Child immunisation as key pathway to health for all

The Ebola outbreak has been continuing for about six months in the Democratic Republic of Congo. Every life lost is a tragedy but the vaccination programme has given a vital boost to the Ebola response, preventing thousands from contracting this dreadful disease.As of 24 April 2019，，，，more than 104,000 people had been vaccinated against Ebola in the Democratic Republic of Congo.

This is just the latest example of howvaccineshave transformed public health in Africa. In recent decades many countries have made tremendous gains in increasing access to immunisation.

Three years ago, African leaders endorsed the亚的斯州免疫声明to ensure that every child in Africa receives the full benefits of immunisation. This historic pledge includes commitments to increase political, financial and technical investments in immunisation programmes, as well as making universal access to vaccines a cornerstone ofhealth和非洲的发展努力。

“All children – no matter where they are born – should have access to prevention as well as healthcare including live-saving vaccines.”

Seth Berkley and Githinji Gitahi

In parallel, political support for universal health coverage — the idea that everyone should be able to access quality health services without suffering financial hardship — is gaining momentum across Africa. Most countries recognise the importance of promoting ‘health for all’, both as a means of improving health outcomes, and because it is the right thing to do.

However, achieving universal health coverage for many countries may look like a grand challenge. Thus, a step-wise approach that involves adding the most cost-effective interventions first, and as there are more resources, further expanding interventions might be more attainable.

Immunisation and universal health coverage

普遍健康覆盖范围的一个特殊切入点是免疫，这是最具成本效益的干预措施之一，通常用于衡量一个国家医疗保健的力量system。

In the past, countries have used the foundation laid for delivering immunisation services to strengthen access to other healthcare services. For instance, when Ebola cases were confirmed in Abuja, Nigeria in July 2014, community网络built at the time of polio immunisation programmes were repurposed to actively find cases and track potential chains of Ebola transmission,helping the country stop Ebola in three months。

However, vaccine-preventable疾病are still每年在非洲杀死超过五个以下的50万儿童。[4]覆盖率停滞在约74％in recent years — well below the global target of90 per cent。

Children need access to healthcare

所有儿童（无论他们出生的地方）都应该获得预防以及包括储蓄疫苗在内的医疗保健。这是普遍健康覆盖范围的基本原理。然而，低收入，移民和边缘化群体继续面临不成比例的挑战，即获得预防和质量，负担得起的医疗保健。

“我们需要在这些环境中开发有效的免疫传递途径，这与其他地方的免疫交付的“往常”不同。”

Seth Berkley and Githinji Gitahi

Achieving health for all in Africa means paying close attention to the needs of these key populations. Vaccines are one of the few interventions that act as a unifier across those with varying social and economic realities. Vaccines play a role in financial risk protection by preventing illness (and subsequent high-cost treatments) and protect children from diseases in places where medical attention could be several days away. In this sense, vaccines truly embody the principle of universal health coverage because immunised children are protected from disease no matter where they live.

需要有效的免疫输送系统

查看免疫覆盖范围data更接近地，人们意识到，非洲的许多国家，例如刚果民主共和国，索马里和南苏丹，免疫接种率低都具有脆弱的卫生系统。这些国家容易遭受危机，例如武装冲突，突然的经济冲击，beplay足球体育的微博环境的冲击或重大疾病爆发，例如埃博拉病毒。

实际上，almost two-thirds of unvaccinated children live in fragile countriesor those affected by conflict, and more needs to be done to tailor immunisation delivery systems to these contexts.

为了接触未接种的儿童，我们需要在这些环境中开发有效的免疫输送途径，这与其他地方的免疫交付的“往常”不同。2017年，非洲近980万儿童被免疫了，并且没有接受所有三剂含白喉 - 含毒素（DTP）的疫苗。

The same year,八个非洲国家including Central African Republic, Chad and Nigeria, had an immunisation rate of less than 50 per cent, with many of these countries being fragile states and states affected by emergencies. Past experience shows that in countries where immunisation rates have dramatically dropped due to fragility and conflict, political leadership has been vital in turning the situation around.

As commitment to reaching the last mile in health gains momentum, it is critical that we come together as a community — political leaders, technical experts and civil society alike — to find ways to deliver basic healthcare services such as immunisation to every person no matter where they come from.

3月，来自2019年非洲卫生议程国际会议的各个部门和国家的主要专家和机构在卢旺达举行了有关政治意愿的这些对话，cooperation并加强卫生系统，目的是在2030年实现整个非洲大陆的普遍覆盖范围。

With the亚的斯州免疫声明and commitments to achieving healthcare for all, heads of states across Africa have shown bold leadership in prioritising progress on healthcare. This leadership is key.

但是要取得成功，政治层面上的这些承诺必须与有效的伙伴关系和敬业的公民社会结合在一起，反映出必须塑造每个国家对所有人健康的独特途径的当地情况和国家对话。

Seth Berkley is CEO of Gavi, the Vaccine Alliance and can be reached viawmunge@gavi.orgGithinji Gitahi是Amref Health Africa的小组首席执行官and -chair of the UHC2030 Steering Committee, and can be到达通过Elizabeth.ntonjira@Amref.org

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.