Reaching the unreached: immunisation in East Asia and the Pacific

I still remember my first work mission from over 20 years ago, to follow up a two-year-old polio case in a remote village in China. When I entered the house, I was shocked to find that it was not only the boy who was unable to walk, but also his parents. They were both polio survivors.

Tears rolled down my face when I saw that the mother could only move her arms, while the father ‘walked’ with one arm and one leg on one side of body. I could never forget that tragic moment. From that moment on, immunization has changed from being my job to a lifetime duty.

Today, children in the East Asia and Pacific region live free from polio, and in many places the disease is just a distant memory. This year, the Expanded Programme on Immunization (EPI) is celebrating its 40th birthday. The programme has made tremendous achievements globally since its establishment in 1974.

Thanks to this, many millions of people who would have lost their health, or even lives, without access to immunization services can instead enjoy a healthy and happy life. The EPI is recognized by many national governments as being one of the top public health achievements in recent decades.

More work to do

However, we should not forget that there are still many children who have not yet been reached with immunization services. In 2012, 21 million infants globally missed their first dose of measles vaccine. Among the ten countries with the highest number of children unimmunized against measles, two are in this region: Indonesia and the Philippines, at fourth and seventh place respectively.

Even when vaccinations are provided as part of national immunization programmes, these do not always get all the way to health facilities or communities in the hardest-to-reach remote rural areas. Furthermore, while some diseases such as polio and measles can by totally prevented with vaccines, others such as pneumonia and diarrhoea cannot be prevented in 100 per cent of cases through vaccination alone.

In recent years, I have had the opportunity to visit many vulnerable communities, including in urban slums, poor rural villages, remote mountainous areas, and isolated islands. Sometimes I felt like I had travelled back to that moment over 20 years ago when I stood in front of the two-year boy with polio.

In certain countries, I was still seeing children suffering from vaccine-preventable diseases such as pertussis, measles, and even diphtheria. Some died from severe pneumonia and diarrhoea. Many of these tragedies could have been prevented through vaccination. In some cases, life-saving vaccines might even have been available at the national or district level.

Unreached children like these are anxiously waiting for needed services to arrive regularly. Health workers in hard-to-reach areas or working for hard-to-reach communities are also anxiously waiting for adequate support to help them deliver services to children.

There is a Chinese saying that ‘ninety miles is only half of a hundred-mile journey’. The last part of an endeavour is often the hardest to finish, demanding stronger commitment and additional resources.

However, many development organisations are moving away from this region. They see the economic growth that countries here have enjoyed, while not recognizing growing disparities between the rich and the poor in accessing basic health care services such as immunization.

In reality, immunization programmes in many less-developed areas in this region are short of adequate resources to bring services to the hardest-to-reach communities and children.


A young girl after her measles vaccination in Cambodia
© UNICEF EAPRO/Xiaojun Wang


Our shared responsibility 

Promoting equity in basic health care services is a high priority for UNICEF. To reduce inequalities in immunization, we are working throughout the Asia Pacific region to develop and implement effective strategies to ensure immunization services can ‘reach every community’ and family, including the hardest-to-reach.

Reaching every community, and sustaining these gains, will call for stronger commitment from political leaders and more active engagement from communities. It will also need more resources, from both governments and development partners, to help make outreach health services more accessible and reliable for the most vulnerable communities and families.

As one of the leading immunization agencies in the region, UNICEF has been tirelessly working towards reaching every child with life-saving vaccines. It is our firm commitment, working much harder in the last 10-miles of the journey, to reach every last child.

The world has changed significantly in the last decade. Roads are built in places that had none in the past, and mobile phones have reached even very remote rural villages. However, there is still much distance – geographically and socially – between immunization services and the last child to be reached.

It should not be like this. The sun should warm all children, no matter where they live, or who they are. Reaching these unreached children is our shared responsibility, no matter who we are, and where we stand.

The author
Xiaojun Wang, Immunization Specialist for UNICEF East Asia and Pacific

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  1. Great post Xiaojun – thank you! As Viet Nam deals with measles outbreaks, the need to reach hard to reach populations becomes even more important for Universal Health coverage and equity. I believe immunization programmes can lead the way!

    1. Thank you Craig. Achieving measles elimination requires great efforts to reach those previously unreached. It also presents a great strategic opportunity to tackle inequalities in immunization and beyond. As Bill Foege says: "Eradication attacks inequities and provides the ultimate in social justice".

    2. Xiaojun, great reflection,

      Come across your poster when preparing my lecture "Polio eradication – state of the art approach to social justice and health equality".