Gavi must ensure routine vaccinations for all children under five

A growing number of unvaccinated children in crisis-hit countries remain unprotected against deadly diseases.

Vaccination in Mingala

Central African Republic 2019 © Victor Manjon/MSF

NEW YORK/GENEVA, APRIL 25, 2023—Gavi, the Vaccine Alliance, must make sure that all children five years old and younger who have missed some or all of their routine childhood vaccines have the opportunity to receive them, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). MSF is making this call during World Immunization Week, which has the theme of “The Big Catch-Up” this year following interruptions in childhood vaccinations due to factors like the COVID-19 pandemic, conflict, and overburdened health systems.

Gavi, which is funded by public and private donors like the US government, was set up 20 years ago to pay for vaccines for the world's poorest countries. However, it currently does not adequately cover catch-up vaccinations for children who have not received any routine vaccines. Expanding its criteria for vaccination—from children under one to include children up to age five—would be particularly critical in countries experiencing humanitarian crises. In these contexts, there are often large pockets of children who haven’t received any vaccines despite living in conditions, such as refugee camps, where deadly diseases can spread rapidly. Children in these settings also often lack access to basic medical services and are more likely to die if they contract preventable but life-threatening diseases.

“The double-whammy of humanitarian crises and the pandemic has left a growing number of children in many countries where we work at a high risk of contracting life-threatening diseases like measles, diphtheria, or pneumonia that could be prevented with vaccines,” said Miriam Alía Prieto, vaccination and outbreak response advisor for MSF. “Expanding the age range for vaccinating children to at least five years is crucial for those who have missed their scheduled vaccines, allowing them to catch up and gain protection against these potentially fatal diseases. Gavi must take immediate action and provide vaccines up to at least five years of age in the countries that wish to do so to protect millions of vulnerable children whose lives are at stake.”

Between 2010-2019, while the number of children who hadn’t received any vaccines reduced globally, there was no progress in crisis-hit countries. Furthermore, there was historic backsliding on childhood immunization—partly due to the COVID-19 pandemic—that resulted in a drop in global vaccination coverage from 86 percent in 2019 to 81 percent in 2021. Between 2019-2021, 67 million children missed out on routine vaccinations, which includes 48 million children who did not even receive a single dose of the most common childhood vaccines, including the diphtheria-tetanus-pertussis (DTP) vaccine.

Gavi’s Fragility, Emergencies, and Displaced populations policy aims to reach children who haven’t been vaccinated at all by offering more flexible support to countries in need. Gavi has also launched the Zero-Dose Immunization Programme to get vaccines to children who haven’t been vaccinated in some of the world’s toughest regions across the Sahel region and the Horn of Africa. However, Gavi has not been clear publicly about the age groups that will be covered under these initiatives and the financial support that will be offered to countries to help carry out these catch-up vaccinations.

“Despite the progress made in expanding global vaccination coverage, nearly 11 million of the un- and under-vaccinated infants live in fragile or humanitarian settings, including countries affected by conflict, and remain the most vulnerable to disease outbreaks,” said Dr. Sharmila Shetty, vaccines medical advisor for MSF’s Access Campaign. “We cannot let any child suffer or lose their life simply because they are based far from the reach of available vaccines.”

For more than five decades, MSF has been vaccinating children through routine vaccinations and in response to outbreaks of disease in some of the world’s most challenging humanitarian contexts. In war-torn Syria, for example, MSF administered over 118,000 vaccine doses to children up to the age of five in 2016. In 2019, MSF teams vaccinated a large group of children who had not received a single vaccine dose in two years against nine vaccine preventable diseases in Mingala, a remote area in the Central African Republic. Overall, MSF vaccinated more than 2.5 million children under the age of five as part of routine vaccination in its various projects around the world in 2021.