Immunization is a proven and cost-effective public health intervention, saving the lives of millions of children and protecting millions more from illness and disability. Immunization is also a wise financial investment - with every $1 invested in immunization returning an estimated $16 in health-care savings and increased economic productivity. Most countries in Europe and Central Asia have immunization coverage of 95 percent or more for three doses of diphtheria, tetanus and pertussis (DTP), often seen as the measure of national performance on immunization. However, while most national averages for DTP vaccination may be adequate, the regional average is hovering at around 92 percent, a slight decrease from the previous year, which is not high enough to ensure immunity for everyone. Over 70 percent of the region’s unvaccinated infants are from middle income countries, with Ukraine presenting the lowest coverage rate and the greatest challenge. National averages also mask disparities, with Roma children and those from other ethnic and vulnerable groups, including refugee and migrant children, all lagging behind. Measles outbreaks are a growing problem. Last year there were over 10,000 cases of measles in the region. Despite increased coverage of the first dose of the measles vaccine among children (up from 63 percent in 2000 to 93 percent in 2016) more work is urgently needed, as children are not fully protected against measles unless they receive two doses. Currently, second dose coverage is at 88 percent, which does not provide adequate protection. In total, over 500,000 children in the region are still not protected against measles - a life-threatening, but easily preventable disease. There are also concerns about ‘vaccine hesitancy’ – a growing mistrust of immunization among some parents, fuelled by myths and misinformation. Such hesitancy may stem from negative media stories linking a child’s death to immunization without the full facts. It may be influenced by the region’s anti-vaccine movements, which spread anti-immunization messages. Meanwhile, measures to counter vaccine hesitancy and build parental trust in immunization are hampered by a lack of discussion with parents about its importance and the minimal risks. A baby girl receives her vaccination at a clinic in Serbia. A baby girl receives her vaccination at a clinic in Serbia. Donor support for immunization is falling in some countries that still require such support. Elsewhere, the concern is to ensure financial sustainability for immunization programmes once countries ‘graduate’ from the support provided by Gavi (The Vaccine Alliance). Ongoing reforms in some countries are affecting both the structure and financing of immunization programmes. Some countries, challenged by competing priorities at home and inaccessibly priced vaccines on the global market, experienced several vaccine shortages in 2015–2016, sometimes causing critical disruptions of services. These issues are particularly acute in middle-income countries, many of which self-procure vaccines and continue to face significant challenges in achieving financial sustainability of their immunization programmes. Some countries also lack adequate monitoring of vaccine coverage, which is critical to understand and address any gaps. As a result of such challenges, the region faces outbreaks of vaccine-preventable disease, such as a polio outbreak in 2015 and an ongoing measles outbreak in Ukraine – a country where conflict and economic recession have depleted stocks of vaccines and vaccine hesitancy is reducing immunization coverage. There is also an ongoing large measles outbreak in Romania, with over 10,000 cases of the diseases and 38 deaths. During the last five years, measles outbreaks have been registered in Georgia (2013), Kazakhstan (2014), Kyrgyzstan (2015), and Tajikistan (2017). Outbreaks in one country can spread rapidly to others, signalling the interdependence and vulnerability of all countries, whatever their stage of economic development.
Europe and Central Asia has surpassed global progress on child mortality, more than halving the deaths of children under five and infants since 1990. And as progress for the poorest households has accelerated, the health gap between the richest and poorest has narrowed. However, persistent inequities reflect a continued failure to invest effectively in child-centred health systems for all. In South-East Europe, for example, child mortality among the Roma population is two to three times higher than national averages. Problems missed at an early age can be more difficult and expensive to address later in life. Such inequities are compounded by a failure to spot problems during pregnancy and during the first 1,000 days of life, when children’s bodies and brains build the foundations for their life-long development. Problems missed at an early age can be far more difficult and expensive to address later in life. Across the region, more than half of the children who die before their fifth birthday die in their first month of life.These deaths are often the result of conditions that are readily preventable or treatable at low cost through, for example, access to good obstetric, ante-natal and post-natal care, routine immunization and exclusive breastfeeding . The main killers of children under the age of five in the region are also preventable: pneumonia and injuries. Emergencies have an intense impact on child health and nutrition. The impact of emergencies on children's health and nutrition can be extreme. Children on the move, such as those caught in Europe’s refugee and migrant crisis , for example, often lack adequate clothing, food, shelter or warmth. Access to health services, including immunization, has often been inadequate on their journey. The region’s existing HIV prevalence, coupled with lack of safe water and sanitation, as well as ongoing challenges related to early child development and protection all heighten the vulnerability of children during emergencies. The region is also experiencing vaccine ‘hesitancy’ – the reluctance of some parents to immunize their children, or parental delays in immunization . This hesitancy, often fuelled by misinformation, puts children at risk of contracting, and even dying from, infectious diseases, including polio and measles.
Conflict in Ukraine
"Before he got hit, Sasha was like a proper child. Now he seems like a grown up. He can tell from the sounds what type of weapon is firing." - 12-year-old Sasha's guardian talking about the changes in him since he was shot in the ankle by a stray bullet. After nearly five years of conflict in eastern Ukraine, 3.4 million people are in need of humanitarian assistance – 60 per cent of them are women and children. Approximately 1.6 million people have been forced from their homes and tens of thousands of civilians have been killed or wounded. The situation is particularly grave for girls and boys living in areas with the fiercest fighting: Donetsk and Luhansk oblasts – within 15 kilometres of the ‘contact line’ – a line that divides government- from non-government-controlled areas. Children face the immediate threats posed by the conflict, and the long-term impact of lost education and trauma. Children living in these areas face grave threats from shelling, landmines and unexploded ordnance. Their lives are also threatened by destruction of vital civilian infrastructure – health centres, schools and water supplies – as a result of the fighting. Millions of people depend on water infrastructure that is in the line of fire. Aleksey washes his face and his missing fingers are highlighted. Aleksey, 14, lost two fingers and a thumb when a discarded shell exploded in his hand. Education – so crucial for a child’s sense of ‘normalcy’ – has been shattered, with more than one in five schools in eastern Ukraine damaged or destroyed. Teachers and psychologists report signs of severe psychosocial distress among children, including nightmares, social withdrawal and panic attacks triggered by loud noises. More than one in four children in Donetsk and Luhansk are thought to need psychosocial support. Few, however, get that support, as the available services are over-stretched and under-funded. “It is extremely painful to recall how we almost died twice. It is hard for us to talk about how we had to leave behind everything we had – a home, a job and friends – so we could stay alive.” - Amina, aged 12, from the village of Mykolaivka in Donestk, now living in Kiev. Immunization coverage has been undermined by a combination of conflict, lack of vaccines and vaccine hesitancy (a reluctance among parents to have their children immunized). The country experienced polio outbreaks in 2015 and is at high risk for polio transmission, according to the Polio Regional Certification Committee.