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2019-07-17

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Developmental Issues
www.thehindu.com

Globally, since 2010, vaccination coverage for children with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine had stalled at around 86 %.   | Photo Credit: V.V. Krishnan

Twenty million children worldwide – more than 1 in 10 – missed out on life-saving vaccines against diseases such as measles, diphtheria and tetanus in 2018, according to data from the WHO and the UNICEF. It showed that an additional 1.5 million deaths could be avoided if global immunisation coverage improved.

Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine had stalled at 86 %.

In 2018, an estimated 19.4 million infants worldwide were not reached with routine immunisation services such as three doses of DTP vaccine. Around 60% of these children live in 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines and Vietnam.

“While high, this is not sufficient. 95% coverage is needed — globally, across countries, and communities — to protect against outbreaks of vaccine-preventable diseases,’’ said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

While vaccines were one of the most important tools for preventing outbreaks and keeping the world safe, far too many were left behind. Unacceptably, it was often those who were most at risk — the poorest, the most marginalised and those touched by conflict or forced from their homes — who were persistently missed, he noted.

Most unvaccinated children lived in the poorest countries, and were disproportionately in fragile or conflict-affected nations. Almost half were in just 16 countries — Afghanistan, the Central African Republic, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Iraq, Mali, Niger, Nigeria, Pakistan, Somalia, South Sudan, Sudan, Syria and Yemen.

“If these children do get sick, they are at risk of the severest health consequences, and least likely to access lifesaving treatment and care,” noted the WHO.

Stark disparities in vaccine access persisted across and within countries of all income levels. This had resulted in devastating measles outbreaks in many parts of the world, including countries that had high overall vaccination rates.

In 2018, almost 3,50,000 measles cases were reported globally, more than doubling from 2017. 

“Measles is a real-time indicator of where we have more work to do to fight preventable diseases,” said Henrietta Fore, UNICEF’s Executive Director. “Because measles is so contagious, an outbreak points to communities that are missing out on vaccines due to access, costs or, in some places, complacency. We have to exhaust every effort to immunise every child.” 

 Ukraine leads a varied list of countries with the highest reported incidence rate of measles in 2018. While the country has now managed to vaccinate over 90% of its infants, the coverage had been low for several years, leaving a large number of older children and adults at risk.

Several other countries with high incidence and high coverage have significant groups of people who have missed the measles vaccine in the past. This shows how low coverage over time or discrete communities of unvaccinated people can spark deadly outbreaks.

Meanwhile, for the first time, there is also data on the coverage of human papillomavirus (HPV) vaccine that protects girls against cervical cancer later in life. As of 2018, 90 countries —home to 1 in 3 girls worldwide — had introduced the HPV vaccine into their national programmes. Just 13 of these are lower-income countries. This leaves those most at risk of the devastating impacts of cervical cancer least likely to have access to the vaccine.

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