Vaccinations are one of the most successful and cost-effective ways to protect children’s health and futures. Improving vaccine coverage could prevent an additional 1.5 million deaths annually. But in recent years, global vaccination coverage has stagnated.
In countries where child mortality takes the heaviest toll, more than half of children still miss out on the vaccines they need to survive and thrive.
Most of these children face multiple deprivations – from poor nutrition to inadequate health, water and sanitation services – leaving them even more susceptible to diseases like pneumonia, diarrhoea and measles. Many live in camps for displaced persons or in countries wracked by conflict.
Today, a growing number of unvaccinated children live in densely populated, urban poor communities, including slum environments, where immunization coverage is limited.
Low vaccination rates increase the risk of vaccine-preventable disease outbreaks. In poor urban communities, overcrowding, limited health services, and a continuous influx of new people only intensifies this risk.
As urbanization continues to rapidly increase in the coming decades, the population of urban slum dwellers is only expected to rise, particularly in Africa and Asia.
We cannot afford to let any child go unprotected against disease, disability and death.
To reach every child, UNICEF works with governments and other partners to expand the benefits of immunization for children, with a focus on the most disadvantaged.
Read on to learn more about how we are making vaccines accessible for the world’s most vulnerable children.
It was 7 a.m., and Ms. Ye, an experienced village health volunteer, knew this was the best time to catch villagers at home and let them know that outreach workers from a local health centre would be coming the next day.
After weaving through the streets, she parked and went door to door, speaking directly with residents about the free life-saving services scheduled.
Ms. Ye has been a village health volunteer for 10 years in Svay Pak, an urban poor settlement 9 kilometres north-west of the Cambodian capital, Phnom Penh. She acts as an important messenger to this vulnerable community, sharing the benefits of practices such as vaccination and appropriate pre- and postnatal health for mothers, while also encouraging regular check-ups at the local health centre for all family members.
Around 5,000 people live here. A third are migrants from rural areas in search of work. They live in informal settlements composed of small wooden houses with tin roofs squeezed tightly together. Most are packed beyond capacity with inhabitants, including many small children.
Because these settlements are typically illegal and unorganized, they are not registered with the municipality and therefore receive no public services. Clean water and electricity are supplied by private providers, which are more expensive than public lines. In such communities, there is neither proper drainage nor garbage collection, resulting in a dangerous situation of poor sanitation and hygiene.
Diarrhoea, pneumonia, dengue fever, skin infections and malnutrition are commonplace, particularly among children.
Barriers to care
A 2014 UNICEF assessment showed that of Phnom Penh’s population of 1.6 million, a quarter earn less than US$1.60 a day – many of them migrant workers like those in Svay Pak. These economic hardships mean disadvantaged communities are disproportionately affected by disease. In Cambodia’s poorest households, only 6 of 10 children are vaccinated, compared to 9 of 10 in the wealthiest homes.
At the local health centre, villagers need to pay around 2,000 riels or US$0.50 for administrative services (the vaccines themselves are free). Those classified as ‘very poor’ by local authorities are entitled to free health care. But without legal documentation of residency, migrants cannot claim this benefit.
Chanreourn Meas and her husband migrated from the eastern province of Prey Veng four months ago. They live with siblings and work as garbage collectors. The 27-year-old mother says her family simply cannot afford to wait at the health centre.
“Every day we earn between 10,000 and 20,000 riels (US$2.50 to US$5) and can only cover the cost of our food; we cannot spend time at the health centre as we must go out and work,” she says.
Many villagers have limited knowledge of public health services, and are unaware of what is available – and affordable – to them. Parents often do not know the vaccines their children need and when to get them.
That is why the work of Ms. Ye is so important.
Today, like every other day for Nazaama, starts at 4 a.m. She walks empty alleys, rummaging through the trash bins before the garbage trucks make their morning rounds. Using a stick to dig deep into the mounds of mixed household rubbish, she picks out discarded plastic bottles, collecting them in the large sling bag across her shoulders.
After five hours, she hurries back home, happy with her cache that she sells for less than US$3 to the informal shops that recycle the plastic. Today her children will have a full meal.
This is Chandmari – an urban settlement of 417 rag picker families in Ghaziabad, Uttar Pradesh, just 20 miles from India’s national capital New Delhi.
Living in tattered huts made of plastic sheets and bamboo sticks with electric wires drawn illegally from the municipal supply, Chandmari is a settlement that the world has forgotten.
“Kismet. This is fate. Life has to be lived somehow,” says Nazaama sitting on her cot made of rope. She seems tired, but her face, framed by a blue shawl, has a certain strength as her soft voice fills the hut.
Hers was a love marriage – the first in the close-knit community of rag pickers. Married at 18 to Abrar, who earns a living from performing stunts and magic tricks on the streets, she has four children. Unlike many of the parents in Chandmari, Nazaama has made sure all of her children are fully vaccinated.
A vaccine advocate
In Uttar Pradesh, India’s most populous state, only 50 per cent of children are fully immunized. District Ghaziabad where Chandmari is located has over 12,000 families working and living at 365 brick kilns, 118 construction sites, 42 nomadic settlements and 131 slums. Out of 656 sites with high-risk groups, almost 6,000 children under 5 years of age should be fully vaccinated. Fewer than 1,000 are.
Dropout rates are high. Myriad reasons are given. The child was sick. Last time there was fever. We were visiting. I am a daily labourer and if I don’t earn, then what will my family eat? Or simply not knowing. Parents are not educated about the number of vaccines needed, the diseases that they prevent, and the timing of the shots.
In a community where most mothers do not understand the long-term health benefits of immunization, Nazaama is a rare advocate for vaccines.
The young couple welcomed their daughter Lakeshia into the world one week ago, and they are beaming with love and pride. They speak in hushed tones so as not to wake her, but the sounds of the city outside still filter in through the window.
Joseph and Sicilia live in a small, one-room house made from corrugated iron sheets, in one of Nairobi’s largest informal settlements. Space is limited here, and families make do with what they can afford. For Joseph, a casual labourer earning less than US$5 a day, and Sicilia, a housewife, it isn’t much. And even as they peer down at their sleeping beauty, the new dad is worried about how he will provide and care for his growing family.
The Obwoge’s story is shared by millions of other Kenyans living in urban informal settlements. They work hard, earn little and live under poor, crowded and hazardous conditions. Children born into these homes face multiple deprivations that limit their potential in life. The first being access to affordable quality healthcare, including immunization.
In recent years, Kenya has made tremendous progress in reaching every child with life-saving vaccines. Eight vaccine formulations, procured by UNICEF, are provided against ten childhood diseases free of charge in all public health facilities. But far too many children still miss out on this service.
In 2016, an estimated 350,000 children did not receive all of their scheduled vaccines. Many of them came from poor households, in urban informal settlements where health facilities are few and offer low quality service. It is therefore no surprise that Nairobi has one of the highest number of unvaccinated children in Kenya.
But for parents struggling to survive, the only numbers that matter are the kind that put food on the table.
UNICEF Kenya Health Specialist Peter Okoth says, “Caregivers spend a lot of time working for their livelihood. The time to go to hospital is constrained. We are therefore advocating for facilities to open over the weekend to meet the needs of these children.”
Halyna keeps track of her children’s immunization schedules with great detail, but has not always done so.
“Three years ago, I woke up to five very sick children. I panicked and went with them to the hospital where they were all admitted for one week,” she says.
The diagnosis was whooping cough – easily preventable through routine childhood immunizations, but until then, Halyna had never bothered much about vaccines. Although her doctors had continuously reminded her of the need to get her children vaccinated, she had opted to trust her neighbours, who had all foregone immunizations for their children.