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World Immunization Week: UNICEF Goodwill Ambassador Liam Neeson headlines week-long commemoration of global vaccination efforts and calls for greater investment

https://www.unicef.org/eca/press-releases/world-immunization-week-unicef-goodwill-ambassador-liam-neeson-headlines-week-long-0

NEW YORK, 24 April 2022 – UNICEF Goodwill Ambassador Liam Neeson is leading UNICEF’s global immunization initiative with a global message thanking the scientists, parents, health workers and others who have been so critical in helping to immunize children over the last two decades. In a video released ahead of World Immunization Week , Neeson talks about how the efforts of scientists such as Jonas Salk, who developed the first vaccine against polio, and dedicated workers who fill vials at factories or deliver vaccine injections, have made it possible to save two to three million child lives each year. “Vaccines are a remarkable human success story. Over last the 75 years, billions of children have been vaccinated, thanks to scientists, to health workers, to volunteers. If you’ve ever been vaccinated, or vaccinated your children, then you are part of the arm-to-arm chain that keeps all humanity safe,” said Liam Neeson, UNICEF Goodwill Ambassador. “We live our lives free of worry about catching smallpox. Once a terrifying diagnosis, polio is no longer a threat in most of the world. The conversation about vaccines in recent years has lost sight of how much good they have done for each of us. We need to celebrate this. It is perhaps one of the biggest collective achievements in human history.” Every like, share, or comment on posts mentioning a UNICEF social media account and using the hashtag #longlifeforall from now until May 10 will unlock US $1 to UNICEF, from the United Nations Foundation’s Shot@Life campaign and the Bill & Melinda Gates Foundation – up to a total of US$10 million – to help ensure all children get the life-saving vaccines they need. Despite the successes, an alarming 23 million children missed out on vaccinations in 2020. This number can only be reduced through greater commitment to and investment in immunization services. UNICEF is the world’s leading provider of vaccines to children in over 100 countries. With Gavi, the Vaccine Alliance and partners UNICEF supplies vaccines to reach 45 per cent of the world’s children under five. UNICEF also works with Governments in over 130 countries to strengthen national health and immunization programmes. “The last two years have taught us that a health care system that leaves some children exposed, is a health care system that leaves all children exposed,” said UNICEF Executive Director Catherine Russell. “The best way for the world to recover from this pandemic – and to prepare for future health emergencies -- is to invest in stronger health systems, and immunization and essential health services for every child.” World Immunization Week – celebrated every year in the last week of April – is spearheaded by the World Health Organization and brings together global partners to promote the use of vaccines to protect people of all ages against disease. The theme for this year is #LongLifeForAll, with ‘long life’ reflecting the importance of lifespan vaccinations. “We are in a race against time to restore the immunization services disrupted by the COVID-19 pandemic and accelerate progress against all vaccine-preventable diseases,” said Gargee Ghosh, President of Global Policy and Advocacy at the Bill & Melinda Gates Foundation. “That is why we are thrilled to work with UNICEF and other partners around the world to ensure children – especially those in the world’s poorest countries – have access to the vaccines they need to live a long, healthy life.” “UNICEF ensures that nearly half of the world’s children under five are ‘protected by love’ with lifesaving vaccines,” said Martha Rebour, Executive Director of Shot@Life, United Nations Foundation. “We are honored to support and promote their work during World Immunization Week and hope that others will join us in our advocacy for these critical global vaccine programs.” ##### Notes to editors The video and campaign will go live at 00.01 GMT 24 April. Online conversations with UNICEF Ambassadors will be shared on Facebook and Instagram and also available to download here under embargo and throughout World Immunization Week. Find out more about UNICEF’s work on immunization here . Vaccination UNICEF

World Immunization Week: UNICEF Goodwill Ambassador Liam Neeson headlines week-long commemoration of global vaccination efforts and calls for greater investment

https://www.unicef.org/eca/press-releases/world-immunization-week-unicef-goodwill-ambassador-liam-neeson-headlines-week-long

NEW YORK, 24 April 2022 – UNICEF Goodwill Ambassador Liam Neeson is leading UNICEF’s global immunization initiative with a global message thanking the scientists, parents, health workers and others who have been so critical in helping to immunize children over the last two decades. In a video released ahead of World Immunization Week , Neeson talks about how the efforts of scientists such as Jonas Salk, who developed the first vaccine against polio, and dedicated workers who fill vials at factories or deliver vaccine injections, have made it possible to save two to three million child lives each year. “Vaccines are a remarkable human success story. Over last the 75 years, billions of children have been vaccinated, thanks to scientists, to health workers, to volunteers. If you’ve ever been vaccinated, or vaccinated your children, then you are part of the arm-to-arm chain that keeps all humanity safe,” said Liam Neeson, UNICEF Goodwill Ambassador. “We live our lives free of worry about catching smallpox. Once a terrifying diagnosis, polio is no longer a threat in most of the world. The conversation about vaccines in recent years has lost sight of how much good they have done for each of us. We need to celebrate this. It is perhaps one of the biggest collective achievements in human history.” Every like, share, or comment on posts mentioning a UNICEF social media account and using the hashtag #longlifeforall from now until May 10 will unlock US $1 to UNICEF, from the United Nations Foundation’s Shot@Life campaign and the Bill & Melinda Gates Foundation – up to a total of US$10 million – to help ensure all children get the life-saving vaccines they need. Despite the successes, an alarming 23 million children missed out on vaccinations in 2020. This number can only be reduced through greater commitment to and investment in immunization services. UNICEF is the world’s leading provider of vaccines to children in over 100 countries. With Gavi, the Vaccine Alliance and partners UNICEF supplies vaccines to reach 45 per cent of the world’s children under five. UNICEF also works with Governments in over 130 countries to strengthen national health and immunization programmes. “The last two years have taught us that a health care system that leaves some children exposed, is a health care system that leaves all children exposed,” said UNICEF Executive Director Catherine Russell. “The best way for the world to recover from this pandemic – and to prepare for future health emergencies -- is to invest in stronger health systems, and immunization and essential health services for every child.” World Immunization Week – celebrated every year in the last week of April – is spearheaded by the World Health Organization and brings together global partners to promote the use of vaccines to protect people of all ages against disease. The theme for this year is #LongLifeForAll, with ‘long life’ reflecting the importance of lifespan vaccinations. “We are in a race against time to restore the immunization services disrupted by the COVID-19 pandemic and accelerate progress against all vaccine-preventable diseases,” said Gargee Ghosh, President of Global Policy and Advocacy at the Bill & Melinda Gates Foundation. “That is why we are thrilled to work with UNICEF and other partners around the world to ensure children – especially those in the world’s poorest countries – have access to the vaccines they need to live a long, healthy life.” “UNICEF ensures that nearly half of the world’s children under five are ‘protected by love’ with lifesaving vaccines,” said Martha Rebour, Executive Director of Shot@Life, United Nations Foundation. “We are honored to support and promote their work during World Immunization Week and hope that others will join us in our advocacy for these critical global vaccine programs.” ##### Notes to editors The video and campaign will go live at 00.01 GMT 24 August. Online conversations with UNICEF Ambassadors will be shared on Facebook and Instagram and also available to download here under embargo and throughout World Immunization Week. Find out more about UNICEF’s work on immunization here . Vaccines work UNICEF Seven-year-old Anisija stands still while the nurse is administering her a vaccine in polyclinic "Jane Sandandski" Skopje, North Macedonia.

Immunization services begin slow recovery from COVID-19 disruptions, though millions of children remain at risk from deadly diseases – WHO, UNICEF, Gavi

https://www.unicef.org/eca/press-releases/immunization-services-begin-slow-recovery-covid-19-disruptions-though-millions

GENEVA/NEW YORK, 26 April 2021 --- While immunization services have started to recover from disruptions caused by COVID-19, millions of children remain vulnerable to deadly diseases, the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance warned today during World Immunization Week , highlighting the urgent need for a renewed global commitment to improve vaccination access and uptake. “Vaccines will help us end the COVID-19 pandemic but only if we ensure fair access for all countries, and build strong systems to deliver them,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “And if we’re to avoid multiple outbreaks of life-threatening diseases like measles, yellow fever and diphtheria, we must ensure routine vaccination services are protected in every country in the world.” A WHO survey has found that, despite progress when compared to the situation in 2020, more than one third of respondent countries (37%) still report experiencing disruptions to their routine immunization services. Mass immunization campaigns are also disrupted. According to new data, 60 of these lifesaving campaigns are currently postponed in 50 countries, putting around 228 million people - mostly children - at risk for diseases such as measles, yellow fever and polio. Over half of the 50 affected countries are in Africa, highlighting protracted inequities in people’s access to critical immunization services. Campaigns to immunize against measles, which is one of the most contagious diseases and can result in large outbreaks wherever people are unvaccinated, are the most impacted. Measles campaigns account for 23 of the postponed campaigns, affecting an estimated 140 million people. Many have now been delayed for over a year. “Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight against preventable child illness, with 20 million children already missing out on critical vaccinations,” said Henrietta Fore, UNICEF Executive Director. “The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives.” As a result of gaps in vaccination coverage, serious measles outbreaks have recently been reported in countries including the Democratic Republic of the Congo, Pakistan and Yemen, while likely to occur elsewhere as growing numbers of children miss out on lifesaving vaccines, the agencies warn. These outbreaks are happening in places already grappling with conflict situations as well as service disruptions due to ongoing response measures to COVID-19. The supply of vaccines and other equipment is also essential for child vaccinations. Due to disruptions at the onset of the COVID -19 pandemic, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019. “Millions of children across the world are likely to miss out on basic vaccines as the current pandemic threatens to unravel two decades of progress in routine immunization”, said Dr Berkley, CEO of Gavi, the Vaccine Alliance. “To support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children. To do this, we need to work together – across development agencies, governments and civil society – to ensure that no child is left behind”.

Vaccines – a vital support for long life and the good of all

https://www.unicef.org/eca/press-releases/vaccines-vital-support-long-life-and-good-all

Geneva and Copenhagen, 24 April 2022 Everyone deserves an equal opportunity to live a long and healthy life irrespective of their age, gender, place of birth or residence. Vaccination not only prevents and interrupts the spread of disease, but it also creates a cascade of benefits for the individual and for society. The last two years have demonstrated a simple but incontestable truth – if we leave anyone behind, in the end, we leave everyone behind. It is our collective responsibility to ensure that all children everywhere have access to all vaccinations in their national routine immunization schedules and that any doses missed can be provided as quickly as possible. In the past two years since COVID-19 was declared a global pandemic, we have all been witness to the devastating impact of this disease on our world, our families, and particularly our children. It has been a trying time for everyone as new variants and new waves of this virus have required near constant adaptation to changing conditions and have brought daily life and economies to a grinding halt. Thanks to unprecedented global collaboration, COVID-19 vaccines on various platforms were developed in record time and we have seen an unprecedented undertaking by the Ministries of Health to roll out the approved COVID-19 vaccines worldwide, thereby saving untold lives. COVID-19 vaccination has significantly reduced the number of severely ill and hospitalized individuals, decreasing the burden on health care systems so that hospitals and clinics have the capacity to treat those seeking care for other ailments. A study published in November 2021 estimated that 470 000 lives were saved just among those aged 60 years and older in 33 of the 53 countries in the WHO European Region from December 2020 to November 2021. To date, more than 1.5 billion doses of COVID-19 vaccines have been administered in the WHO European Region. This is a great achievement, but there is still a long way to go. Millions of people, including many of those who are most at risk of severe disease, remain unprotected as the virus continues to spread across the Region. At the same time, the COVID-19 pandemic impacted routine immunization, resulting in backsliding of immunization coverage in several countries in the Region and leaving thousands of children at risk of contracting vaccine-preventable diseases. During this period, the European Region has also demonstrated its resilience to respond to the outbreaks of vaccine-derived poliovirus, in Tajikistan and Ukraine and now in Israel. Effective outbreak response measures in Tajikistan, including stepped-up polio surveillance and 3 rounds of supplementation immunization of all children under 6 years of age, have most likely interrupted transmission of the virus in the country. However, we are concerned that the virus is still present in Ukraine. A nationwide vaccination campaign to protect 140,000 unvaccinated children throughout the country was disrupted just weeks after its launch on 1 February this year. The humanitarian crisis still unfolding in Ukraine has taken a tragic toll on health and well-being. Health services, already strained by COVID-19, have been stretched beyond capacity. Among the many serious and long-term impacts has been the disruption of immunization in the country. Any day that passes without resumption of services where they have been disrupted, or catch-up opportunities for displaced children, increases the risk of polio circulation, outbreaks of other childhood diseases, and further spread of COVID-19. The occurrence of these outbreaks is a stark reminder of the fragility that lies in our communities when we have un- and under-vaccinated populations. By preventing disease, vaccination prevents suffering and the economic burden of medical treatment, acts as our first defense against antibiotic resistance, and prevents the life-long debilitating effects that impact social and economic opportunity. The collective effect of widespread vaccination cannot be underestimated in its contribution to economic stability, social equity, and overall quality of life. As we pause today and take stock of the historic achievements of vaccination – including the eradication of smallpox, near eradication of polio, greatly reduced burden of measles, rubella, and many more once-common diseases – it is also clear that we cannot let our progress slip away. If we do so, many of our other goals: to ensure health and wellbeing, to end poverty, to empower women, to improve human rights, become harder to reach. The full benefits of vaccines can only be achieved if no one is left behind and if the European Immunization Agenda 2030, a vision and strategy created and adopted by all Member States for the next decade, is fully implemented. It is up to all of us to make the benefits of vaccines work for the good of all. Polio vaccines UNICEF

UNICEF and WHO warn of ‘perfect storm’ of conditions for measles outbreaks, affecting children

https://www.unicef.org/eca/press-releases/unicef-and-who-warn-perfect-storm-conditions-measles-outbreaks-affecting-children

NEW YORK/ GENEVA, 27 April 2022 – An increase in measles cases in January and February 2022 is a worrying sign of a heightened risk for the spread of vaccine-preventable diseases and could trigger larger outbreaks, particularly of measles affecting millions of children in 2022, warn WHO and UNICEF. Pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization are leaving too many children without protection against measles and other vaccine-preventable diseases. The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures for COVID-19 implemented during the height of the pandemic. In addition, with millions of people being displaced due to conflicts and crises including in Ukraine, Ethiopia, Somalia and Afghanistan, disruptions in routine immunization and COVID-19 vaccination services, lack of clean water and sanitation, and overcrowding increase the risk of vaccine-preventable disease outbreaks. Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of 2021. As measles is very contagious, cases tend to show up quickly when vaccination levels decline. The agencies are concerned that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly. Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes a child more vulnerable to other infectious diseases like pneumonia and diarrhoea, including for months after the measles infection itself among those who survive. Most cases occur in settings that have faced social and economic hardships due to COVID-19, conflict, or other crises, and have chronically weak health system infrastructure and insecurity. “Measles is more than a dangerous and potentially deadly disease. It is also an early indication that there are gaps in our global immunization coverage, gaps vulnerable children cannot afford,” said Catherine Russell, UNICEF Executive Director. “It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles.” In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019. Top 5 countries with reported measles cases in the last 12 months, until April 2022 [1] Country Reported Measles cases Rate per million cases First dose measles coverage (%), 2019 [2] First dose measles coverage (%), 2020 [3] Somalia 9,068 554 46 46 Yemen 3,629 119 67 68 Afghanistan 3,628 91 64 66 Nigeria 12341 58 54 54 Ethiopia 3039 26 60 58 As of April 2022, the agencies report 21 large and disruptive measles outbreaks around the world in the last 12 months. Most of the measles cases were reported in Africa and the East Mediterranean region. The figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential underreporting. Countries with the largest measles outbreaks since the past year include Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia. Insufficient measles vaccine coverage is the major reason for outbreaks, wherever they occur. “The COVID-19 pandemic has interrupted immunization services, health systems have been overwhelmed, and we are now seeing a resurgence of deadly diseases including measles. For many other diseases, the impact of these disruptions to immunization services will be felt for decades to come,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Now is the moment to get essential immunization back on track and launch catch-up campaigns so that everybody can have access to these life-saving vaccines.” As of 1 April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children. Of these, 19 are measles campaigns, which put 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and thereafter due to the war. Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks as in 2017-2019, when there were over 115,000 cases of measles and 41 deaths in the country – this was the highest incidence in Europe. Coverage at or above 95 per cent with two doses of the safe and effective measles vaccine can protect children against measles. However, COVID-19 pandemic-related disruptions have delayed the introduction of the second dose of the measles vaccine in many countries. As countries work to respond to outbreaks of measles and other vaccine-preventable diseases, and recover lost ground, UNICEF and WHO, along with partners such as Gavi, the Vaccine Alliance, the partners of the Measles & Rubella Initiative (M&RI), Bill & Melinda Gates Foundation, and others are supporting efforts to strengthen immunization systems by: Restoring services and vaccination campaigns so countries can safely deliver routine immunization programmes to fill the gaps left by the backsliding; Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations; Rectifying gaps in immunization coverage, including identifying communities and people who have been missed during the pandemic; Ensuring that COVID-19 vaccine delivery is independently financed and well-integrated into overall planning for immunization services so that it is not carried out at the cost of childhood and other vaccination services; Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases and strengthening immunization systems as part of COVID-19 recovery efforts. ###### Notes to Editors For more information on the 24-30 April WHO World Immunization Week campaign and all resources . [1] Source: Provisional data based on monthly data reported to WHO as of April 2022 [2] Source: WHO/UNICEF estimates of national immunization coverage, 2020 revision. [3] Source: WHO/UNICEF estimates of national immunization coverage, 2020 revision. Vaccination of children UNICEF Skopje, 17 January 2022: With a smile on her face, four-year-old Izabela is sitting in her mum’s lap waiting for MMR (measles, mumps, rubella) re-vaccination in “Gjorce Petrov” Polyclinic.

29 November 2018

Measles cases spike globally due to gaps in vaccination coverage: New report

https://www.unicef.org/eca/press-releases/measles-cases-spike-globally-due-gaps-vaccination-coverage-new-report

GENEVA/ATLANTA/NEW YORK, 29 November 2018: Reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease. This is according to a new report published today by leading health organizations. Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease. Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016. The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organization (WHO) region where measles incidence fell. “The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.” Measles is a serious and highly contagious disease. It can cause debilitating or fatal complications, including encephalitis (an infection that leads to swelling of the brain), severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss. Babies and young children with malnutrition and weak immune systems are particularly vulnerable to complications and death. The disease is preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85 percent. This is far short of the 95 percent needed to prevent outbreaks, and leaves many people, in many communities, susceptible to the disease. Second dose coverage stands at 67 percent. “The increase in measles cases is deeply concerning, but not surprising,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Complacency about the disease and the spread of falsehoods about the vaccine in Europe, a collapsing health system in Venezuela and pockets of fragility and low immunization coverage in Africa are combining to bring about a global resurgence of measles after years of progress. Existing strategies need to change: more effort needs to go into increasing routine immunization coverage and strengthening health systems. Otherwise we will continue chasing one outbreak after another.” Responding to the recent outbreaks, health agencies are calling for sustained investment in immunization systems, alongside efforts to strengthen routine vaccination services. These efforts must focus especially on reaching the poorest, most marginalized communities, including people affected by conflict and displacement. The agencies also call for actions to build broad-based public support for immunizations, while tackling misinformation and hesitancy around vaccines where these exist. “Sustained investments are needed to strengthen immunization service delivery and to use every opportunity for delivering vaccines to those who need them,” said Dr Robert Linkins, Branch Chief of Accelerated Disease Control and Vaccine Preventable Disease Surveillance at the U.S. Centers for Disease Control and Prevention (CDC) and Measles & Rubella Initiative Management Team Chair. The Measles and Rubella Initiative is a partnership formed in 2001 of the American Red Cross, CDC, the United Nations Foundation, UNICEF, and WHO. Notes to Editors ‘Progress Toward Regional Measles Elimination — Worldwide, 2000–2017’ is a joint publication of WHO and CDC. It is published within the WHO Weekly Epidemiological Record and in CDC’s Morbidity and Mortality Weekly Report. Launched in 2001, the Measles & Rubella Initiative (M&RI) is led by the American Red Cross, the United Nations Foundation, CDC, UNICEF and WHO. M&RI is committed to ensuring that no child dies from measles or is born with congenital rubella syndrome, and achieving the Global Vaccine Action Plan goal of measles and rubella elimination in at least five WHO regions by 2020. Measles elimination is defined as the absence of endemic measles virus transmission in a region or other defined geographical area for more than 12 months. Conversely, a country is no longer considered to be measles free if the virus returns and transmission is sustained continuously for more than a year. The report is available in CDC’s Morbidity and Mortality Weekly Report as of November 29 2018 and in WHO’s Weekly Epidemiological Record from November 30 2018. Further information on immunization progress is also contained within the 2018 Assessment Report of The Global Vaccine Action Plan by the Strategic Advisory Group of Experts on Immunization, published in November 2018. Dana, 1.3, held by her mother Inna, doesn’t cry while being administered her first dose of mumps, measles and rubella (MMR) vaccine on 4 April 2018 in Children’s Policlinic №1 in Obolon district, Kyiv, Ukraine. UNICEF/UN0201055/Krepkih

Over 20 million children worldwide missed out on measles vaccine annually in past 8 years, creating a pathway to current global outbreaks - UNICEF

https://www.unicef.org/eca/press-releases/over-20-million-children-worldwide-missed-out-measles-vaccine-annually-past-8-years

NEW YORK, 25 April 2019 – An estimated 169 million children missed out on the first dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, UNICEF said today. Widening pockets of unvaccinated children have created a pathway to the measles outbreaks hitting several countries around the world today. “The ground for the global measles outbreaks we are witnessing today was laid years ago,” said Henrietta Fore, UNICEF Executive Director. “The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike.” In the first three months of 2019, more than 110,000 measles cases were reported worldwide – up nearly 300 per cent from the same period last year. An estimated 110,000 people, most of them children, died from measles in 2017, a 22 per cent increase from the year before. Two doses of the measles vaccine are essential to protect children from the disease. However, due to lack of access, poor health systems, complacency, and in some cases fear or skepticism about vaccines, the global coverage of the first dose of the measles vaccine was reported at 85 per cent in 2017, a figure that has remained relatively constant over the last decade despite population growth. Global coverage for the second dose is much lower, at 67 per cent. The World Health Organization recommends a threshold of 95 per cent immunization coverage to achieve so-called ‘herd immunity’. Top ten high-income countries where children not vaccinated with the first measles vaccine dose 2010 - 2017 1. United States: 2,593,000 2. France: 608,000 3. United Kingdom: 527,000 4. Argentina: 438,000 5. Italy: 435,000 6. Japan: 374,000 7. Canada: 287,000 8. Germany: 168,000 9. Australia: 138,000 10. Chile: 136,000 In high income countries, while coverage with the first dose is 94 per cent, coverage for the second dose drops to 91 per cent, according to the latest data. The United States tops the list of high-income countries with the most children not receiving the first dose of the vaccine between 2010 and 2017, at more than 2.5 million. It is followed by France and the United Kingdom, with over 600,000 and 500,000 unvaccinated infants, respectively, during the same period. In low- and middle-income countries, the situation is critical. In 2017, for example, Nigeria had the highest number of children under one year of age who missed out on the first dose, at nearly 4 million. It was followed by India (2.9 million), Pakistan and Indonesia (1.2 million each), and Ethiopia (1.1 million). Worldwide coverage levels of the second dose of the measles vaccines are even more alarming. Of the top 20 countries with the largest number of unvaccinated children in 2017, 9 have not introduced the second dose. Twenty-countries in sub-Saharan Africa have not introduced the necessary second dose in the national vaccination schedule, putting over 17 million infants a year at higher risk of measles during their childhood. UNICEF, with partners such as the Measles and Rubella Initiative and Gavi, the Vaccine Alliance , is helping address this measles crisis by: Negotiating vaccine prices: the cost of the measles vaccine is now at an all-time low; Helping countries identify underserved areas and unreached children; Procuring vaccines and other immunization supplies; Supporting supplementary vaccination campaigns to address gaps in routine immunization coverage; Working with relevant countries to introduce the second dose of the measles vaccine in the national immunization schedule. Cameroon, Liberia and Nigeria are on track to do so in 2019. Introducing innovations like the use of solar power and mobile technologies to maintain vaccines at the right temperature. “Measles is far too contagious,” said Fore. “It is critical not only to increase coverage but also to sustain vaccination rates at the right doses to create an umbrella of immunity for everyone.” ###### Notes to editors Download photos and broll here . About the Analysis The analysis is based on UNICEF and WHO’s estimation of national immunization coverage of 194 countries for 2017. Provisional measles and rubella data is based on monthly data reported to WHO Geneva in April 2019. For high income countries, follow the World Bank country classification by income in July 2018. About World Immunization Week Celebrated in the last week of April, World Immunization Week aims to promote the use of vaccines to protect people of all ages against disease. Find more details about UNICEF’s WIW efforts here . About Measles and Rubella Initiative UNICEF is part of the Measles and Rubella Initiative , a private-public partnership including WHO, CDC, United Nations Foundation and American Red Cross that spearheads a global push towards measles and rubella elimination and control. Alexander sits quietly as he waits to get his vaccine at City Children’s Hospital in Ivano-Franskiv in Ukraine. UNICEF/Pavel Zmey Alexander sits quietly as he waits to get his vaccine at City Children’s Hospital in Ivano-Franskiv in Ukraine.

20 million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018

https://www.unicef.org/eca/press-releases/20-million-children-miss-out-lifesaving-measles-diphtheria-and-tetanus-vaccines-2018

NEW YORK/GENEVA, 15 July 2019 – 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF. Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine has stalled at around 86 percent. While high, this is not sufficient. 95 percent coverage is needed – globally, across countries, and communities - to protect against outbreaks of vaccine-preventable diseases. “Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “While most children today are being vaccinated, far too many are left behind. Unacceptably, it’s often those who are most at risk– the poorest, the most marginalized, those touched by conflict or forced from their homes - who are persistently missed.” Most unvaccinated children live in the poorest countries, and are disproportionately in fragile or conflict-affected states. Almost half are in just 16 countries - Afghanistan, the Central African Republic, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Iraq, Mali, Niger, Nigeria, Pakistan, Somalia, South Sudan, Sudan, Syria and Yemen. If these children do get sick, they are at risk of the severest health consequences, and least likely to access lifesaving treatment and care. Measles outbreaks reveal entrenched gaps in coverage, often over many years. Stark disparities in vaccine access persist across and within countries of all income levels. This has resulted in devastating measles outbreaks in many parts of the world – including countries that have high overall vaccination rates. In 2018, almost 350,000 measles cases were reported globally, more than doubling from 2017. “Measles is a real time indicator of where we have more work to do to fight preventable diseases,” said Henrietta Fore, UNICEF’s Executive Director. “Because measles is so contagious, an outbreak points to communities that are missing out on vaccines due to access, costs or, in some places, complacency. We have to exhaust every effort to immunize every child.” Ten countries with highest reported incidence rate of measles cases (2018) Coverage with measles first dose (2010) Coverage with measles first dose (2018) 1. Ukraine 56 91 2. Democratic Republic of Congo 74 80 3. Madagascar 66 62 4. Liberia 65 91 5. Somalia 46 46 6. Serbia 95 92 7. Georgia 94 98 8. Albania 99 96 9. Yemen 68 64 10. Romania 95 90 Ukraine leads a varied list of countries with the highest reported incidence rate of measles in 2018. While the country has now managed to vaccinate over 90 percent of its infants, coverage had been low for several years, leaving a large number of older children and adults at risk. Several other countries with high incidence and high coverage have significant groups of people who have missed the measles vaccine in the past. This shows how low coverage over time or discrete communities of unvaccinated people can spark deadly outbreaks. Human papillomavirus (HPV) vaccine coverage data available for the first time For the first time, there is also data on the coverage of human papillomavirus (HPV) vaccine, which protects girls against cervical cancer later in life. As of 2018, 90 countries – home to 1 in 3 girls worldwide - had introduced the HPV vaccine into their national programmes. Just 13 of these are lower-income countries. This leaves those most at risk of the devastating impacts of cervical cancer still least likely to have access to the vaccine. Together with partners like Gavi, the Vaccine Alliance, WHO and UNICEF are supporting countries to strengthen their immunization systems and outbreak response, including by vaccinating all children with routine immunization, conducting emergency campaigns, and training and equipping health workers as an essential part of quality primary healthcare. ###### For photos and broll, please click here . For the 2018 data, click here . The 2018 data will go live only at 09.00 am EST 15 July. About the data Since 2000, WHO and UNICEF jointly produce national immunization coverage estimates for Member States on an annual basis. In addition to producing the immunization coverage estimates for 2018, the WHO and UNICEF estimation process revises the entire historical series of immunization data with the latest available information. The 2018 revision covers 39 years of coverage estimates, from 1980 to 2018. DTP3 coverage is used as an indicator to assess the proportion of children vaccinated and is calculated for children under one year of age. The estimated number of vaccinated children are calculated using population data provided by the 2019 World Population Prospects (WPP) from the UN. Maryana Dzuba, 9, receives her first dose of MMR vaccine on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, Ukraine. UNICEF/UN0284080/ Dyachyshyn Maryana Dzuba, 9, receives her first dose of MMR vaccine on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, Ukraine, as part of a three-week long catch-up vaccination campaign to increase MMR coverage among school aged children in the region.

UNICEF launches #VaccinesWork campaign to inspire support for vaccines

https://www.unicef.org/eca/press-releases/unicef-launches-vaccineswork-campaign-inspire-support-vaccines

NEW YORK, 18 April 2019 – UNICEF is launching a new global campaign on 24 April to emphasize the power and safety of vaccines among parents and wider social media users. The campaign will run alongside World Immunization Week from 24 to 30 April to spread the message that together communities, including parents, can protect everyone through vaccines. #VaccinesWork has long been used to bring together immunization advocates online. This year, UNICEF is partnering with the Bill & Melinda Gates Foundation , the World Health Organization (WHO), and Gavi, the Vaccine Alliance to encourage even greater reach. The Bill & Melinda Gates Foundation will contribute USD$ 1 to UNICEF for every like or share of social media posts using the hashtag #VaccinesWork in April, up to USD$1 million, to ensure all children get the life-saving vaccines they need. Vaccines save up to 3 million lives yearly, protecting children from potentially deadly, highly infectious diseases such as measles, pneumonia, cholera, and diphtheria. Thanks to vaccines, fewer people died from measles between 2000 and 2017 and polio is on the verge of being eradicated. Vaccines are one of the most cost-effective health tool ever invented – every USD$1 spent on childhood immunization returns up to USD$44 in benefits. “We want the awareness that #VaccinesWork to go viral,” said Robin Nandy, UNICEF’s Chief of Immunization. “Vaccines are safe, and they save lives. This campaign is an opportunity to show the world that social media can be a powerful force for change and provide parents with trustworthy information on vaccines.” The campaign is part of a global, week-long celebration under the theme, Protected Together: Vaccines Work , to honour Vaccine Heroes – from parents and community members to health workers and innovators. “More children than ever before are being reached with vaccines today,” said Violaine Mitchell, Interim Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. “We are delighted to work with UNICEF and all the global and country partners around the world who are working tirelessly to ensure all children, especially those in the world’s poorest countries, can be protected from life-threatening infectious diseases.” Despite the benefits of vaccines, an estimated 1.5 million children died of vaccine-preventable diseases in 2017. While this is often due to lack of access to vaccines, in some countries, families are delaying or refusing to vaccinate their children because of complacency or skepticism about vaccines. This has resulted in several outbreaks, including an alarming surge in measles, especially in higher-income countries. Uncertainty about vaccines on digital and social media platforms is one of the factors driving this trend. That is why the centerpiece of this UNICEF campaign is a 60-second animated film, “Dangers,” which, along with illustrated animations for social media posts and posters, is based on the relatable insight that kids, by their very nature, are little daredevils who are constantly putting themselves in danger. Available in Arabic, Chinese, French, Hindi, Russian, Spanish and Tagalog, the video explains that while parents can’t prevent all the dangers their kids get themselves into, they can use vaccination to help prevent the dangers that get into their kids. In addition, UNICEF experts will be answering questions about vaccination, including how vaccines work, how they are tested, why children should receive vaccines, as well as the risks of not vaccinating children in a timely manner. Additional quotes from campaign supporters: Angélique Kidjo, UNICEF Goodwill Ambassador and Grammy Award-Winning Singer: “Today nine in ten children receive immunizations, but we cannot leave anyone behind. We must reach every child with life-saving vaccines.” Maisa Silva , 16-year-old, Brazilian TV hostess and actress: "I accepted the invitation to participate in this campaign because I know the importance of vaccines for children's health. It is a way to protect children from various hazards we already know. Health is a very serious matter and we must not forget that vaccines work and are necessary. " ### Notes to editors Download photos and b-roll here , including the “Dangers” video, which is embargoed till 24 April. Learn more about the campaign here . For more information on UNICEF’s work on immunization, click here . On 20 February 2014 in Turkey, a Syrian girl refugee receives a dose of oral polio vaccine, in Osmaniye Province. UNICEF/UN01324/Yurtsever

23 February 2021

UNICEF begins shipping syringes for the global rollout of COVID-19 vaccines under COVAX

https://www.unicef.org/eca/press-releases/unicef-begins-shipping-syringes-global-rollout-covid-19-vaccines-under-covax

NEW YORK, 23 February 2021 – UNICEF has sent 100,000 syringes and 1,000 safety boxes for COVID-19 vaccinations to the Maldives by air freight from UNICEF’s humanitarian warehouse in Dubai—part of the first wave of COVID-19-related syringe shipments to begin rolling out in the coming days. Others in the first wave of shipments include Côte d'Ivoire and São Tomé and Príncipe. The 0.5 ml syringes and safety boxes are expected to arrive in Malé, Maldives on Tuesday. Over the next few weeks, UNICEF will ship more than 14.5 million 0.5 ml and 0.3 ml auto-disable syringes to more than 30 countries. While the 0.5 ml syringes are meant for use with the Serum Institute of India/AstraZeneca vaccine, the 0.3 ml ones are to be used with the Pfizer-BioNTech vaccine. “In this global fight against the COVID-19 pandemic, syringes are as vital as the vaccine itself,” said UNICEF Executive Director Henrietta Fore. “It is critical to have adequate supplies of syringes already in place in every country before the vaccine arrives so that the vaccine can be administered safely. This would allow immunization to start immediately and help turn the tide on this terrible virus.” The countries that will receive syringes in this initial tranche are from those included in the COVAX indicative distribution and that have put in requests to UNICEF to supply syringes. These shipments will support the country rollout of COVID-19 vaccines, and is part of work by the COVAX Facility to provide vaccines to all participating countries. The 0.5 ml syringes are being dispatched from UNICEF’s humanitarian warehouse in Dubai, while the 0.3 ml & 2 ml syringes will be transported directly from a manufacturer in Spain. The consignments will also include safety boxes for the safe disposal of syringes. Both syringes are of the auto-disable type, which means they cannot be used again after a single dose of vaccine has been administered. This reduces the risk of infection from blood-borne diseases as a result of syringe re-use. In all, UNICEF will be supplying up to 1 billion syringes and 10 million safety boxes to countries in 2021 to ensure they are ready for COVID-19 vaccinations. In order to meet the demand for these vital supplies, UNICEF created a stockpile of almost half a billion syringes in its warehouses in Copenhagen and Dubai in preparation for the broader rollout of COVID-19 vaccines in 82 low- and lower middle-income countries. UNICEF has been working with airlines, logistics operators and freight forwarders to ensure the syringes are treated as priority freight, whether they are being shipped direct from a manufacturer or from UNICEF warehouses to the destination country’s port of entry. Although the first deliveries will be transported by air, most of the syringes and safety boxes will be transported by sea due to the large amount of space they take up as cargo. UNICEF is aiming to make 2 billion COVID-19 doses available for delivery in 2021. Even before COVID-19, UNICEF was already the largest single vaccine buyer in the world, procuring over 2 billion vaccines annually in order to reach almost half of the world’s children under 5. In addition, the agency procures and supplies around 600-800 million syringes for regular immunization programmes annually. COVAX is a global collaboration co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO, and includes UNICEF, which leads on procurement and delivery, as well as getting countries ready to receive vaccines. ##### Двое мужчин на складе с коробками UNICEF/UN0419486/Pableo

WHO and UNICEF warn of a decline in vaccinations during COVID-19

https://www.unicef.org/eca/press-releases/who-and-unicef-warn-decline-vaccinations-during-covid-19

GENEVA/NEW YORK, 15 July 2020 – The World Health Organization and UNICEF warned today of an alarming decline in the number of children receiving life-saving vaccines around the world. This is due to disruptions in the delivery and uptake of immunization services caused by the COVID-19 pandemic. According to new data by WHO and UNICEF , these disruptions threaten to reverse hard-won progress to reach more children and adolescents with a wider range of vaccines, which has already been hampered by a decade of stalling coverage. The latest data on vaccine coverage estimates from WHO and UNICEF for 2019 shows that improvements such as the expansion of the HPV vaccine to 106 countries and greater protection for children against more diseases are in danger of lapsing. For example, preliminary data for the first four months of 2020 points to a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3). This is the first time in 28 years that the world could see a reduction in DTP3 coverage – the marker for immunization coverage within and across countries. “Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunized than ever before,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself. But it doesn’t have to be that way. Vaccines can be delivered safely even during the pandemic, and we are calling on countries to ensure these essential life-saving programmes continue.” COVID-19 disruptions Due to the COVID-19 pandemic, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond. According to a new UNICEF, WHO and Gavi pulse survey , conducted in collaboration with the US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, three quarters of the 82 countries that responded reported COVID-19 related disruptions in their immunization programmes as of May 2020. The reasons for disrupted services vary. Even when services are offered, people are either unable to access them because of reluctance to leave home, transport interruptions, economic hardships, restrictions on movement, or fear of being exposed to people with COVID-19. Many health workers are also unavailable because of restrictions on travel or redeployment to COVID response duties as well as a lack of protective equipment. “COVID-19 has made previously routine vaccination a daunting challenge,” said UNICEF Executive Director Henrietta Fore. “We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.” Stagnating global coverage rate Progress on immunization coverage was stalling before COVID-19 hit, at 85 per cent for DTP3 and measles vaccines. The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of 5 is less than 20 per cent. In 2019, nearly 14 million children missed out on life-saving vaccines such as measles and DTP3. Most of these children live in Africa and are likely to lack access to other health services. Two-thirds of them are concentrated in 10 middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Children in middle-income countries account for an increasing share of the burden. Progress and challenges, by country and region There has been some progress. Regional coverage for the third dose of DTP in South Asia has increased by 12 percentage points over the last 10 years, notably across India, Nepal and Pakistan. However, that hard-won progress could be undone by COVID-19 related disruptions. Countries that had recorded significant progress, such as Ethiopia and Pakistan, are now also at risk of backsliding if immunization services are not restored as soon as feasible. The situation is especially concerning for Latin America and the Caribbean, where historically high coverage has slipped over the last decade. In Brazil, Bolivia, Haiti and Venezuela, immunization coverage plummeted by at least 14 percentage points since 2010. These countries are now also confronting moderate to severe COVID19-related disruptions. As the global health community attempts to recover lost ground due to COVID-19 related disruptions, UNICEF and WHO are supporting countries in their efforts to reimagine immunization and build back better by: Restoring services so countries can safely deliver routine immunization services during the COVID-19 pandemic, by adhering to hygiene and physical distancing recommendations and providing protective equipment to health workers; Helping health workers communicate actively with caregivers to explain how services have been reconfigured to ensure safety; Rectifying coverage and immunity gaps; Expanding routine services to reach missed communities, where some of the most vulnerable children live. ### Notes to editors Download photos , the report, data files and b-roll from UNICEF here or from WHO here . After 2pm CET 15 July, read the analysis of the data in this report, Are we losing ground? . Review presentation and graphs related to the data here . Nurses in Kosovo immunizing children when vaccination programme was resumed UNICEF/2020/S.Karahoda Nurses in Kosovo immunizing children when vaccination programme was resumed

19 October 2020

UNICEF to stockpile over half a billion syringes by year end, as part of efforts to prepare for eventual COVID-19 vaccinations

https://www.unicef.org/eca/press-releases/unicef-stockpile-over-half-billion-syringes-year-end-part-efforts-prepare-eventual

NEW YORK, 19 October 2020 – As the world awaits a COVID-19 vaccine, UNICEF has begun laying the groundwork for the rapid, safe and efficient delivery of the eventual vaccine by purchasing and pre-positioning syringes and other necessary equipment. As soon as COVID-19 vaccines successfully emerge from trials and are licensed and recommended for use, the world will need as many syringes as doses of vaccine. To begin preparations, this year, UNICEF will stockpile 520 million syringes in its warehouses, part of a larger plan of 1 billion syringes by 2021, to guarantee initial supply and help ensure that syringes arrive in countries before the COVID-19 vaccines. During 2021, assuming there are enough doses of COVID-19 vaccines, UNICEF anticipates delivering over 1 billion syringes to support COVID-19 vaccination efforts on top of the 620 million syringes that UNICEF will purchase for other vaccination programmes against other diseases such as measles, typhoid and more. “Vaccinating the world against COVID-19 will be one of the largest mass undertakings in human history, and we will need to move as quickly as the vaccines can be produced,” said Henrietta Fore, UNICEF Executive Director. “In order to move fast later, we must move fast now. By the end of the year, we will already have over half a billion syringes pre-positioned where they can be deployed quickly and cost effectively. That’s enough syringes to wrap around the world one and a half times.” In line with the longstanding collaboration between the two partners, Gavi will reimburse UNICEF for the procurement of the syringes and safety boxes, which shall then be used for the COVID-19 Vaccine Global Access Facility (COVAX Facility) and for other Gavi-funded immunization programmes if necessary. Besides syringes, UNICEF is also buying 5 million safety boxes so that used syringes and needles can be disposed in a safe manner by personnel at health facilities, thus preventing the risk of needle stick injuries and blood borne diseases. Every safety box carries 100 syringes. Accordingly, UNICEF is “bundling” the syringes with safety boxes to ensure enough safety boxes are available to go along with the syringes. Injection equipment such as syringes and safety boxes have a shelf life of five years. Lead-times for such equipment are also long as these items are bulky and need to be transported by sea freight. Vaccines , which are heat sensitive, are normally transported more quickly by air freight. In addition to saving time, early purchase of syringes and safety boxes also reduces pressure on the market and pre-empts potential early spikes in demand when vaccines do become available. As the key procurement coordinator for Gavi, the Vaccine Alliance, UNICEF is already the largest single vaccine buyer in the world , procuring more than 2 billion doses of vaccines annually for routine immunization and outbreak response on behalf of nearly 100 countries. Every year, UNICEF provides vaccines for almost half of the world’s children and procures and supplies around 600-800 million syringes for regular immunization programmes. COVID-19 vaccines will likely treble or quadruple that number, depending on the number of COVID-19 vaccines that are ultimately produced and secured by UNICEF. “Over two decades, Gavi has helped an additional 822 million children from the world’s most vulnerable countries access critical, life-saving vaccines,” said Seth Berkley, CEO of Gavi. “This would not have been possible without our partnership with UNICEF, and it is this same collaboration that will be essential to Gavi’s work with the COVAX Facility.” To make sure that vaccines are transported and stored at the right temperature , UNICEF, along with WHO, is also mapping out existing cold chain equipment and storage capacity – in the private as well as public sector – and preparing necessary guidance for countries to receive vaccines. “We are doing everything we can to deliver these essential supplies efficiently, effectively and at the right temperature, as we already do so well all over the world,” Fore said. Even prior to the COVID-19 pandemic, with support from Gavi and in partnership with WHO, UNICEF has been upgrading the existing cold chain equipment across health facilities in countries to ensure that vaccines remain safe and effective throughout their journey. Since 2017, over 40,000 cold-chain fridges, including solar fridges, have been installed across health facilities, mostly in Africa. In most countries, UNICEF is promoting solar technologies to help countries maintain supply chains. In South Sudan , the least electrified country in the world, where temperatures frequently exceed 40 degrees Celsius, more than 700 health facilities have been equipped by UNICEF with solar power fridges, approximately 50 per cent of health facilities in the country. A health volunteer fills a syringe UNICEF/UN070241/Hatcher-Moore