My first Magazine EDUCARE MAGAZINE SPECIAL NOVEMBER EDITION 2019 | Page 24

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The good news is that there is plenty we
can do to close these gaps and plenty of
progress to build upon. Since 2000, routine
immunization in Africa has risen
considerably, with the percentage of
children receiving all three doses of the
most basic vaccines - diphtheria-pertussis-
tetanus (DTP3) - increasing from 57% in
2000 to 80% by 2014. The impact has been
remarkable. With millions more children
getting access to immunization, the number
of cases of vaccine-preventable diseases,
like measles and meningitis, has fallen in
many countries. Indeed, Africa has now
gone nearly two years without a single case
of wild polio (since 24 July 2014). This is a
huge milestone and a significant step
towards eradicating a disease that until
recently was paralyzing 1,000 children
globally every day.
H o w e v e r, i n c r e a s e s i n n a t i o n a l
immunization rates can conceal actual
decreases in coverage that exist in pockets
of marginalized communities. Often the
children who are still missing out are not
just the last to be reached; they are also the
hardest to reach, living on the very edge of
societies, from remote rural regions to
urban slums.
This is evident if we assess progress
towards the goals of the Global Vaccine
Action Plan (GVAP), the global health
community's 10-year vision, as well as the
Regional Vaccine Action Plan (RVAP). By
2014, as many as 23 out of the 54 countries
in Africa had already reached the GVAP
2020 target of 90% national coverage for
receiving three shots of DTP. However,
only nine had achieved the second target of
at least 80% DTP3 coverage in every district
- a clear indication of disparities within
countries.
So, if we are to succeed in the task of
reaching these children, then we will need to
do more. One of the biggest challenges lies
in the supply chain. In many parts of Africa,
the entire vaccine distribution system is in
great need of either improvement or
extension, or both. Equipment is often
faulty or non-existent, transport is less than
optimal, there is a lack of staff and a lack of
staff training, accountability and quality
data. Currently, in low-income countries
around 20% of health facilities that need
cold chain equipment don't have it; of those
that do, many of the installed devices do not
work. Where equipment does work, in the
majority of cases it works very poorly, with
60% running the risk of damaging vaccines
by exposing them to excessive freezing or
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unacceptably high temperatures.
Moving more doses of vaccines through
existing supply chains will place an ever-
greater strain on their already faltering
equipment and resources. So
improvements are even more urgent if we
are to successfully increase access to
immunization. After all, we would not just
be reaching more children, but also
reaching them with increased numbers of
new and underused vaccines, to ensure
protection against infectious diseases not
already covered in national programmes.
Countries like Mozambique have already
taken great strides towards this end with the
introduction of new supply chain systems.
Initially introduced in one province, the
system proved so successful that it has now
been rolled out to serve half the country.
Such examples are extremely encouraging,
but the sheer cost of such wide-scale
improvements can nevertheless act as a
deterrent to governments with struggling
economies - even though modernizing the
supply chain can translate into significant
long-term savings through the use of more
energy-efficient equipment.
Organizations like the World Health
Organization, UNICEF and Gavi, the
Vaccine Alliance, can help, and indeed have
already played a major role in increasing
immunization coverage. In my own
country, Tanzania, we doubled the number
of vaccines given to children in just 14
years, something that would have taken
considerably longer if it wasn't for Gavi's
catalytic support.
Besides working tirelessly to bring down
the prices of existing vaccines, the Vaccine
Alliance has accelerated access to new
vaccines, such as pneumococcal and
rotavirus, which provide protection from
the biggest killers of children, pneumonia
and diarrhea. The human papillomavirus
(HPV) vaccine has also been made available
to girls in 21 African countries, thanks to
Gavi, providing protection against the
biggest cause of cervical cancer. Without
the Vaccine Alliance's support, it could have
taken more than a decade before the price
of these vaccines came down sufficiently to
become more affordable to low-income
countries.
Now, Gavi is applying the same public-
private partnership business model to help
improve supply chains in poor countries. As
part of its new supply-chain strategy, Gavi
is now looking to stimulate innovation in
and improve access to the latest cold chain
technology by providing incentives to
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manufacturers.
While all of this presents African nations
with a golden opportunity to close
immunization gaps, it will not be successful
without country ownership. African Health
Ministers already understand the
importance of immunization. In addition to
supporting GVAP, in 2014 they committed
to Universal Health Coverage in Africa.
Several also signed up to the Immunize
Africa 2020 Declaration.
However, it will take more than their
support and more than declarations to
achieve these goals; it will require action
throughout government. It is only by acting
together and speaking with one voice that
we can truly bring about change. From
heads of state and prime ministers, to
ministers of finance, we all have a role to
play, whether that involves becoming a
champion of immunization or ensuring
that vaccines are a line item in budgets. MPs,
civil society, religious and community
leaders must also do their part to strengthen
demand for vaccines, to hold governments
to account and to ensure that policies are
implemented.
We already know what immunization can
do in terms of saving lives and securing
promising futures for children. I have seen
this first-hand in my own country, Tanzania.
But it is important to recognize the
economic benefits too; between 2011 and
2020, the majority of countries in Africa will
collectively see a net economic benefit of
US$224 billion by investing in
immunization programmes . Immunization
is truly an investment, not just in the health
of a nation's future - its children - but also in
its economic future.
Written By Dr.
Jakaya Mrisho
Kikwete
Dr. Jakaya Mrisho
Kikwete is the
fourth former
President of the
United Republic
o f Ta n z a n i a .
During his
P r e s i d e n c y, h e
distinguished
himself as a
champion of global
health, particularly
women's and children's health. Since his retirement, he has been
devoting his time to campaigning for universal immunization as a
GAVI Global Ambassador for Immunization. He also served as
chairperson of the United Nations High-Level Panel on the Global
Response to Health Crises. He is currently Commissioner for the
International Commission on Financing Global Education
Opportunity and a Co-Chair of the UN High-Level Advisory
Group on Every Woman Every Child
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