“Our mission is to reach every child with life-saving vaccines”
Andrew Jones, Principal Advisor in UNICEF Supply Division’s Vaccine Centre, outlines the challenges and opportunities the world faces to immunize children in 2022 and beyond.
What are routine childhood vaccines and why are they important?
Routine vaccines are the vaccines all children should receive to make sure they grow up healthy. They are one of the greatest advancements in global public health and I can’t overstate the role they play in saving children’s lives. They help to prevent around 3 million deaths per year – a truly staggering figure. Without them, diseases such as polio, measles, diphtheria and tetanus can spread incredibly fast, affecting children of all ages but especially those with developing immune systems, such as infants. We have a chance to eliminate some of these deadly diseases forever as long as children’s routine vaccination rates remain high. That is why UNICEF is committed to reach as many children as possible with vaccines.
Tell us about some standout vaccination success stories in recent years.
There are so many achievements countries can be proud of. One recent example is last year’s enormous effort supplying measles-rubella vaccines to Pakistan. Cases had surged dramatically in recent years, affecting thousands of children and claiming many lives. The vaccines were delivered for a two-week campaign to immunize every child in the country between nine months and 15 years old – 90 million children in total. This was actually the second-largest measles-rubella procurement operation in UNICEF’s history with 113 million doses shipped to Pakistan. More than 386,000 health workers were involved in the campaign.
Other successes will bear fruit in the coming years, helping to save countless lives. I’m thinking specifically of developments with the malaria vaccine. After positive trials in Africa in 2021, the World Health Organization (WHO) recommended the widespread use of the malaria vaccine for children in sub-Saharan Africa and other regions, and we are now in the middle of a tender to put in place arrangements to procure the vaccine. In 2019, more than 400,000 people died of the disease so you can imagine the life-saving impact this vaccine will have, especially for children.
What is UNICEF’s role in childhood vaccine procurement and delivery?
UNICEF is the biggest buyer of vaccines globally. We support countries to meet their national vaccination targets by procuring and delivering routine childhood vaccines, as well as vaccines for outbreak response. Every year, UNICEF supplies vaccines to reach 45 per cent of the world’s children under five years of age. In 2021, excluding COVID-19 vaccines, we procured more than 2.3 billion doses, with almost one-quarter of these dedicated to polio eradication campaigns. The rest were for immunization drives against diseases such as pneumonia, tuberculosis, diarrhoea and yellow fever. Our mission is to reach every child with life-saving vaccines.
Around 30 per cent UNICEF’s shipments annually contain vaccines carefully transported at the right temperature until they reach hospitals, health centres and clinics around the world. But we do more than buy and deliver vaccines. UNICEF is at the forefront of vaccine market shaping, meaning we work with vaccine manufacturers and partner organisations to ensure children’s vaccines are affordable and available to meet the needs of countries.
"In 2021, UNICEF delivered more than 52,000 vaccine fridges, which highlights the cold chain needs many countries have."
What are some of the biggest challenges the world faces in vaccinating children? How do the challenges differ in high-income versus lower-income countries?
One of the main challenges is ensuring adequate ‘cold chain’ equipment and facilities. These are the fridges and freezers required to store vaccines at a specific, uninterrupted temperature. If these refrigeration requirements are not met, vaccines will not be effective.
In recent times, great strides have been made to improve the cold chain in lower-income countries. UNICEF and Gavi, the Vaccine Alliance have been collaborating for years to improve countries’ cold chain capacity, so vaccines make it everywhere from cities to difficult-to-reach areas. In 2021, UNICEF delivered more than 52,000 vaccine fridges, which highlights the ongoing cold chain needs many countries have. We’ve also been innovating by providing solar-powered fridges, which are critical for vaccinations to take place in areas that have unreliable electricity.
The distance children and their families are from health centres is another major challenge. In high-income countries, it’s generally very easy to get vaccinated in your local doctor’s surgery. They’re usually well-stocked and have appropriate storage facilities. In low-income countries, that’s not always the case. It can be difficult because of a lack of transport options, poor infrastructure and having fewer health care centres or clinics. Then we have the impact of COVID-19, which rippled through routine immunization programmes across the world. In 2020, 23 million children missed out on basic vaccines. This marked a backsliding on progress made prior to the pandemic. We are keen to see the numbers from 2021 to understand how the impacts echoed into the second year of pandemic. The challenges are many, but UNICEF will keep finding solutions to reach more children by improving country capacity to accept, store and roll out childhood vaccines.
How can we overcome some of these challenges?
Different countries have different needs. What is critical for one may not be for another, so we need to tailor our support. Broadly speaking, we want to increase country demand for childhood vaccines and support their access, whether that is procuring directly through UNICEF or as part of Gavi’s programme support. Then we have the long-term goals around integrating routine vaccination with health care. That means children should be immunized against diseases as part of their health care growing up, whether that is at the central or community level. In essence, stronger health systems lead to better health outcomes. At UNICEF, we place a lot of attention on strengthening these systems and supply chains by helping countries with financial and technical resources, as well as crucial supplies such as vaccines, cold chain equipment, syringes and safety boxes.
"We’ve got to remember health workers not just as heroes during COVID-19, but for everything they do beyond it."
As part of World Immunization Week 2022, UNICEF Goodwill Ambassador Liam Neeson thanked the health workers who have been instrumental in routine immunization. What has COVID-19 taught us about their efforts?
I don’t think words can do justice to the phenomenal efforts of health care workers throughout the pandemic. They put themselves out there every day, facing great personal risk, especially before COVID-19 vaccines were available to them. The toll on many was immense. That’s one of the reasons COVAX was set up – to protect frontline health workers and other vulnerable groups. We want to prevent severe illness and save lives, but also make sure hospitals and primary health care centres keep running, so children, their families and entire communities are supported. This, of course, includes routine immunization and the boundless benefits that access to vaccines can bring. So, we’ve got to remember health workers not just as heroes during COVID-19, but for everything they do beyond it – including the ongoing drive to reach and vaccinate children around the world.