DR SAMLEE PLIANBANGCHANG
Countries in South-East Asia are going through unprecedented economic growth despite uncertainties in the global economic situation. To be able to maintain this upward trend countries need to secure the health of their citizens — especially the children. A high under 5 mortality rate threatens the overall economic development in the Region. Approximately 10 million children in WHO’s South-East Asia Region remain at risk from diseases like measles, diphtheria, whooping cough and tetanus — all of which are vaccine preventable.
So why is South-East Asia leaving so many children behind? Even in countries with over 80-90 per cent immunization coverage the challenge is equity. Children who are outside the vaccine protective shelter are often poor and marginalized. These children are vulnerable to diseases because of malnutrition, unhygienic living conditions, poor water quality etc. Once sick, health-care costs further impoverish their families. Parents who are day workers need to look after ailing children while they use up their savings and miss out on their daily earnings, pushing them further down the spiral of poverty.
Immunization is one of the most cost-effective health interventions that can prevent disease and death among millions of children. When countries focus on the poorest of the poor, and reach the marginalized with childhood immunization, they reap rich socioeconomic dividends.
While some causes for unimmunized children are common to all countries, each country has its unique challenges and each has to find its own way to address these. There is a need to adapt delivery of services so that daily wage earners can bring their children for immunization without losing a day’s wages. We must make vaccines regularly available in the hard to reach areas. Increasing the number of immunization centres and the frequency of sessions in conjunction with strengthened infrastructure such as cold chain and logistics would help countries achieve their immunization targets.
Realizing the impact
of this equity gap on
childhood immunizations, 11 countries in WHO’s South-East Asia Region have decided to focus their efforts on children in areas where the routine immunization coverage is below 80 per cent.
Conflict and violence have frustrated efforts of some countries to reach and immunize children. Sri Lanka which has an overall national average of 100 per cent coverage is now focusing its immunization efforts on the two northern districts were severely affected by conflict. Thailand with
a high 98 per cent national coverage was earlier unable to provide full immunization cover to three of
its southernmost provinces of Pattani, Yala, and
Narathiwat due to security conditions. It is now
committed to focusing on these districts.
Focusing immunization efforts can make a big difference as has been seen in Bangladesh. Bangladesh has successfully reduced
its under 5 morality by
integrating efforts, including immunization, and focusing on its very young children. With 80% vaccination coverage throughout the country, Bangladesh
has now decided to give a push to routine immunization in 31 districts and
4 city corporations that needed additional assistance for increasing and sustaining coverage.
Geographic factors impact immunization coverage in several countries. Nepal is reaching out to 33 of its 75 districts with intensified immunization efforts and has hired additional vaccinators to reach them. These districts include those in far-flung mountainous areas and some lie in the Terai belt.
The challenges before Indonesia and India are somewhat similar. These countries are among the most populous and are home to over half the birth cohort of WHO’s South-East Asia Region. In Indonesia providing uniform immunization services to populations scattered over 13,000 islands is both costly and logistically challenging.
For India the biggest challenge lies in the size of its population, including the large number of migrant populations. India is applying best practices from its vast Polio Eradication programme to intensify routine immunization. These practices include mapping of migrant populations and risk assessments to guide actions and priorities. India is also providing increased priority for vaccine safety and security. State-level efforts are being made to strengthen the surveillance and reporting of adverse events following immunization (AEFI) which could
otherwise erode public
Countries are also facing difficulties in financing the routine and new vaccines selected by them for inclusion in their national immunization schedules. It is vital that adequate funds are allocated for these vaccines.
Inequity in health services slows down a country’s economic progress. Immunization is an important tool in our arsenal to
prevent death and disease in children. The time has come to invest in equity to ensure continued socioeconomic development in South-East Asia.
Dr. Plianbangchang is
Regional Director, WHO South-East Asia