In the third blog in our World Immunization Week series, Laura Kerr, Policy Advocacy Officer (Child Health) at RESULTS UK discuses the equity scorecard and access to immunisation.
60% of the world’s unimmunised children live in 10 countries.
Nigeria is one of those countries where in 2014, only 66% children received basic immunisation. This is well below the 90% target that all countries in the world committed to meeting by 2015 at the launch of the Global Vaccine Action Plan.
Along with low national coverage, Nigeria faces huge internal inequalities. Children from wealthy households are 11 times more likely to be immunised than children from poor households. This gap has increased by over 20% since 2008. Coverage in the South East of the country is nearly six times higher than it is in the North West.
Low national coverage and internal inequalities are not just problems for Nigeria. Globally, access to immunisation is inequitable.
Launched today, a new equity scorecard from RESULTS UK and Save the Children UK highlights the need to go further, act faster and make access to immunisation fairer if we are to reach universal immunisation coverage.
The scorecard, which analyses national immunisation coverage and equity coverage based on wealth quintile in 75 low and middle income countries, highlights that too many countries are not reaching the 90% coverage target and inequalities persist.
More than half of the countries in the scorecard (45 countries) are yet to reach the global target of 90% national coverage, with only 30 countries meeting this level of coverage. In 22 countries national immunisation coverage has worsened between 2010 and 2014. Eight of the poorest countries have immunisation rates below 50%.
One of the most challenging findings from the scorecard when trying to analyse the data is that 35 of the scorecard countries have no published, disaggregated data to identify which children are being left behind. Of the countries which do produce data, 20 countries in the scorecard have not made any progress in closing the coverage gap between the richest and poorest households. In 7 of these countries the gap is actually widening. It is important to also recognise that 18 countries are making progress in closing the gap.
Data is one of the most important things we can gather to work out which children are being missed and why. Until data improves, policies and programmes cannot be designed and shaped to ensure children are not left behind.
More and improved quality of data was just one of the five reasons set out by the Strategic Advisory Group of Experts last year that they identified as hampering, or could be tackled to improve, progress on routine immunisation coverage.
Another was the importance of a strong health system. Immunisation is often a baseline service of a health system, allowing other health services to be built out of the system which has been designed around reaching every child with a vaccine. Similarly, strengthening a health system has a consequential effect on routine immunisation services, and reduces the occurrence of missed opportunities to immunise a child.
Further, routine immunisation policies must be grounded in the principle of equity if every last child is to be reached. Prioritising routine immunisation as a fundamental basis of the health system can therefore embed the principle of equity into the wider system, resulting in more equitable access to health services.
Unfortunately, even with this grounding, children are still being missed. We need to see more efforts being made to reach children even in the hardest to reach areas, especially those living in countries affected by conflict. We also need to see faster progress. Global routine immunisation rates have stagnated, with only around a 1% increase in the last five years. And we need to ensure fairness and tackling inequities is top priority.
Without all of this, children will continue to be left behind and lose their lives from vaccine preventable diseases. That is not something that we should settle for and World Immunisation Week provides us with the opportunity to create the voice and the solidarity to effect change.
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