Covid is a chance to build a world where everyone has access to basic vaccines | David Miliband and Anuradha Gupta

Preventable diseases still plague those missing out on vaccines. Efforts to halt coronavirus could help crack this issue

The massive public, private and foundation investments in a coronavirus vaccine are producing results at a record pace. And countries are reacting accordingly. A recent global assessment of purchasing agreements for Covid-19 vaccines reveals that high-income countries, as well as a few middle-income countries with high manufacturing capacity, have already bought enough doses for their populations.

But delivery of the vaccine needs a new level of focus. This is especially the case for populations in poor and war-torn countries, where the health system is weak or nonexistent. Even before the pandemic, approximately 20 million infants a year, often some of the most vulnerable in the world, were missing out on basic vaccines. For example, there are estimated to be more than 10.6 million children in the world’s poorest countries who in 2019 did not receive even a first dose of a diphtheria-pertussis-tetanus vaccine (DPT).

The geography of this population is not random: roughly half of unvaccinated children live in fragile or conflicted-affected countries, mirroring the new concentration of poverty in these states (like Yemen, the world’s largest humanitarian emergency).

Cracking this problem requires new ways of working, and the Covid-19 crisis provides the perfect opportunity. Our organisations are determined to work together to learn from each other’s experiences.

One urgent priority is internally displaced people (IDPs), who lack the international protections of refugees and typically have very limited access to health systems. With 79.5 million people displaced in 2019 – more than half of them IDPs and double the number 10 years ago – the gap between need and provision is growing.

In 2017 we saw an outbreak of diphtheria, the worst in decades, among Rohingya living in refugee camps in Cox’s Bazar, Bangladesh. The Rohingya, who have been denied citizenship in Myanmar since 1982, were largely unable to access immunisations there. The diphtheria outbreak prompted a huge vaccination campaign in and around the camps, swiftly ending the crisis, but that an outbreak of such a highly preventable disease could occur in the first place was an indication of the extent to which internally displaced people miss out on basic vaccinations.

Even before the arrival of Covid, stagnant immunisation rates weakened our global health security. Data from the World Health Organization and US Centers for Disease Control and Prevention (CDC) found measles deaths in 2019 grew to more than 200,000, a figure 50% higher than in 2016. Immunisation plays a critical role in preventing outbreaks, but it can only work if all people have access. The fact that today we cannot reach all people with widely available vaccines such as measles, polio and diphtheria does not just mean we have collectively failed to protect these people, it is an indictment of our global pandemic preparedness.

Health systems must be strengthened by shoring up supply chains, ensuring sustainable and adequate financing, and empowering community health workers. In many conflict and crisis-affected contexts, the formal health system is not able to reach the full population needing access to immunisations. Health facilities are sometimes destroyed (and attacked) and flight from conflict can take people to other, safer areas, which may not be near health facilities. It is here that community health workers have a vital role to play. A study of the impact of community health workers on immunisation in Kenya found that their intervention raised coverage rates to 99%, a rise of 10 percentage points.

Many vaccines – including for Covid-19 – require cold storage, and this means we need a supply chain that can reach places affected by conflict or in areas lacking electricity and specialised equipment. Strengthening the supply side and availability of vaccines must occur alongside efforts to build the demand for vaccines. This will occur only when communities trust vaccines and local health services. To do this, we need to involve communities in the planning processes and keep them engaged throughout the vaccination journey, with access to information and services as well as motivation to participate.

To address this issue, the International Rescue Committee and Gavi, the vaccine alliance, are launching a new partnership aimed at reaching the most vulnerable within the Horn of Africa and the Sahel with high-quality care. This moment can serve as a valuable opportunity, when the world’s attention will be more focused than ever before on preventing the spread of infectious diseases and bridging gaps in immunisation.

Now is the time for a new effort that ensures every child receives the life-saving benefits of vaccination. Whether it’s measles, diphtheria or Covid-19, global pandemics and their aftershocks will not end until everyone is accounted for and able to access the immunisations they need.

• David Miliband is CEO of the International Rescue Committee and Anuradha Gupta is deputy CEO of Gavi, the vaccine alliance


David Miliband and Anuradha Gupta

The GuardianTramp

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