Immunization (UNICEF)

© UNICEF/NYHQ2006-1081/Figueira

A child receives a dose of oral polio vaccine during a UNICEF-supported immunization campaign, Namibia.

Immunization, one of the most cost-effective public health interventions, has been protecting children everywhere against common yet potentially life-threatening diseases over the past two centuries. In Eastern and Southern Africa, immunization has long been a standard health care service in all countries, and enormous progress has been achieved. 

The vaccines under the current routine immunization programmes protect children against a wide range of common childhood diseases, including tuberculosis (BCG), diphtheria, pertussis (whooping cough) and tetanus (jointly referred to as DPT), polio, measles, hepatitis b (HepB) and meningitis (Hib). 

Regional coverage for each of the vaccines is above 70 per cent, with some countries achieving 90 per cent of coverage for DPT3 [1].

In recent years, new vaccines have  been introduced to ESA and developing countries around the world to protect children from pneumonia (PCV) and diarrhoea (rotavirus vaccine), two of the biggest child killers, and the human papillomavirus (HPV).

Still, many children are not reached, particularly those from the most marginalized and excluded communities. In 2012, out of the 14.3 million children under the age of one covered under routine immunization in all 21 ESA countries, 13 per cent, or 1.8 million, were left unprotected. Most of these children were from rural and remote areas, as well as from urban slums. Children affected by conflict, and those whose families and communities refused to have them immunized, were also part of that group. Nearly 90 per cent of all un-immunized children lived in nine countries –Angola, Ethiopia, Kenya, Madagascar, Somalia, South Sudan, Tanzania, Uganda and Zambia.

The Horn of Africa had been polio-free for years, but with the confirmation of a two-year old child infected with the virus in Somalia in May 2013, that record no longer holds. To date, some 200 children and adults have been affected, mainly in Somalia, and also Kenya and Ethiopia. Thanks to the rapid responses by the region’s governments and their partners, the progression of the outbreak has been significantly eased off. The risk of the virus continuing to spread, however, remains high, particularly with close to one million children, most of them in Somalia, have never been immunized or have not received the required number of doses.

© UNICEF/NYHQ2009-1235/Pirozzi

A health worker vaccinates a pregnant woman against tetanus in a health centre in Madagascar.

UNICEF in action

In response to the challenges in global immunization, WHO and UNICEF developed the Global Immunization Vision and Strategy (GIVS). Launched in 2006, GIVS is a 10-year framework (2006–2015) aimed at controlling illness and death from vaccine-preventable diseases, and helping countries immunize more people with a greater range of vaccines and innovative technologies.

Under GIVS, the goal for every country is to ensure that at a national level, 90 per cent of children under one year of age are reached through routine immunization, and at least 80 per cent in every district or equivalent administrative unit. Another goal is to reduce deaths by measles by 90 per cent compared to the 2000 level. In addition, UNICEF, together with partners under the Global Alliance for Vaccines and Immunization (GAVI), helps introduce new and improved vaccines to all countries.

For the children who are missed during routine immunization, UNICEF and WHO use a number of strategies to close the gap, including advocacy with faith-based leaders. Bi-annual Child Health Days, which combine immunization with vitamin A supplementation, de-worming, and other health interventions, also contribute greatly to the overall immunization efforts.

Results for children

• Botswana, Burundi, Eritrea, Malawi, Rwanda, Swaziland, Tanzania and Zimbabwe reached the GIVS national DPT3 coverage of more than 90 per cent in 2011. Eight other countries - Angola, Comoros, Kenya, Lesotho, Madagascar, Namibia, Uganda and Zambia - are moving towards this target, with DTP3 coverage between 80 and 89 per cent. 
• Angola, a country where poliovirus was re-introduced in 2005, made significant progress, with no cases reported since 2012. 
• All countries in ESA now conduct periodic follow-up immunization campaigns as part of the regional strategies to control and eliminate measles.
• Fifteen countries in the region have been validated for the elimination of maternal and neonatal tetanus, with Tanzania being validated the latest in 2012. 
• Six countries - Burundi, Ethiopia, Kenya, Malawi, Rwanda and South Africa -added the pneumococcal conjugate vaccine (PCV) to their routine immunization programmes. Three countries - Botswana, Rwanda and South Africa - introduced the rotavirus vaccine to protect children against diarrhoea. 
• Rwanda has become the only country in the region to have introduced the human papillomavirus vaccine (HPV) for girls aged 9–13, to protect them against cervical cancer, among other diseases, when they become sexually active.