Picture: 123RF
Picture: 123RF

It was Nelson Mandela who said, “Life or death for a young child too often depends on whether he is born in a country where vaccines are available or not.” Introducing vaccines to developing countries has been one of the greatest public health feats of our century, with as much as a 70% reduction in the number of people dying from vaccine-preventable diseases achieved in the past two decades. 

This quiet revolution means that today a child born in Mombasa will enjoy similar access to life-saving vaccines as a child born in Munich. Levelling this playing field between the world’s richest and poorest countries has required bold actions and innovations: aggregating demand to leverage economies of scale; introducing “vaccine bonds” to provide upfront financing for large-scale investments; incentivising vaccine manufacturers to develop affordable products; and forging purposeful partnerships with public and private institutions, as well as civil society.

But while inequality between nations has been much reduced, the challenge to ensure equity — that every child within a country has equal access to vaccines — remains unsolved. More than 10-million children in 68 lower-income countries remain deprived of even a single dose of the most basic vaccines. Too often they also lack basic education, nutrition, sanitation, drinking water, safety, equality and dignity.

Reaching these “zero-dose” children and assisting them in their plight is not just a moral imperative, it’s also an economic one. Children who have been vaccinated have a greater chance of staying healthy, finishing their education and attaining their potential in life. Bringing zero-dose children to the front and centre not just of immunisation but broader developmental efforts would fetch exceptionally high financial returns, create more equitable, educated societies and improve prospects for peace and stability.

So if every dollar spent on immunisation generates an economic return of $54, why have we failed to reach those children who have, in Mandela’s words, among the lowest chances of survival? The answer is we have not been able to reach them yet. Living in remote villages, urban slums or conflict zones and belonging to the poorest and most marginalised elements of society, they are all too often invisible, mute and powerless.

This is changing. Thanks to technology, we can now use satellite imaging to help us locate these children. We can use biometrics to give them an identity for the first time, drones to deliver the vaccines even in the most inaccessible geographies, and mobile apps to track their progress. All of these innovations have wider benefits: at the same time as helping us locate vulnerable children, satellite imaging helps urban planners organise and improve informal settlements.

For children who are born without birth certificates and grow up without medical records, the biometric records that track vaccinations are often their first formal identity — an important step towards an inclusive society. The drones that began shipping vital medicines and vaccines to remote communities are now at the forefront of an African-led revolution in mobility and transportation.

Innovation can be low-tech too: in certain parts of the world we have been able to greatly improve coverage by moving vaccination closer to communities and extending opening hours to times that suit mothers. With the help of the private sector, vaccines are helping address age-old gender norms by encouraging fathers as well as mothers to actively participate in their child’s health care. By training local people to administer vaccines, we have been able to tackle hesitancy that can put the health of the whole community at risk.

This unprecedented level of collaboration has helped us protect a whole generation of children, saving more than 10-million lives. It has also provided us with the tools and the know-how to go one step further and reach those children who have been left behind. It has taught us that for some children and communities, greater investment will be required.

It is time to translate the successes of the past 20 years in eradicating vaccine inequality into achieving vaccine equity. It is also time to go even further: by partnering with other agencies, government departments and community groups, we can create an integrated platform for sustainable development capable of delivering better nutrition, reproductive and sexual health, education, clean water, basic sanitation, gender empowerment and poverty reduction strategies.

By joining hands and working together, we can ensure no child is left behind ever again. Now that would be a legacy Mandela would approve of.

• Gupta is deputy CEO of Gavi, the Vaccine Alliance.