A new gap in immunization is emerging

Pneumonia and diarrhoea are the two greatest causes of death in children younger than 5 years of age. In 2010 and 2011, children in lower-income countries started to receive vaccines to protect them against these two diseases. Meanwhile, children living in industrialized economies had started receiving these vaccines some eight years prior.

Reducing this time lag has been a key objective of the GAVI Alliance – the partnership that was created to close the gap in immunization access. The vaccines that protect children from pneumonia and diarrhoea were included in the GAVI Alliance’s strategic plan in 2006. Donors provided funding, countries applied for support and manufacturers scaled up production.

Using aggregated forecasts, multi-year contracts and special contractual terms, unprecedentedly low prices for the vaccines were achieved. Procurement began, and children started being immunized. Thus far, approximately 33 million children in 45 lower-income countries have been immunized with pneumococcal and rotavirus vaccines, and this number is increasing each year. It would increase at a faster pace if not for current global supply constraints related to production capacity of the desired vaccines.

A small boy getting vaccinated in Bangui, Central African Republic © UNICEF/UNICEF_CAR063/JAN GRARUP

A small boy getting vaccinated in Bangui, Central African Republic
© UNICEF/UNICEF_CAR063/JAN GRARUP

During this same period, governments of middle-income countries that are not eligible for support from GAVI, such as Morocco and the Philippines, also established plans to introduce these vaccines. Uptake, however, has been much slower and more difficult.

Worryingly, we have seen a growing gap between children in middle-income countries receiving these vaccines, as compared to children in lower- and high-income countries.

Working with the World Health Organization (WHO), governments and industry, in 2013 UNICEF issued a tender to speed up access to and obtain lower prices of new vaccines for middle-income countries, while not replacing national procurement systems. That programme is under way, and we have some options for countries, including for an additional vaccine (HPV) to protect against cervical cancer.

Improving access is difficult not only because of the constrained supply availability, but also because these markets are usually affected by multiple channels, including existing commercial agreements, national legislation and concerns around demand from some manufacturers.

As more suppliers of vaccines enter the market and availability increases, access should significantly improve. We are confident that children everywhere can be immunized with these vaccines, regardless of the income level of the country in which they live.

But until then, UNICEF will continue to work with industry, governments and partners to overcome barriers so that healthy markets fairly serve these countries – and children everywhere.

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