Immunization against major diseases is a means to ensure child survival, a human right. Children should have equal access to the protection immunization provides against death and disability, wherever they live and whatever their social or economic circumstances.
As this report card makes plain, substantial progress is being made in many countries towards the goal of 90 per cent coverage against measles, the primary immunization-related indicator in MDG 4. But there is an enormous amount of work still to be done.
Meeting MDG 4 will require reaching children with a package of essential child health interventions - a multipronged approach that addresses the illnesses that are taking children's lives, such as diarrhoea, pneumonia, neonatal tetanus, malaria, measles and HIV/AIDS. Of all the immediate interventions, immunization would arguably be the easiest to roll out universally, thanks to the massive amount of evidence and experience that has been gained over the last three decades.
Immunization is vital not just in itself, however, but as an entry point for other health interventions. Once seen as a 'vertical' intervention unconnected with and sometimes even fragmenting other health services, immunization is now increasingly being linked to other specific health interventions - for example, distributing vitamin A as part of polio or measles immunization campaigns, or distributing long-lasting insecticide-treated bednets during supplementary immunization activities.
Building up the infrastructure and capacity of health systems is vital for long-term success. Physical infrastructure is, of course, important, from the clinics and the roads that service them to the basic supplies on which health care depends. It is just as important, however, to invest in high-quality and motivated health workers, not only through proper training and decent pay but also through equipping people to serve their own local communities.
What is more, these systems need to be accessible to every child, which means removing any prohibitive user fees that can otherwise deny the poorest children the basic health care they need.
Internationally, public confidence in the efficacy of immunization remains high; and with good reason, since it continues to save the lives of millions of children every year. But there are still children it is failing to reach, many of whom will die needlessly in the years ahead if immunization's reach is not extended. The task now is to use all the experience gained - and devote all the resources needed - to ensure that their lives, too, are protected.