Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance

With high child and maternal mortality, 22% immunisation coverage, and an economy weakened by low oil prices, Chad has more than its fair share of difficulties. But hidden within every immunisation challenge is an opportunity to save lives, and that’s the message I shared with political leaders and partners when I visited in June.

Chad proved they can do better than this. In 2012, the country eliminated polio through vaccination even in the face of insecurity, finding success through customising campaigns to reach refugee populations, nomadic groups and security compromised areas. Even now, there are also regions within Chad that buck the trend of low vaccine coverage. Take Mandoul, for example, an area in the south that shares a border with Central African Republic. There, healthcare providers are protecting 71% of children with basic vaccines protecting against diseases like diphtheria, tetanus and whooping cough.

The author with the President of Chad (third from right), the Minister of Health (furthest on the left) after discussing their commitment to immunisation.

The key now is to unlock the same leadership, commitment and well-earned pride that made these achievements possible, and harness them for routine immunisation. After all, polio is not the end of the immunisation journey, but the beginning, and if it is possible to vaccinate more children in Mandoul, why not in Batha where only 3% of children are receiving basic vaccine protection?

Given the disparities in immunisation coverage across 23 regions, there is clear value in customising programmes to drive results. For the nomadic populations of Batha, for example, Chad is contemplating taking an innovative ‘One Health’ approach. It may sound strange, but, for nomadic families, vaccinating children and animals at the same time can be convenient and effective. Embracing local solutions to local problems, while maintaining accountability, will help realise our collective vision of leaving no one behind.

One thing that strikes you hard in Chad is the need to use limited human and financial resources wisely, maximising every health contact with the community. For instance, the country seems to be creaking under the weight of single-disease, stand-alone, campaigns, which have not prioritised this. But now there is a strong appetite to move away from standard approaches and instead think and act differently.

Chad also reminded me that there are high costs of not moving fast enough. Out of the 227 children who lose their lives in Chad every day before celebrating their fifth birthday, 77 die because of pneumonia and diarrhoea alone. These deaths can be prevented through introduction of rotavirus and pneumococcal vaccines, which neighbouring countries such as Niger have already done. Unless Chad vastly improves its coverage of basic vaccines, it won’t be able to take full advantage of Gavi support and children will continue to die of vaccine- preventable diseases.

The author at a partners’ meeting in Chad.

From what I experienced last week, the country is ready to rise to the occasion. I was heartened by the commitment I heard from the President, the First Lady and all the ministers and parliamentarians, the Governor of N’Djamena, and the CSOs I met. One remark from the Minister of Health, Aziz Mahamat Saleh, has remained with me. He told me “responsibility for vaccination remains that of the state – it is up to us to take care of our children.” This political commitment, if translated into action, has the potential to blaze a trail, proving that vaccination coverage can improve even in the most challenging contexts.

I left the country optimistic about the commitment of both the government and partners, and full of hope that when I return next year I will see real change. This also presents a strong opportunity for the Gavi Alliance to be bold and fully support Chad’s leadership in ways that we have not tested before.

One thing is clear – there can be no more business as usual for vaccination in Chad.