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Giving immunisation a boost

Sticking with the railway analogy from my last blog — but with the assurance that I’m no train spotter and that it’s the best example I can think of –- I want to talk about immunisation in the context of the health service.

So far, so riveting, hey? Stick with me.

Imagine if you wanted to introduce a brand new shiny high-speed train to the network that would alleviate over-crowding and shorten journey times.

This is a train so great that it would laugh in the face of leaves on the line, plough through snowdrifts like a hot knife through butter and could essentially revolutionise the face of rail travel. Sounds good.

The challenge

What if you have this amazing new train but the tracks weren’t strong enough, the source of fuel was unreliable and there weren’t enough train drivers or guards that knew how to operate it?

What if it there were only a few stations in major cities so that only those in the places that already had good rail links were able to use it?

It’s starting to appear less like a magic solution.

This is the challenge that faces immunisation. We have these amazing new vaccines that can save the lives of millions of children, but the health services through which they are delivered are poorly resourced and rely on weak infrastructure.

They are also massively understaffed — there’s a global shortage of at least 3.5 million health workers who are needed to put the jab in the child’s arm.

The solution

The solution is to strengthen the health systems and make sure that immunisation is an integral part of the health service, rather than operating through one-off campaigns. This is the fourth target outcome of the Decade of Vaccines Action Plan.

In discussions around this target there were many questions on what ‘integration’ means. Should vaccination programmes run alongside existing health services? Should they be joined together or should they merge?

If immunisation and the health service are both 20-seater buses, do we send two buses, do we tie one to the other or do we create a new 40-seater vehicle? (Thanks to Raj Kumar at GAVI for another transport analogy).

One size doesn’t fit all

There can be disadvantages in integration (lack of focus, dilution of funding, etc) so the route to integration is not one size fits all.

To combat this lack of coherence and clarity, the Decade of Vaccines should commission a report as a guide, bringing together best practice on integration and disseminate it to practitioners.

To create incentives for innovations, the Decade of Vaccines could launch a scholarship for individuals or a research grant for institutions that is specifically designed to spur innovation in this area. 2020 seems like a realistic deadline for this to deliver results.

Universities, research institutes, pharmaceuticals and others who have the potential to come up with a game-changing idea on vaccines could be contacted straight away and after one year the first Decade of Vaccine Scholars could already be at work.

Closing the health worker gap

A strong integrated health system also depends on having sufficient human resources, so one of the areas where the Decade of Vaccines could make a difference is on health workers. You can’t train an army of health workers overnight, but a decade seems like about the right time scale.

The Decade of Vaccines should seriously consider how it can work with training institutions and ministries of health to help close the health worker gap.

What an amazing legacy that would be.

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