Immunization is one of the world’s most cost-effective public health interventions, saving millions of lives and protecting countless children from illness and disability.

A woman loads vaccine into a syringe

The challenge

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.

Most countries in Europe and Central Asia have immunization coverage of 95 per cent or more for three doses of diphtheria, tetanus and pertussis (DTP), often seen as the measure of national performance on immunization. 

Nevertheless, measles outbreaks and low vaccination rates in parts of the region remind us of the need for constant vigilance and for greater efforts to achieve – and sustain – universal routine immunization to protect children against deadly, but easily preventable, diseases. 

While most national averages for DTP vaccination may be adequate, the regional average is hovering at around 91 per cent  – which is not high enough to ensure immunity for everyone. National averages also mask disparities, with Roma children, those from other ethnic groups and refugee and migrant children all lagging behind.   

Despite increased vaccine coverage against measles (up from 63 per cent in 2000 to 91 per cent in 2015) around 525,000 children in the region are still not protected against this preventable, life-threatening 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 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 polio outbreaks in 2015 in Ukraine – a country where conflict and economic recession have depleted stocks of vaccines and vaccine hesitancy is reducing immunization coverage.

There have also been measles outbreaks in Georgia in 2013, Kazakhstan (2014), Kyrgyzstan (2015), Romania (2016 and 2017), 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.  

The solution

UNICEF knows that the best defence against the spread of vaccine-preventable childhood diseases 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. 

We urge governments in Europe and Central Asia to invest in health systems that reach the most vulnerable children with life-saving immunizations to reduce equity gaps.

Working with national governments, the World Health Organization, Gavi (The Vaccine Alliance), other international agencies, non-governmental organizations and vaccine manufacturers, we support the provision of quality-assured vaccine supplies. We also mobilize the funding and technical assistance needed to strengthen the management of national immunization programmes, reach those who are not immunized and introduce new vaccines. 

We support regional, national and local information campaigns to educate the public on the critical importance of immunization, while addressing vaccine hesitancy, building public trust, tackling dangerous myths and combating misinformation. 

We also work closely with governments to equip parents and communities with the knowledge they need to protect their children. We support the training of front-line health workers on how to inform families about the benefits of immunization, and reinforce government efforts to monitor public attitudes and immunization rates to tackle any problems as quickly as possible.

Five-year-old Maksym bravely takes his Hepatitis B vaccine injection in Ukraine.
Five-year-old Maksym bravely takes his Hepatitis B vaccine injection in Ukraine.

As part of our response to Europe’s refugee and migrant crisis, UNICEF purchased thousands of doses of vaccines for children in Greece in 2016, including 50,000 doses of MMR, 11,000 doses of PCV and 1,200 doses of BCG for refugee and migrant children.  

In Ukraine, critical shortages of essential medicines and vaccines in 2015 prompted the Ministry of Health to ask international organizations, including UNICEF, to support vaccine procurement while the Ministry reformed its procurement system. UNICEF’s delivery of the first supplies in 2016 was closely linked to its response to the polio outbreak and efforts to increase demand for immunization, and we continue to support the procurement of vaccines on behalf of the Ukrainian Government.