Inequalities in immunisation: a country-specific approach

Stepping up efforts to achieve equity

In a comment piece published in this week’s Lancet, GAVI CEO Seth Berkley and others stress the need to do more to achieve equity in access to vaccines and to reach the fifth of children who are still missing out on even the most basic childhood vaccines.

‘Prediction of immunisation performance‘ recognises the efforts of stakeholders in making vaccines more accessible in low-income countries, but emphasises the need to step up efforts to ensure the poorest, the most vulnerable, and the most marginalised subgroups of the population in these countries are reached.

What drives immunisation performance?

The authors highlight the need to strengthen systems to improve overall routine immunisation coverage. Key to this is identifying the factors that affect immunisation performance. But with the many drivers at play, this isn’t a straightforward exercise.

On average, low-income countries fare worse when it comes to immunisation coverage, however there are a number of countries that break this trend, eg, Burundi, Malawi, Eritrea, Nepal, Tanzania, Rwanda and Burkina Faso all have DTP3 coverage greater than 90%.

Moreover, GAVI hasn’t found a strong relationship between “fragile” states and immunisation performance. There are also a number of socio-economic indicators that may be associated with immunisation outcomes.

It’s clear that the range of potential factors is vast and that the impact of these varies across countries.

Country-specific strategies must tackle inequalities

As the determinants of immunisation performance are context-specific, so too must be the strategies to address them.

In response to this, GAVI is defining country-specific strategies to better respond in countries that are lagging behind. As they embark on this task, they must make addressing inequalities a top priority.

Support must address the challenges these countries face in tackling inequalities, ensuring that services benefit even the hardest-to-reach children. Progress in these countries must translate into progress for all children.

Ensuring universal access

Save the Children’s report Immunisation for All: No child left behind calls for equitable progress towards universal access to the full benefits of immunisation, integrated with other essential health services.

In order to achieve this, systems must be strengthened to ensure sustainable access to immunisation, as a part of a package of essential health services, so that no child dies from preventable causes.