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.
In Focus: Immunization
Immunization is one of the world’s most cost-effective public health interventions, saving millions of lives each year, and protecting children from illness and disability. Vaccines have helped to halve the number of child deaths worldwide since 1990 and represent a sound financial investment: every $1 spent on childhood immunizations returns an estimated $44 in economic and social benefits. Despite the achievements of immunization programmes in the Europe and Central Asia Region in recent decades, reported immunization rates are uneven across countries — from as high as 98 percent in Albania to as low as 19 percent in Ukraine. The regional average for Eastern Europe and Central Asia stands at 92 percent, still not high enough to protect all children from preventable diseases. What’s more, there was no improvement in coverage between 2014 and 2016. At national levels, disparities can be shocking, with the most vulnerable children often missing out on immunization. Across the Region, more than half a million children have missed out on their routine measles vaccination, and many countries continue to face outbreaks of vaccine-preventable diseases that threaten the lives and well-being of children. Challenges to immunization include weak political commitment and health systems, ‘vaccine hesitancy,’ and concerns about the financial sustainability of national immunization programmes in middle-income countries. UNICEF knows that the whole Region benefits when ALL countries achieve and maintain high vaccine coverage at both national and sub-national levels. Download file (PDF, 981,23 KB) July 2018
Saving lives one dose at a time - Immunization across Europe and Central Asia
Vaccines protect children against disease and death, saving up to 3 million lives globally every year, and are one of the most cost-effective child survival interventions. In short, #VaccinesWork. The Europe and Central Asia Region continues to enjoy overall high childhood immunization coverage and is polio-free. The benefits of vaccines, however, are spread unevenly. Too many children are still missing the protection they deserve. A mother in Serbia holds her baby during her free vaccination as part of the Serbia's national immunization plan. A mother in Serbia holds her baby during her free vaccination as part of the Serbia's national immunization plan. Of particular concern is a rebounding of measles in the region, despite a record-low of new cases in 2016, causing over 33,000 cases and 79 deaths. The largest current outbreaks have been in Romania (12,368 cases and 49 deaths including 46 children), Ukraine (16,500 cases, 13 deaths including nine children) and Serbia. Although Serbia has a long and successful tradition in child-health protection, it is currently facing a measles outbreak with nearly 5,000 cases (as of 24 April 2018) which have resulted in 15 fatalities. UNICEF is working with the Ministry of Health to support its response and to improve records of immunization in the future. A little boy cries as he receives a routine vaccination at a clinic in Moldova. A little boy cries as he receives a routine vaccination at a clinic in Moldova. Due to universal vaccinations of newborns in Moldova, cases of Hepatis B have dropped from 682 in 1994 to only four in 2015. However, only 89 percent of all children are immunized against all preventable diseases and UNICEF has been working with the government to precure more vaccine doses to ensure all children have access to immunizations. A young boy puts on a brave face as he receives his second dose of the MMR vaccine in Kyiv, Ukraine. A young boy puts on a brave face as he receives his second dose of the MMR vaccine in Kyiv, Ukraine. Two-thirds of the world’s unvaccinated children live in fragile countries or countries affected by armed conflict. Between 2010 and 2016, conflict-affected eastern Ukraine had the world’s second lowest coverage rate of children fully immunized against diphtheria, pertussis, and tetanus. The country also had the third lowest coverage rate in the world for MMR vaccine in 2016. A plane with a crate of UNICEF-labelled MMR vaccines next to it. On the 26 February, 220,000 doses of the MMR vaccine arrived in Ukraine facilitated by UNICEF. UNICEF in Ukraine is helping to fast-track the delivery of MMR vaccines, assisting the Ministry of Health to respond to the recent measles outbreak in which 14,500 people have been infected – killing 13 people including nine children. Nine-month-old Sasha gets a kiss from his mother, after receiving the diphtheria, pertussis, tetanus (DTP) vaccine in Kyiv. Nine-month-old Sasha gets a kiss from his mother, after receiving the diphtheria, pertussis, tetanus (DTP) vaccine in Kyiv. Vaccine hesitancy has also become an issue in Ukraine but UNICEF is working to change attitudes and educate people on the dangers of not vaccinating their children. “Before his birth, we decided we would give our child all the necessary vaccinations,” says Sasha's father. “When my grandmother was a child, she got polio and, although she recovered from the illness, she was disabled for life. As caring parents, we want to protect Sasha from all sorts of infections.” In Turkey, a boy receives a dose of the Oral Polio Vaccine (OPV). In Turkey, a boy receives a dose of the Oral Polio Vaccine (OPV). UNICEF Turkey is supporting a vaccination program, led by the Ministry of Health. The campaign has included nine rounds of polio campaigns reaching 1.4 million refugee and migrant children and Turkish children in remote provinces between 2013-2015, and the provision of additional doses of MMR, Hepatitis B, Diphtheria, Tetanus, Pertussis, Polio and Haemophilus in 2017. A health worker vaccinates a one-year-old Syrian refugee boy at a neighbourhood health centre in Gaziantep, Turkey. A health worker vaccinates a one-year-old Syrian refugee boy at a neighbourhood health centre in Gaziantep, Turkey. UNICEF has also helped produce and disseminate information materials, in both Turkish and Arabic, to raise awareness about the importance of being immunized. A young baby receives her vaccination injection in Uzbekistan. In Uzbekistan, four-month-old Ziyoda receives a dose of the new polio vaccine - 'Inactivated Polio Vaccine’ (IPV) - which is designed to help stop polio globally. Despite Uzbekistan having an almost 99 percent coverage rate of the Polio vaccine, UNICEF continues to work with the Government to ensure that no child is left unimmunized in the future. A group of women wait for their children to be vaccinated at a village clinic in Uzbekistan. A group of women wait for their children to be vaccinated at a village clinic in Uzbekistan. Ensuring vaccination levels are high in every country across the region is essential. UNICEF is working to ensure all children are protected against the spread of vaccine-preventable childhood diseases and the best defence is a vaccine-protected population and a strong and responsive health system. The whole region benefits when ALL countries achieve and maintain high vaccine coverage at both national and subnational levels.
Protecting young children from vaccine-preventable diseases
Vaccination is one of the world’s safest and most cost-effective public health interventions. Yet growing distrust in science, coupled with misinformation, means that vaccination coverage rates are declining in some countries and communities, resulting in an upsurge of vaccine-preventable diseases. Research shows that those caring for children…
Tracking anti-vaccination sentiment in Eastern European social media networks
This UNICEF working paper aims to track and analyse online anti-vaccination sentiment in social media networks by examining conversations across social media in English, Russian, Romanian and Polish. The findings support the assumption that parents actively use social networks and blogs to inform their decisions on vaccinating their children. The…
Refugee and migrant children in Europe
People have always migrated to flee from trouble or to find better opportunities. Today, more people are on the move than ever, trying to escape from climate change, poverty and conflict, and aided as never before by digital technologies. Children make up one-third of the world’s population, but almost half of the world’s refugees: nearly 50 million children have migrated or been displaced across borders. We work to prevent the causes that uproot children from their homes While working to safeguard refugee and migrant children in Europe, UNICEF is also working on the ground in their countries of origin to ease the impact of the poverty, lack of education, conflict and insecurity that fuel global refugee and migrant movements. In every country, from Morocco to Afghanistan, and from Nigeria to Iraq, we strive to ensure all children are safe, healthy, educated and protected. This work accelerates and expands when countries descend into crisis. In Syria, for example, UNICEF has been working to ease the impact of the country’s conflict on children since it began in 2011. We are committed to delivering essential services for Syrian families and to prevent Syria's children from becoming a ‘ lost generation ’. We support life-saving areas of health , nutrition , immunization , water and sanitation, as well as education and child protection . We also work in neighbouring countries to support Syrian refugee families and the host communities in which they have settled.