The Most Important Faces in Global Health

They are the children that modern medicine forgot, or utterly failed to reach.

Last year, 140 million children were born into this world. Every second, four new people!

They arrived into the vastly varied circumstances of human existence in 2021. Some of them were born into great privilege, others into deep poverty. Some were born in sparkling modern hospitals, while others were born in the dirt.

Of these 140 million children, some 122 million received some or all of the recommended course of vaccinations during their first year of life. But 18 million had no vaccines at all, according to new data from WHO and UNICEF. The two organizations released their annual global immunization coverage estimates on 15 July of this year.

The unvaccinated 18 million infants are the so-called “zero-dose children” -- the children that modern medicine forgot, or more accurately, failed to reach.

That we have 18 million new zero-dose children in this world is an important fact.

It is important in a direct sense: there are 18 million children more who are totally unprotected against the wide range of diseases that vaccines now prevent.

It is also important in a broader sense: zero-dose status is a marker of deprivation; it indicates the proportion of infant children not being reached by even the most basic health services. It shows the limits of the world’s healthcare systems, and vast machinery of global health.

The number of zero-dose children has increased during the pandemic – two years ago, it stood at 14 million. Before that, it had barely changed for a decade, despite a great deal of effort and investment to reduce it. That is an interesting phenomenon in global health – the plateau effect.

This lack of progress in improving immunization coverage has become the norm, but it wasn’t always. Forty years ago, just 20% of children in the world were vaccinated. Over the next 30 years, thanks to the Expanded Programme on Immunization (EPI), that figure of 20% was grown to 83%.

How? Political will; funding; the at-scale application of proven technologies and approaches; and multi-lateral cooperation.

But then something happened. The improvement trajectory slowed almost to a stop. Over the next decade, the world succeeded in introducing an ever-expanding array of vaccines, preventing millions of deaths particularly from diarrhoea and pneumonia. But coverage was essentially stagnant. The vaccines carried on reaching the same kids and missing the same kids.

Why?

And, what will it take to push past the 86% peak coverage (achieved back in 2019), break through the plateau, and re-establish a momentum of improvement to reach 90% or higher?

A crucial part of this – now well-established – is the need to focus sharply on reducing the number of zero-dose children as a unique, specific, and critical goal unto itself, not as part of some larger, amorphous agenda. This is the headline goal of the Immunization Agenda 2030, and the central target of Gavi’s strategy.

Breaking through requires really and truly understanding why we were stuck. It is easy to make assumptions. True understanding comes from listening to the people whose children are not being vaccinated, and taking the time to understand the problems in depth. Albert Einstein reportedly said, “If I had one hour to solve a problem, I would spend 55 minutes thinking about the problem and five minutes thinking about solutions.”

There’s a valuable insight here.

Too often in global health, we focus on implementing the solutions without first achieving a true, in-depth understanding of the problems. Then we are forced to correct our errors in the middle of executing a failed solution, or a solution that is only partially successful. (In some quarters, this is known as the “Ready, Fire, Aim” syndrome.)

To my mind, the goal of vaccinating the world’s zero-dose children is the most important objective in global health.

So many global health goals are statistical measures – coverage rates, mortality rates, life expectancy. Important, but hard to relate to. Zero-dose children are relatable: they are individual people.

And not just any people – they are the infants most in need. Some born in war zones, some in areas remote from modern services, some in densely packed urban slums.

The concentrated focus on zero-dose children is a powerful, and arguably even virtuous, approach. It brings to life the buzzwords of access, equity, and coverage in real human faces…maybe the most important faces of all.

Between 1974 and 2000, the world made concerted and impressive progress in expanding immunization from a fortunate minority to the majority. Now is the time to expand it to everyone, to reach the final crucial minority – one zero-dose child at a time.

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GLOBE is an outlet that allows colleagues and friends of the ApiJect Global Initiative to share their thoughts on matters related to global health and their ongoing work. Send questions or responses to media@apijectglobal.com.

To learn more about the ApiJect Global Initiative, visit our website.

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