Amy Whalley, Head of Policy Advocacy, RESULTS, and Simon Wright, Head of Child Survival, Save the Children.

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18.7 million children around the world are still missing out on basic immunisation. That’s 18.7 million children put at unnecessary risk from preventable disease and infections, mostly because of where they happen to be born or live, poverty and social exclusion. They are also the children most likely to miss out on other essential health services.

A new immunisation equity scorecard, launched today by RESULTS UK and Save the Children highlights the countries where children are missing out and the considerable challenges that must be tackled to address inequalities and exclusion on the path to achieve universal immunisation coverage.

The scorecard explores progress on national immunisation coverage and equitable access to immunisation in the 75 countries identified as having the highest numbers of child and maternal deaths.

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A preview of the scorecard.

More than half of the countries in the scorecard (45 countries) are yet to reach the global target of 90% national coverage. Eight countries have immunisation coverage below 50%.

In 22 countries, national immunisation coverage has worsened between 2010 and 2014.

35 countries have no published, disaggregated data to identify which children are being left behind. Countries can’t reach every last child if they don’t know who or where those children are.

Of the 40 countries in the scorecard who do produce this data, 20 have not made any progress in closing the coverage gap between the richest and poorest households. On the other hand, 18 countries are making progress in closing the gap.

The scorecard shows us that we need to go further, acting in a much faster and fairer way if we are to reach every last child with immunisation, aiming towards universal coverage.

Further

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Photo: RESULTS/Tom Maguire

We’ve come a long way since the Millennium Development Goals were agreed in 2000. Under-five mortality has halved, and immunisation including the creation of Gavi, the Vaccine Alliance, has played a significant role in this. Now, we must go further to reach the poorest, most marginalised and excluded children with potentially life-saving vaccinations. Ensuring better-funded, staffed and equipped health systems is vital to increase access to immunisation and take countries one step further towards universal health coverage.  Countries need to be financially prepared, especially when transitioning from Gavi support, to ensure they can equitably increase and sustain levels of immunisation as well as building their health system for all other health needs. Improving data collection to find out who is missing out would allow for more informed strategies and plans to reach every last child.

Last year, all countries agreed to achieve universal health coverage by 2030 in the new Sustainable Development Goals. This includes universal coverage of immunisation. Governments must increase investments to strengthen primary health care which targets people in the poorest, underserved and excluded areas. Development partners have a key role to play in supporting countries to do this.

Faster

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Photo: RESULTS/Tom Maguire

Immunisation rates have increased by nearly 12% globally over the last decade – reaching 86% in 2014. However, recently progress has stalled, with coverage only increasing by approximately 1% in the last five years.  The Global Vaccine Action Plan (GVAP) target to achieve DTP3coverage above 90% in all 194 countries by 2015 was missed. In Africa, for example, progress must accelerate by over 50% in order to meet 90% coverage by 2020. At the mid-point of the 2010-2020 Plan, we must move forward with a sense of determination and urgency to reach universal coverage.

Fairer

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Photo: RESULTS/Tom Maguire

At the heart of global immunisation efforts is the principle of equity. Never before has there been commitment to reach every last child. However, where a child is born or lives, their poverty or other social exclusion results in inequitable access to health services. In some countries, inequalities are growing. In Nigeria, the country with the highest inequalities highlighted in the scorecard, children from wealthy households are 11 times more likely to be immunised than children from poorer households. In the Central Africa Republic, a child from a wealthy household is three times as likely to receive vaccination as a child from a poor household. Equity must remain at the heart of the immunisation agenda. Government action through policies and finance must be improved and targeted to ensure we reach every last child.

Universal immunisation is possible. Challenges can be overcome. But we need the political will to make this is a priority, and then reality.