Agnes Binagwaho, Ministry of Health Rwanda and Anisha Hedge, University of Virginia School of Medicine.
Rwanda has demonstrated the value of vaccines over the past 15 years, as the rollout of new and underused vaccines has helped us reduce under-five mortality by two thirds, and achieve the fourth Millennium Development Goal (MDG) along the way. This year, as the world transitions to the Sustainable Development Goals (SDGs) and partners aim to end poverty by 2030, immunisation must remain at the core of the health agenda. As well as saving lives, the benefits of vaccination programmes stretch beyond immunisation to improving health services and promoting social integration, and Rwanda is the case study to prove it.
1. Vaccination campaigns at the centre of societal development
Rwanda has increased basic vaccine coverage (DTP3) from 77% in 2001 to 99% in 2014. In the last seven years Rwanda has introduced new and under-used vaccines against pneumococcus, rotavirus, rubella and human papillomavirus (HPV), and maintained high rates for traditional vaccines. Vaccination campaigns present the opportunity to reach out to the population with a range of other health services. During the pneumococcal campaign in 2009, advice was given on causes and symptoms of pneumonia to facilitate early detection and access to treatment. Community health workers also educated parents on good health practices such as breastfeeding and wholesome nutrition.
Pneumococcal vaccine launch in Rwanda. Photo: Gavi/Riccardo Gangale
2. Achieving equality in healthcare
To encourage equal access to health care, Rwanda holds a Mother and Child Health Week twice a year. It offers a range of health services; vaccination campaigns such as rubella and HPV for adolescent girls, the provision of iron tablets for pregnant and lactating women to prevent anaemia, vitamin A supplements for all children under five years and a family planning campaign for women of reproductive age.
A mother and baby at the launch of rotavirus vaccine in Rwanda in 2012, which protects against a leading cause of diarrhoea. Photo: Gavi/Diane Summers.
3. Forging national partnerships
Vaccination programmes have fostered new working relations between different governmental and non-governmental organisations. This was evident with the rollout of the HPV vaccine in schools in Rwanda which involved a partnership between the Ministry of Health, Ministry of Education, Ministry of Gender and Family Promotion and the Ministry of Local Government in order to reach adolescent girls in schools and communities.
A still from 2013, when Rwanda launched the first combined measles-rubella vaccination campaign targeting 5 million children under 15. Photo: Gavi/Charlie Whetham.
4. Strengthening healthcare infrastructure
Adequate health system infrastructure is essential for the effective rollout of vaccines. In Rwanda this has included improved waste disposal facilities for contaminated materials, new cold rooms for temperature-controlled storage and increased medical storage capacity.
Cold storage equipment in Kenya. Photo: Gavi/Doune Porter
Currently, the Rwandan government self-finances all traditional vaccines, such as the tuberculosis vaccine BCG, and co-finances with international partners to provide new and under-utilised vaccines. This trend has been demonstrated with the pneumococcal vaccine and is currently unfolding with the HPV vaccine, which protects against major causes of cervical cancer. Looking ahead, we hope that as demand increases, vaccine prices will be driven down, thereby creating a sustainable future for vaccine provision.
PCV launch in Rwanda. Photo: Gavi/Riccardo Gangale
Globally, there is still a way to go. One in five children in Gavi supported countries still miss out on the basic package of childhood vaccines; around the world about 1.5 million children die from vaccine-preventable diseases each year. But as our country has shown, immunisation can sustainably address this inequity, and so much more besides. With immunisation as part of the next set of development goals, we can help all countries make the most of these vital tools, and we should — because life, whether lived in the remote areas of Rwanda or the suburbs of London, deserves a fighting chance.