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
Interpersonal Communication for Immunization
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immunization-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. It consist of a Facilitator Guide, Participant Manual and a set of Presentations. Options Available options Facilitator guide Participant manual Presentation Download file (PDF, 5,62 MB) (PDF, 5,57 MB) (PDF, 11,88 MB) November 2019
World Immunization Week 2019
Vaccines act as a shield, protecting children and newborn babies from dangerous diseases and saving up to 3 million lives each year. Yet, there are still nearly 20 million unvaccinated and under-vaccinated children in the world today. These children are at risk of serious illness, complications, and even death. Many parents want to vaccinate their children, but can’t because they don’t have access to healthcare. But increasingly, some parents are choosing not to. This reluctance often stems from misconceptions about vaccines, or complacency about the likelihood of getting infected. That’s why staying informed about the benefits of vaccines – and the risks of not getting vaccinated – is more important than ever. This World Immunization Week, UNICEF is launching a global campaign to emphasize the power and safety of vaccines among parents and social media users. From 24-30 April, the Bill & Melinda Gates Foundation will contribute US$1 to UNICEF for every like or share of social media posts using the hashtag #VaccinesWork, up to US$1 million, to ensure all children get the life-saving vaccines they need. Help protect children from deadly diseases by telling parents around the world, #VaccinesWork !
Interpersonal Communication for Immunization. Presentation
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Download file (PDF, 11,88 MB) November 2018
Interpersonal Communication for Immunization. Participant manual
Good interpersonal communication can mean the difference between a child being fully immunized or not at all. This Interpersonal Communication for Immunization Participant manual seeks to help health workers value, acquire, and consistently use the knowledge, skills, and attitudes needed to communicate effectively with caregivers and communities about childhood immunization. Interpersonal communication for immunization capacity development is critical. Almost every study of health worker practices in the region finds that interpersonal communication for immunization overall is weak. Yet, at the same time, the vast majority of caregivers of young children cite health workers as their primary source of information about immunization. Health workers and health services must close this gap if nations and the world are to achieve universal immunization. Download file (PDF, 5,57 MB) November 2019
Interpersonal Communication for Immunization. Facilitator Guide
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immuni-zation-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. Download file (PDF, 5,62 MB) November 2019
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.
Maintaining routine immunization services vital during the COVID-19 pandemic – WHO and UNICEF
The COVID-19 pandemic is a stark reminder that infectious diseases know no borders. All countries are vulnerable, regardless of income levels or the strength of their health care systems. Across the European Region, where tens of millions of people have been living in lockdown for weeks, and over 100,000 people have died, the speed and devastation of the novel coronavirus has completely upended lives. The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. As scientists around the world work to develop a vaccine against the novel coronavirus and health care capacities are stretched in responding to COVID-19, national routine immunization programmes are more critical than ever before. Governments across the Region must use every opportunity possible to protect people from the many diseases for which vaccines are already available. When routine vaccinations are missed, the risk of disease outbreaks increases. In 2018, approximately 527 000 children missed their first-dose of measles-containing vaccine in the WHO European Region. One year later in 2019, the measles virus exposed immunity gaps in Europe, infecting over 100 000 people, across all age-groups. Protecting children, adolescents and adults from vaccine-preventable diseases through vaccination is a must for the sustainability of health care systems. “We know that vulnerability to infectious diseases anywhere is a threat to public health everywhere,” said Ms. Afshan Khan, UNICEF Regional Director for Europe and Central Asia. “It is critical that routine immunization programmes continue during this crisis, while adequately protecting health workers and individuals receiving vaccinations. Reaching the most vulnerable children who have missed routine immunizations in the past should be prioritized.” If, during these unprecedented times, local COVID-19 response measures cause temporary interruptions of routine immunization services, countries should plan to resume immunization services as quickly as possible after the situation stabilizes. Countries should be prepared to vaccinate those at higher risk and ensure everyone, including the most marginalized, will have equal access to a COVID-19 vaccine when it becomes available. “ We can prevent further impact of COVID-19 on our healthcare systems by assuring that individuals of all ages remain vaccinated according to national schedules. I urge countries to maintain immunization service delivery and drive demand for vaccination, through the life-course even at this difficult time. Prioritizing immunization is one of my four flagship areas and central to WHO’s vision for health in the new European Programme of Work” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. WHO and UNICEF will continue to support governments’ efforts to strengthen their immunization programmes, including through strategic planning for equitable provision of immunization, strengthening vaccine-preventable disease surveillance and community engagement and education. As we step into a new future, vaccines will continue to serve as a foundation for health and wellbeing for all. It is through solidarity, joint action and tireless commitment to leaving no one behind that we can create a healthier future together. #Vaccineswork Georgia immunization UNICEF/UN0326765/Georgia
What you need to know about COVID-19 vaccines
Vaccines save millions of lives each year and a COVID-19 vaccine could save yours. The COVID-19 vaccines are safe and effective, providing strong protection against serious illness and death. WHO reports that unvaccinated people have at least 10 times higher risk of death from COVID-19 than someone who has been vaccinated. There is also evidence that being vaccinated can help prevent you from spreading the virus, so it protects people around you. It is important to be vaccinated as soon as it’s your turn, even if you already had COVID-19. Vaccines offer more reliable protection than natural immunity. Getting vaccinated is a safer way for you to develop immunity from COVID-19 than getting infected. The COVID-19 vaccines are highly effective, but no vaccine provides 100 per cent protection. Some people will still get ill from COVID-19 after vaccination or pass the virus onto someone else. Therefore, it is important to continue practicing safety precautions to protect yourself and others, including avoiding crowded spaces, physical distancing, hand washing and wearing a mask.
Increasing immunization coverage is priority for Ukrainian Government – Vice Prime Minister of Ukraine
– Ukrainian Vice Prime Minister Pavlo Rozenko, representatives of the Ukrainian Government and the Presidential Administration have expressed their commitment to restore the routine immunization programme in Ukraine. Speaking at a high-level roundtable on immunization, organized by the Ministry of Health of Ukraine and UNICEF on the occasion of World Polio Day, Vice Prime Minister Rozenko said: “Evidence-based medicine confirms the effectiveness of vaccines to prevent diseases such as polio, tetanus or whooping cough. Increasing the rates of immunization coverage is an important task and a priority of the government and a matter of national security.” Ukraine currently has the lowest routine immunization rates in the world. According to the Ministry of Health data, only 30 percent of children in Ukraine were fully immunized against measles, only 10 percent against hepatitis B, and only 3 percent against diphtheria, pertussis and tetanus, as of August 2016. Moreover, only 44 percent of children under 18 months of age were fully immunized against polio. Shortage of vaccine supplies has been one of the main reasons behind the critically low immunization rates in the past years. To address this, at the request of the Ministry of Health of Ukraine, UNICEF has procured a number of high quality certified vaccines to protect children against dangerous vaccine-preventable diseases, namely tuberculosis (BCG), measles, mumps and rubella (MMR), hepatitis B, diphtheria, tetanus and pertussis (DTP), tetanus and diphtheria vaccine for adults (Td), paediatric diphtheria and tetanus (DT), rabies, and bivalent oral polio vaccine (bOPV). The vaccines are now available in health facilities across the country. “This time last year, Ukraine was dealing with a polio outbreak. The comprehensive outbreak response was successfully implemented with the help of international partners, but this success is still fragile”, said Marie-Pierre Poirier, UNICEF Regional Director for Europe and Central Asia. “With such low routine immunization coverage, Ukraine is still at risk of outbreaks of long-forgotten diseases. Today, with millions of doses of vaccines available across the country, there is no reason to delay vaccination. Being vaccinated is fundamental to guarantee child’s right to health and now more than ever, it is important for Ukraine to put in place a strong and effective immunization programme,” she added. Speaking at the event, Professor David Salisbury, Chairman of the European Regional Certification Commission for Poliomyelitis Eradication said: “The polio cases in 2015 in Ukraine happened as a direct consequence of failings in the provision of vaccines for children. Efforts have been made to redress these problems but there is still more that needs to be done to give the children of Ukraine protection from vaccine preventable diseases. I am greatly encouraged by the commitments that have been made today and I look forward to being able to remove Ukraine from our list of polio high-risk countries.” Representatives of the Governments of Canada and the United States of America, who provided funding for the polio outbreak response last year, reaffirmed their support for restoring the routine immunization programme in Ukraine. “Canada worked hard last year with Ukraine’s Health Ministry to get nationwide polio vaccination restarted. We are grateful to the thousands of doctors who helped vaccinate millions of children. This year, we are happy to see that the UN has made more vaccines available. But still, far too many children are not routinely fully vaccinated. I urge Ukrainian parents to take advantage of these free vaccines and protect their children from completely unnecessary illnesses,” said H.E. Roman Waschuk, Ambassador of Canada to Ukraine, speaking at the Roundtable today. "Ukraine must continue to build on the great progress that has been made globally to eradicate polio," explained USAID Ukraine Director Susan Fritz. "These positive developments will only have the necessary impact if there is strong and visible political support from leadership at all levels of the Ukrainian Government." “Myths about vaccination that have been spread in recent years are not rooted in evidence-based medicine. As a result, Ukraine has been dealing with cases of diseases that have been long-forgotten in the rest of the world. It is important that the Vice Prime Minister of Ukraine, the Government and our international partners recognize the problem and are willing to work together with the Ministry of Health of Ukraine to resolve it. Increasing vaccination coverage rates in the country is our priority. This is not only a question of health and life of the citizens of Ukraine. This is a national security issue,” said Dr Ulana Suprun, Acting Minister of Health of Ukraine. “Necessary vaccines are available in all regions of the country. I appeal to all citizens who care about their life and health: get vaccinated and vaccinate your children,” added Dr Suprun. Nurse Ivana Knysh administers Maksym, 5, with a Hepatitis B vaccine as he holds his mother's hand, at Novoselytsi Family Medical Facility, Chernivtsi Oblast, Ukraine. UNICEF/UN060132/Oleksii Nurse Ivana Knysh administers Maksym, 5, with a Hepatitis B vaccine as he holds his mother's hand, at Novoselytsi Family Medical Facility, Chernivtsi Oblast, Ukraine.
Immunization services begin slow recovery from COVID-19 disruptions, though millions of children remain at risk from deadly diseases – WHO, UNICEF, Gavi
--- 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