Childhood vaccination remains one of the most effective ways to reduce child deaths and accelerate achievement of the Sustainable Development Goal for child survival (SDG 3.2). But currently coverage rates for the most lifesaving vaccines for children targeting pneumonia, diarrhea, measles, meningitis, and diphtheria/pertussis/tetanus (DTP) are well below the Immunisation Agenda 2030 (IA2030) target of 90%. And the new malaria vaccines are just beginning to roll out across Africa with introductions in 17 countries, according to the World Health Organization (WHO).
In 2023, coverage of the pneumococcal conjugate vaccine (PCV) was just 65%, rotavirus vaccine was 55%, measles (2 doses) was 74%, and diphtheria/pertussis/tetanus (DTP) was 84%, according to the WHO and UNICEF. In the same year, 14.5 million "zero-dose" children did not receive a single dose of DTP vaccine, up from 13.9 million in 2022, according to UNICEF. Further, as measles coverage dips, there have been large outbreaks in Yemen, Pakistan, India, Thailand, Ethiopia, Romania, Afghanistan, Indonesia, Kyrgyzstan, and Viet Nam, according to WHO.
Countries can make significant progress towards achievement of SDG 3.2 by increasing coverage of these vaccines, as pneumonia, diarrhea, malaria, meningitis, measles, and pertussis/whooping cough account for 1.6 million, or 33%, of all 4.8 million child deaths, according to the latest UN child mortality estimates. This is especially critical for the 60 countries that are not on track to achieve SDG 3.2, and which are the focus of the Child Survival Action movement. In more than 7 out of 10 of these off-track countries, the majority of child deaths occur among children aged 1-59 months, and in 83% of the off-track African countries. This makes vaccination a particularly powerful intervention to reduce child mortality as it has the greatest impact on children in the 1 -59 month age range.
In the 60 off-track countries, seven of the top 10 causes of death among children aged between 1 and 59 months are vaccine-preventable. Yet, among this group of off-track countries, eight have yet to introduce the PCV, 11 have yet to introduce the rotavirus vaccine, and second-dose measles coverage is below 60% in 32. It is important to note that behind these national vaccine coverage averages are often deep geographic disparities with specific populations of children within national borders experiencing much lower coverage and often zero coverage. Efforts to close vaccine access gaps must identify these large populations of under-vaccinated children and prioritize support to them.
Further, two other vaccines are highly relevant for child survival - the new malaria vaccines (RTS, S and R21) and the maternal vaccine and monoclonal antibodies for respiratory syncytial virus (RSV). Malaria is a leading cause of child death in 34 of the 60 off-track countries, and the RSV vaccine targets the leading cause of viral pneumonia among children. Both vaccines are estimated to prevent many child deaths, but while the malaria vaccine is having wide uptake, the RSV vaccine is only available in high-income countries. A new vaccine targeting childhood meningitis (Men5CV) is currently being introduced in Nigeria and Niger and new vaccines to prevent TB and shigella are in development.
With just six years left to the SDG 2030 deadline, it is vital that a diverse set of child survival actors can come together regularly to strategize effective ways to support governments to increase coverage of the most lifesaving childhood vaccines with a specific focus on the 60 off-track countries, as this is where vaccine coverage increases have the potential to accelerate national child survival goals and save the most lives.
Under the aegis of the Global Pneumonia Forum Steering Committee, the PCV Sub-group is a strong example of how to successfully advocate for a greater focus on PCV (and rotavirus vaccines) in no- and low-coverage countries. The group not only steered key policy wins on PCV prioritization by governments - including a change in Gavi co-financing eligibility requirements that will enable PCV introduction in a subset of the most fragile countries including Chad, Somalia, South Sudan, and Guinea - but also mobilized ambitious new PCV and rotavirus vaccine commitments from governments and engaged new organizations in the long struggle to protect children from pneumococcal and rotavirus disease.
Building on this successful model, the Childhood Vaccination Subgroup of the Child Health Task Force (the Subgroup) will embed the successful features of the PCV Working Group into a broader childhood vaccine group underpinned by common principles of vaccine equity, accessibility, and affordability and closely aligned with the Child Survival Action initiative. This Subgroup can more effectively support the increases in coverage of the most lifesaving childhood vaccines that will impact SDG 3.2 achievement and improve coordination among the major global and regional childhood vaccine initiatives underway and planned.
Critically, the Subgroup will deepen linkages between childhood vaccine groups and groups focused on other prevention, diagnosis, and treatment interventions relating to the leading child killers and risk factors. The goal is that greater alignment across these groups and initiatives at the global level will signal and strengthen similar collaboration at the country level. Reduced fragmentation across child survival initiatives and greater alignment across programs - including those addressed by other Child Health Task Force Subgroups - will accelerate efforts to reach the most vulnerable children.
Roles and Responsibilities
- Define specific objectives, tasks, and deliverables for the Subgroup in relation to the broader Child Health Task Force agenda and the Child Survival Action initiative.
- Provide technical leadership and facilitate advocacy, coordination, communications, and activities to advance child vaccination programs in the Child Survival Action countries.
- Develop and disseminate tools to assist childhood vaccination program managers and their partners (especially NITAGS) in increasing program performance (reaching >90% of children), cost-effectiveness, and quality (including reducing vaccine wastage) through analysis, reporting, and data use.
Goal
To accelerate high coverage (>90%) of the most lifesaving childhood vaccines, especially in the 60 countries off-track, achieve SDG 3.2 to maximize the impact on saved child lives.
Objectives
The Childhood Vaccination Subgroup will:
- Mobilize support for off-track countries (see Table 2) to introduce PCV and rotavirus vaccines before 2025, including by assisting with Gavi applications, generating lives-saved impact data, costs of introduction, analyzing cost-benefits (including treatment cost reductions) of various introduction options (e.g., catchup campaigns, vaccine product choice, dosing schedules, etc.), and by strategizing solutions to high coverage barriers (e.g., vaccine price, cold chain, workforce, etc.)
- Support national vaccine prioritization exercises that enable governments to assess the relative impact on child deaths of the PCV, rotavirus, measles, DTP, malaria (where relevant), and other vaccines, and the likely impact of the RSV vaccine, including by advocating for country-based and country-led research on new and emerging childhood vaccines
- Conduct independent analyses of PCV, rotavirus, measles, and DTP vaccine coverage in the 59 off-track countries (national and sub-national analyses), and where relevant RSV and RTS,S, R21 vaccines, and publish progress reports with recommendations during World Immunization Week (April) each year
- Convene leading childhood vaccination stakeholders to discuss strategies to better integrate the delivery of critical child survival vaccines in the 60 off-track countries (e.g., National Child Health Technical Working Groups or equivalent, National Immunization Technical Advisory Groups/NITAGs, Immunization Agenda 2030, Measles and Rubella Partnership, Defeat Diarrhea, Malaria Vaccine Initiative, ReSViNET, Meningitis Research Foundation, etc.)
- Contribute to the Integration of Nutrition and Immunisation (INI) agenda by sharing evidence and best practice examples of successful integrated delivery of childhood vaccines with nutrition prevention, diagnosis, and treatment services
- Leverage and join forces with the work of other vaccine initiatives that are active in the 60 off-track countries, including zero-dose vaccine programs (e.g., ZIP program), the Global Polio Eradication Initiative, Global Taskforce on Cholera Control, HPV campaigns, and outbreak response efforts
- Execute campaigns that raise awareness, including among caregivers, and build support for increases in coverage of the most lifesaving childhood vaccines (e.g., calls for industry to reduce prices, community mobilization and awareness), with a special focus on vaccinating vulnerable children (e.g., migrant, displaced, and conflict-affected, pastoral and remote communities, small communities affected by “vaccine quorum” rules)
- Engage industry to announce plans to accelerate access to childhood vaccines by addressing supply constraints, local manufacturing initiatives, the relatively high prices of the PCV, rotavirus, and measles vaccines, and the RTS,S, R21, and RSV vaccines where relevant
- Deepen linkages between vaccine groups and groups focused on other prevention, diagnosis, and treatment interventions relating to the leading child killers and risk factors (e.g., pneumonia, diarrhea, and malaria, malnutrition, air pollution, lack of access to hand washing with soap, unsafe water), as well as maternal education and agency
- Leverage investments in primary health systems strengthening and Universal Health Coverage (UHC) for improvements in coverage of the most lifesaving childhood vaccines, especially focused on adequate numbers of trained, paid vaccinators
- Disseminate the work of the Subgroup and its members to critical decision-making audiences, especially vaccine stakeholders in the off-track countries, including by building a strong social media presence and contributing to broader vaccine advocacy and communications efforts (e.g., Immunization Partners, ONE Campaign, Global Citizen, etc.)
Leadership
Chairs:
Sheetal Lookhar, Save the Children
Jolem Mwanje, Impact Health Organization
Nassor Mohamed, JSI