Stop and reverse the decline in immunization for Zero-Dose children

Worldwide 25 million children missed out on one or more doses of life-saving vaccines in 2021, while 18 million have never received a single dose of vaccines, also known as Zero Dose children (WHO and UNICEF data, 2022)

As world leaders gather for the 77^th United Nations General Assembly (UNGA 77) 2022, the world grapples with myriad challenges including a sharp increase in violent conflicts, acute food insecurity, shortage of energy, the climate crisis, and three public health concerns of international nature (COVID-19, Polio and Monkeypox). These crises have severely affected vulnerable populations, impacting their access to life-saving immunization and socio-economic wellbeing thus limiting their access to health and non-health services such as education, water, and sanitation. The prevailing situation alarms the world about the importance of disease surveillance, health system strengthening and pandemic preparedness.

Immunization is a key component of a strong health care system and is a driving force for health systems strengthening. However, despite decades of reaching more communities and saving countless lives, global coverage has stagnated over the last decade. Recent immunization data shows that  25 million children around the world missed out on one or more doses of life-saving vaccines in 2021. Of those children, 18 million have never received a single dose of vaccines, also known as Zero Dose children. This is notably the largest sustained decline in childhood vaccinations in about three decades, with the vast majority (nearly 60%) of these Zero-dose children living in Low- and Middle-Income economies. This is happening against a backdrop of rapidly rising rates of severe acute malnutrition in the same group of countries. A malnourished child already has weakened immunity, so missed vaccinations expose them to vulnerability and common childhood illnesses. The convergence of a hunger crisis with a growing immunization gap foments the conditions for a child survival crisis. 

The cost of inaction on zero-dose children

Zero-dose children are the face of extreme poverty, with two-thirds of them living in households subsisting on less than $1.90 per day. Most of them are found in communities with multiple vulnerabilities that are missing out on vaccines and a wider range of essential services.  According to WHO inequitable access to vital services such as immunization further exposes these communities to multiple deprivations and may lead to death. Therefore, it is more important to remind the world leaders of their commitments to achieve vaccine equity, the SDGs and Health for All.

“Reaching vulnerable and hard-to-reach communities with integrated and equitable primary healthcare (PHC) services is a pathway to achieve Universal Health Coverage (UHC) and other essential services such as education, nutrition, water, and sanitation.” – Dr Endie Waziri, Chairperson, Gavi CSOs.

Investing in immunization and children’s health guarantees social and economic development and helps reduce the burden of ill health and impaired development on children Significant investments made to reach children with immunisation and build a recurring touchpoint with the health system are essential to narrowing the gap between zero-dose children and missed communities. As such, governments and the development partners should build the much-needed service delivery infrastructure, supply chains, data systems, and community engagement needed to deliver immunization, we shall build a platform through which other primary health care services can be delivered. These investments would be pivotal in reaching zero-dose children as the first step towards comprehensive, equitable, and community-based primary health care thus bridging the gaps in the global health security agenda.

Therefore, as world leaders meet for the 77^th UNGA, they must unite to protect years of progress on child rights through guaranteed access to immunization. The unequal recovery from COVID-19 must not be allowed to further marginalize the disadvantaged and increase inequality in achieving health for All in the lower, middle income and fragile states. There is an urgent need to restore and leverage routine immunisation if the SDGs are to be achieved. World leaders, development partners and civil society must keep a sharp focus on the immunization Agenda 2030, and the target to reduce the number of zero-dose children by 50% by 2030.

It’s possible to leverage and capitalize on COVID-19 vaccination investments, innovations and new tools triggered by the pandemic response to strengthen capacity, expand disease surveillance to cope with future outbreaks, and safeguard the delivery of essential health services that would guarantee routine immunization for zero dose children.  Therefore, we call upon the world leaders and the international community to urgently avail long-term investment in routine immunisation and primary health care to reach zero-dose children.  

Published by Dr Endie Waziri Ndadilnasiya (Chairperson) ewaziri@afenet.net; and Dr Nizam Uddin Ahmed (Vice Chair), nizam1016@gmail.com; the Gavi CSOs Steering Committee