Vaccinating the hard-to-reach

© UNICEF/NYHQ2006-0870/Estey
A toddler is vaccinated against measles in the village of Ngipik, Bantul District in Yogyakarta Province, Indonesia, during a mass immunization drive.

GOAL: UNICEF gives priority to ensure that children from the hardest to reach populations also have access to immunization: those with limited or no geographic access, the urban poor, minorities and children in conflict situations. In crises, at a minimum, UNICEF ensures timely and safe measles vaccination and vitamin A supplementation.

Many obstacles must be overcome to bring immunization to children living in the hardest to reach communities. Some live in remote villages, several days from health centres or cannot be easily reached due to lack of roads or transportation infrastructure. Others are continuously on the move, as is the case with nomadic tribes or peoples displaced due to political or economic upheaval.

“Vaccination is the most cost-effective life-saver for children,” said the UNICEF Representative in Haiti Françoise Gruloos during a recent immunization campaign that covered an estimated 60,000 children under the age of five. “The human cost of not vaccinating a child is immeasurable.”

Ongoing civil conflict can make it dangerous or impossible for vaccinators to access children. Some children are excluded from immunization because they come from discriminated ethnic minorities or live in deeply impoverished city slums, where health services may operate poorly. Some communities may have religious or traditional beliefs that make them suspicious of immunization. Such groups may have mystical associations with disease – such as attributing illness to a visitation from a spirit or to a failure to adequately appease local gods – and may not appreciate the scientific explanation of the relationship between immunization and disease prevention.

The solution

Reaching these children is a matter of overcoming both physical and psychological barriers. In the case of geographical impediments, mobile teams travel to remote sites and often enlist the help of community leaders to motivate parents to bring children for vaccination. In the case of nomadic groups, immunization teams may identify events or locations, where they tend to congregate. For homeless populations, they may engage members of such groups in planning immunization activities.

Addressing fears or misconceptions about immunization is always a top priority, particularly when working with groups whose traditional beliefs may conflict with, or cause suspicion of, immunization. UNICEF brings together religious leaders – priests, pastors, imams and traditional healers – to explain the role of vaccination and to gain the support of their constituencies.

In conflict situations, UNICEF collaborates with other UN partners and the UN Secretary-General’s Office to negotiate temporary cease-fires between warring factions to give health workers access to children. Political or rebel leaders are encouraged to sign a “Days of Tranquility” agreement for all vaccination days in their regions and are given information about the life-saving role of immunization. UNICEF also asks the international and local media to provide information about where immunization will be performed and to encourage factions to observe safe passage for vaccinators.


  • In March and again in April/May 2010, a massive, synchronized vaccination campaign took place in 19 countries in West and Central Africa targeting every child under the age of five - some 85 million. Spearheaded by the Global Polio Eradication Initiative, more than 400,000 volunteers and health workers were mobilized.
  • A total of 2.8 million children under five were targeted in Afghanistan in December 2009 during a three-day immunization campaign using the new bivalent polio vaccine. Four million doses of the vaccine - purchased by UNICEF with the financial support of the Canadian International Development Agency (CIDA) - were distributed in regions of Afghanistan where the crippling disease remains endemic.
  • In early 2009, as a fragile peace held in Gaza, UNCEF worked with the Ministry of Health to vaccinate 120,000 students against measles, mumps and rubella during a two week campaign.



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