This blog is co-authored by Elo Otobo, Health Advocacy Adviser at Save the Children, and Ariane McCabe, Director of Global Health and Public Affairs at GSK Vaccines.
In an incredible display of global partnership and innovation, the emergence of more than 180 COVID-19 vaccine candidates currently in pre-clinical development and 13 approved vaccines in circulation globally signifies a turning point in the pandemic.
The tremendous collective effort to roll out COVID-19 vaccines signifies just how important vaccines are in protecting our health. Investing in vaccines, trusting that vaccines work, and making sure they are readily available in all communities across the world is more important now than ever – especially for children, who depend on life-saving routine vaccines to survive and thrive.
As World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus recently stated:
“Vaccines are one of the most powerful tools in the history of public health…”
The WHO’s Immunisation Agenda 2030 was launched last year and envisions a world where everyone, benefits from vaccines to improve health and well-being. However, the next decade of efforts to increase immunisation coverage is likely to include multiple challenges. Prior to the pandemic, immunisation coverage was already stalling; the pandemic has deepened economic and social inequalities and further strained health systems globally.
Now more than ever is the time to:
- prioritise routine immunisation to
- enhance vaccine research and development
- strengthen vaccine supply chains and health systems
- reach the under-immunised and missed communities that remain vulnerable to preventable disease outbreaks.
Challenges ahead for childhood vaccinations globally
Last year, the pandemic disrupted efforts to expand coverage of immunisation services. By May 2020, respondents to a WHO survey from 82 countries had reported widespread disruptions to immunisation as both fixed and outreach vaccination services were halted or postponed in adherence with national lockdown measures. These challenges were compounded when many countries grounded flights and closed borders, stalling the delivery of important health products, like vaccines. By the end of 2020, 80 million infants were at increased risks of diphtheria, measles and polio after missing introductory DTP3 vaccines – a global marker for immunisation coverage.
Poorer countries face great challenges in scaling up routine immunisation. A disproportionate number of children who experience barriers to access to immunisation services live in poor and marginalised communities and conflict-affected settings. 62% of the 20 million children that miss out on routine vaccinations or remain under-immunised live in just 10 low- and middle-income countries. Of these, 14 million children didn’t receive any dose of basic vaccines and lack access to immunisation services and other health services. We also know that, as the economic impact of COVID means countries’ public revenue is decreasing, competition for scarce healthcare funding is increasing and other health challenges may be prioritised.
Building strong immunisation programmes and resilient health systems
With widespread calls to build back better after the pandemic, the next decade offers an opportunity to increase immunisation coverage. Adopting a systems-wide approach is important to ensure health systems globally have the capacity both to respond to future crises and to sustain basic essential functions, like routine childhood immunisation programmes, which help protect the health of their populations.
The pandemic has shown us how interconnected we are as a world and how quickly an outbreak could spread when any of us remain unprotected. Recent outbreaks of measles in several countries remind us that our protection against life-threatening illness requires effective disease surveillance and high immunisation coverage. Rectifying the gaps in immunisation coverage and immunity is a crucial step in preventing vaccine-preventable disease outbreaks globally.
For many countries, the ability to sustain immunisation services throughout the pandemic has depended on the healthcare workers, including community health workers. In Ethiopia, where GSK and Save the Children are working to strengthen immunisation programmes among pastoralist communities in the Somali Region, COVID-19 arrived amid a national shortage of healthcare workers. However, tailored programme adaptations – like installing handwashing facilities, providing personal protective equipment and delivering COVID-19 orientation training for health workers – helped to make it possible for immunisation services to continue. Over the next decade, the investment in the health workforce needed to expand access to primary healthcare services and achieve universal health coverage requires a surge in financial resources. Increased efforts to mobilise both domestic and donor-driven investments in the health workforce are critical.
Effective supply chains are also important. Their role is to ensure effective vaccine storage, handling, and stock management; rigorous temperature control in the cold chain; and maintenance of adequate logistics management information systems. Their goal is the uninterrupted availability of good-quality vaccines at the point of service-delivery, so that opportunities to vaccinate are not missed because vaccines are unavailable. Since 2015, GSK has been working with UPS Foundation and IFPW Foundation to support Gavi, the Vaccine Alliance’s STEP Programme, which enhances the management capacity of immunisation supply chains through a structured training programme. Such investments build resilient health systems, which can be leveraged to strengthen the pandemic response.
Closing the gap in access to vaccines
The Immunization Agenda 2030 envisions a world where, by 2030, “everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being.” If this is to be realised then we must scale up efforts to reach missed communitie and under-immunised and zero-dose children, and remove the health access inequalities that leave millions of children each year exposed to life-threatening diseases.
Efforts must be made to remove barriers that prevent the uptake of childhood vaccinations and build resilient health systems, including catching up on children missed before and during the pandemic, using innovative approaches to find and reach zero-dose children and missed communities, strengthening local capacity through health worker prioritisation and payment, establishing strong immunisation procurement and supply chains and increasing domestic financing for immunisation.
We should not lose sight of these priorities in the COVID-19 response.
We support Gavi’s efforts to recalibrate its priorities over the next strategic period to address vaccine equity and access to immunisation for zero-dose children – often described as living in “last mile”, hardest-to-reach communities. This is a critical moment for Gavi to focus on restoring and strengthening immunisation with an equity lens. Shrinking health budgets, economic losses faced by families working in the informal sector, and increased displacement of populations due to conflict and climate change will further exacerbate the disruption to immunisation and the barriers faced by last mile communities. Save the Children’s recent partnership with Gavi explicitly aims to address the immunisation needs of these marginalised communities, particularly in fragile and conflict settings.
In poor and displaced communities and conflict-affected settings where children are at risk of missing routine vaccines, tools such as the Humanitarian Mechanism , established by WHO, UNICEF, Médecins Sans Frontières and Save the Children, facilitate access to affordable vaccines for civil society organisations. Through it, partners procure vaccines for populations facing acute humanitarian emergencies and deliver adapted immunisation programs to these communities. Since 2017, GSK has been supplying vaccines against pneumonia and more recently rotavirus to the mechanism.
These initiatives show that we must continue to invest in sustainable primary health care systems to deliver life-saving immunisation.
Over a year on from the start of the COVID-19 pandemic, there may be light at the end of the tunnel. But as we work to expand access to COVID-19 vaccines, we must not lose sight of the value of routine childhood vaccines and the urgency to scale up access to them.
For more information on the GSK–Save the Children programme in Ethiopia, view this story from 2019.
The image at the top of the page shows Ifra, a government health worker in Ethiopia’s Somali region. She's had training in immunisation through the GSK–Save the Children programme. (image: Hanna Adcock/Save the Children)
Close the vaccine gap