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.
Governments must invest in immunizing the most vulnerable children and addressing vaccine hesitancy
- “UNICEF is urging governments in Europe and Central Asia to invest in health systems that prioritize reaching the most vulnerable children with life-saving immunizations alongside national campaigns to address the concerning trend of growing vaccine hesitancy.” “Immunization is one of the most significant and cost-effective public health achievements in modern times. Vaccines save children’s lives and stop the spread of diseases. “Sustainable immunization coverage is only possible through well-functioning health systems that reach all children, including children from minority communities, those living in poverty or children uprooted from their homes. Coverage must be monitored so breakdowns in availability and services are rapidly identified and addressed. “Demand from caregivers and communities equipped with the knowledge to overcome misconceptions and protect their children is equally critical. Misinformation on vaccines has grave implications. Governments must closely monitor public perceptions, counteract misinformation and promote the benefits of immunization. “Measles outbreaks and pockets of unacceptably low vaccination rates are stark reminders that achieving universal routine immunization coverage must be a priority for governments, communities and caregivers.
Celebrating the past, present and future benefits of vaccines
- This past, difficult year of the COVID-19 pandemic has made clear how vulnerable we all are to a deadly new disease, when we don’t have the right vaccines or medical technologies we normally use to fight back. Long before COVID-19, one crucial tool – simply called “routine immunization” – was already saving millions of lives and preventing debilitating sickness, particularly among children. Routine immunization protects not only the person vaccinated, but also others in their communities. It helps pave the way to universal health coverage and Goal 3 of the Sustainable Development Goals – ensuring healthy lives and promoting well-being for all at all ages. The roll-out of COVID-19 vaccination at an ever-increasing speed across the WHO European Region, just a year after the start of the pandemic, is an impressive achievement. The European Union, WHO, UNICEF, all national governments and other partners have worked side by side in this response. Thanks to the global COVAX allocation mechanism and Team Europe’s effort some countries in the region that could not have competed on the global vaccine market on their own, are seeing vaccines being rolled-out. The European Union, WHO and UNICEF are now working with private and public sectors to overcome supply and capacity challenges and enable faster delivery. The uneven roll-out of COVID-19 vaccination to date highlights another truth: Inequitable access to health technologies between and within countries hurts us all. The virus and its impact on interlinked economies and societies know no borders. No country is safe until all countries are safe. While COVID-19 vaccination must continue at a faster and more equitable pace, it must not come at the cost of neglecting routine immunization. Any dip in routine coverage caused by the pandemic in 2020 or 2021 will pave the way for future outbreaks and jeopardize decades of progress. In 2019, the European Region continued its record-breaking trend in routine vaccination coverage rates against measles and other vaccine preventable diseases. While 2020 saw an exceptionally low rate of reported measles cases, the pandemic has challenged national immunization programmes to keep up and catch up on routine shots. We must keep measles and other preventable diseases at bay by maintaining high routine vaccination coverage rates in every community, even during the pandemic. This year, more than ever, we call on everyone to do their part by choosing health information sources carefully, getting all routine vaccinations in due time and accepting COVID-19 vaccination for yourself and your loved ones when your turn comes. Talk to your children and others about vaccination, so they also come to see that it is not just an injection, but an investment in a healthier future and a safer world. A girl is getting her routine vaccination in Armenia. UNICEF Armenia/2021/Margaryan
As the COVID-19 pandemic begins to enter a new phase, UNICEF reminds the world that ‘the light at the end of the tunnel needs to shine for all’
“COVID-19 is the first truly global crisis we have seen in our lifetimes. No matter where we live, the pandemic affects every one of us. Children have been seriously impacted. However, with more news about promising vaccines, and as we begin to imagine a day when COVID-19 is behind us, our guiding principle must be that the light at the end of the tunnel needs to shine for all. “This is why UNICEF has enthusiastically joined the Advance Market Commitment of the COVAX Facility to allow low- and lower-middle income countries access to COVID-19 vaccines. It is the best way to make sure that, as vaccines become available, no country is pushed to the back of the line. This would not only be fundamentally unfair, it would be unwise. The whole world will remain vulnerable to the virus until countries with the weakest health systems are protected from it as well. “In order for the COVAX Facility to work and guarantee equitable and affordable access to low- and lower-middle income countries, we need a global commitment to support and capitalize it, but also to finance the delivery of vaccines and associated supplies such as syringes and safety boxes. Governments must work together to ensure that COVID-19 vaccines are affordable and accessible to all countries. High-income countries should invest financially in the Advance Market Commitment and in UNICEF’s COVID-19 vaccine delivery efforts. All countries should take a strong stand against export controls on – and unnecessary stockpiling of – commodities for the COVID-19 response. “UNICEF is also leveraging our unique strengths in community engagement and vaccine supply to make sure that countries participating in the COVAX Facility have safe, fast and equitable access to the vaccine. This is an enormous undertaking and many challenges still lay ahead. As the largest vaccine buyer in the world, procuring more than 2 billion doses annually for routine immunization and outbreak response on behalf of nearly 100 countries, UNICEF is c oordinating and supporting the procurement, international freight , and in-country distribution of COVID-19 vaccines for the COVAX Facility. “Together with WHO, PAHO, GAVI and other partners at the global and regional levels, UNICEF is also working to support countries to ‘ready’ their immunization programmes for this historic roll-out. This includes assessing capacity and helping countries to strengthen their cold and supply chains so that they have adequate infrastructure to transport and store the vaccines for delivery to the frontlines. “However, the existence of a safe and effective COVID-19 vaccine alone will not end the pandemic. We need a diverse set of tools to help slow the spread of COVID-19, including diagnostics and treatments, as well as a continuance of preventive measures such as hand washing, physical distancing and mask wearing. UNICEF is providing governments with access to personal protective equipment, validated testing approaches, and proven treatments. In addition, UNICEF continues to work with multilateral partners to support governments with infection prevention control, water, sanitation and hygiene supplies, physical distancing, surveillance, contact tracing, case identification and community referral systems to stem the pandemic. “Lastly, we continue to help countries ensure the continuity of key essential services for women, children and young people – especially the most vulnerable. COVID-19 related disruptions have had a heavy impact on children: on their safety, their well-being, their future. Even as the fight against the disease enters into a hopeful new phase, we must not forget the work ahead of us to respond, recover and reimagine a better world for children.” ###
Improving health literacy among refugee and migrant children
UNICEF has worked with partners and with young refugees and migrants on the ground to identify information gaps – work that has, in turn, guided the development of health literacy packages across all five countries on a range of crucial health issues, from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The assessment has shaped the development of detailed plans on how to ensure that health messages reach their audience and have an impact. The health literacy packages have also drawn on existing materials, including Facts for Life , My Safety and Resilience Girls Pocket Guide and an adapted version of the UNFPA curriculum: ‘Boys on the Move’. Refugees and migrants face a chronic lack of health information in their own languages, and a lack of information that reaches them through the channels or people they trust health navigation Some common priorities have been identified by refugees and migrants across all five countries, including access to immunization and other primary health care services, breastfeeding and young child feeding, and the prevention of GBV. They have also flagged up the pressing need for more mental health and psychological services. Other issues have emerged as priorities in specific countries, including cyberbullying and online safety in Italy, and substance abuse among young people In Serbia – the focus of a new in-depth UNICEF study. Not surprisingly, the COVID-19 pandemic is a new and urgent priority for refugee and migrant communities – and one that has heightened the health risks they already face by curtailing their movements and their access to health services. A consultation with refugee and migrant adolescents and young people living in Italy has revealed major gaps in their knowledge about sexual and reproductive health, drawing on an online survey, a U-Report poll and a series of focus group discussions. It has highlighted some common misunderstandings, such as the myth that masturbation causes infertility, and continued perceptions around the importance of a woman’s virginity at marriage, as well as knowledge gaps around menstruation, pregnancy and sexually transmitted infections. The consultation also found, however, that the young participants want to know far more about this crucial area of health. As one young man from Guinea noted during a focus group discussion: “often young people do not want to know if they have an infection, also because they are not aware that these can be treated. It is so critical to raise awareness on STIs tests and treatment options.”
Tackling sexual exploitation and abuse of children: Actions and commitments
– “Sexual exploitation and abuse of children under any circumstances is reprehensible. No organization is immune from this scourge and we are continuously working to better address it. When it comes to the protection of children, we are determined to act. There is no room for complacency. “As UNICEF’s Executive Director, I have put this issue at the top of our agenda and we are committed to strong action and transparency within UNICEF. “To make sure we are doing everything possible, we are commissioning an independent review of our procedures and I will make its recommendations public. “My team is also exploring ways to use technology to quickly assess the risks of sexual exploitation of abuse, and facilitate safe and confidential reporting by the victims. “Starting in locations where the risk of sexual exploitation and abuse is higher, we are implementing more stringent vetting of all personnel and improving safety and protection around children in our operations. “These new measures add to the strong and determined actions we have taken over the years to prevent the abuse of children and respond to the needs of those affected, building on the lessons we have learned and a regular assessment of our approaches: We have made the reporting of sexual exploitation and abuse mandatory, through a notification alert that reports information to me within 24 hours. We have scaled up our assistance to victims and are providing them with safe and confidential support; We are rolling-out community-based complaint mechanisms; We have strengthened our investigations unit; and We have made training on the prevention of sexual exploitation and abuse mandatory. “We have zero tolerance for sexual exploitation and abuse, and we remain committed to continually learning and improving. We want justice for the child victims and are determined to work with all partners to achieve it.” Statement by UNICEF Executive Director Henrietta H. Fore.
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.