© UNICEF ROSA/2015/RLemoyne
Nepal: Female Community Health Volunteer is getting ready to vaccinate a toddler held by her mother.
Immunization is one of the most cost-effective, life-saving health interventions for children, with results being real and long lasting. If children are immunized against common childhood diseases, their chances of surviving to adulthood are significantly improved: roughly a third of deaths in children can be prevented by vaccination. For this reason, and because routine immunization is an important bridge to other health and nutrition interventions, prioritizing it is essential.
Some countries in South Asia have made significant improvements in immunization since 1990 – particularly Bangladesh, Sri Lanka and Nepal – but coverage is still far too low in Afghanistan, India and Pakistan. There are also significant in-country disparities that are masked by country averages. For example, a survey in Shrawasti District in India’s Uttar Pradesh State showed DTP3 (third diphtheria, tetanus, and pertussis vaccine) coverage was only 31 percent.
In Pakistan, over a quarter of districts have less than 80 percent coverage of DTP3; in Afghanistan, it is a third of districts. Some challenges to improving immunization rates are common to many countries. In particular, it can be difficult to generate demand for vaccination if communities and families are unaware of how vaccination can protect their children from disease. The process of buying vaccines, transporting them safely (which often requires the vaccine to be kept refrigerated) and delivering them to children – ‘the supply chain’ or ‘cold chain logistics’ – is a complex activity. Many countries lack the infrastructure and resources to ensure the integrity of this process, especially in remote areas.
UNICEF provides specific help to countries both to increase awareness of the benefits of vaccination and to improve the supply chain.
Despite the extraordinary success of vaccination programs globally, about 23 million children under one year of age remain unimmunized, many of them in South Asia. (In this website, the word unimmunized refers to surviving infants who have not had a third dose of DTP in their first year of life). This situation needs to change, and the success with polio vaccination shows that the task of reaching the vast majority of children is not impossible.
The polio vaccine is of major global interest, and a vast global campaign is underway to eradicate polio completely. The use of the vaccine has seen the disease eradicated from 185 of 188 countries, with polio now restricted to decreasing pockets of transmission in often difficult-to-access areas. But, although six countries in South Asia are now certified polio-free, two of the world’s three remaining polio-endemic countries – Pakistan and Afghanistan – are in this region. The remaining endemic country, Nigeria, appears closest to stopping transmission. As recently as 2009, India had 741 cases of polio and its achievement in stopping transmission in 2011 serves as an enduring reminder that polio can be stopped, even in the most challenging circumstances. The 2014 Polio-Free Certification of India, Nepal, Bangladesh, Sri Lanka, Bhutan and the Maldives is one of the most remarkable public health achievements in the region. However, unless Pakistan and Afghanistan can stop transmission in the remaining polio reservoirs, the threat of spread of polio transmission to polio-free countries in the region and around the world remains real.
INNOVATIONS AND IMPACT
More than 350,000 children in Pakistan die before reaching their fi fth birthday – about 20 percent of them because of pneumonia...
To improve immunization rates, and to achieve and sustain polio eradication, countries should consider...