its strategic objectives.

Big opportunity, big stakes

Every child has the right to immunisation as part of their right to health. But for millions of children this right is not being fulfilled. Global immunisation coverage has stalled at 85% and coverage across Gavi-eligible countries has only increased one percentage point between 2015 and 2017. Universal coverage of life-saving vaccinations is critical for, and can help drive progress on, universal health coverage (UHC) and the Sustainable Development Goals (SDGs) – check out our new blog on this!.

As these globally reaching strategies are developed, it’s crucial we get them right – the stakes couldn’t be higher! This requires a focus on key areas that are critical to building programmatic and financial sustainability of immunisation programmes, as well as ensuring an enabling environment. For this to happen, Save the Children wants to see key issues prioritised:

  • primary healthcare
  • equity
  • market shaping.

Strengthening primary healthcare

Both strategies must prioritise and be framed around strengthening immunisation systems as part of comprehensive primary healthcare, particularly in poor, under-served and excluded areas. This is a critical foundation for equitably and sustainably delivering immunisation and other critical services, towards UHC and SDG3. Increased public investment in primary healthcare systems must be core to this as a critical long-term solution, ensuring equitable allocation of resources to neglected regions, areas and groups.

This must be a priority for national governments. Support from global stakeholders must also be seen through this lens, getting behind national UHC priorities and plans, and supporting domestic resource mobilisation. For example, Gavi and other global health initiatives have a responsibility to make sure they leave a stronger health system in the countries they support. Gavi must show how it is delivering on this through its next strategy and by delivering on commitments made through the Global Action Plan for Healthy Lives and Well-being for All.

Reaching the most deprived and marginalised children

Far too many children are still missing out on immunisation. Inequalities in coverage across and within countries mean that children from the poorest families, the most remote areas and marginalised groups continue to be systematically left behind and excluded from this critical health intervention. Our recent analysis and Scorecard show that more than half of Gavi-supported countries with available disaggregated data (29 out of 55) have poor performance in terms of equity. Meanwhile, two-thirds of unimmunised children are living in conflict-affected countries.

Equity must be at the core of both new strategies, with a focus on reaching the most deprived and marginalised children, including children affected by conflict. Countries and the global community must step up efforts to close the immunisation equity gap. This requires genuine political will to prioritise achieving universal immunisation and reaching children left behind. There is also a clear need to step up efforts in humanitarian contexts. This will require strong collaboration with partners, critically including civil society, leveraging its experience, expertise and reach in delivering immunisation in these contexts.

Improving vaccine affordability

High vaccine prices remain a barrier to achieving universal immunisation coverage, especially for more expensive vaccines like the pneumococcal vaccine (PCV). Some lower-middle-income countries report paying $37–66 for a full course of PCV – nearly four times higher than the Gavi price.

Much more must be done on this front by all actors, particularly for countries transitioning from Gavi support and those that have never been eligible. This is critical to improving coverage and equity and to sustain and grow immunisation programmes, including introducing new vaccines. Partners should work together to support countries through technical and capacity support to help build procurement and price negotiating capacity. Gavi’s next strategy must also step it up on this front through an enhanced and more comprehensive market-shaping role, including integrating a revised Advance Market Commitment-type mechanism into its longer-term strategy. Occupying such a substantive space in the vaccines market, Gavi has a responsibility to do more to use its leverage and purchasing power so that prices are affordable in the long term for all countries.

Getting it right

The coming year will be critical to getting it right for the nearly 20 million children still missing out on immunisation. Governments and national and global immunisation partners must step up to the plate so that all children have access to this and other vital health services, towards UHC.

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