Leave No One Behind: Building Equity into Vaccine Access

Top to bottom, then L-R: 1) Dr. H.M. Agus Samsudin, Chairman of Covid-19 Command Center, Muhammadiyah, Indonesia; Mirafe Solomon, Save the Children Ethiopia; and Maki Igarashi, Coordinator, Emergency Health, IFRC Regional Office, MENA (Beirut); 2) Dr. Vineeta Gupta, Secretariat Director, ACTION Global Health Advocacy Partnership, and Dr Peter Singer, Special Advisor to the Director General at WHO; 3) Dr. Chizoba Wonodi, IVAC-WAVA, Nigeria, and Dr. Ephrem Lemango, WHO Regional office (Africa)


“World Immunization Week matters more than ever, in light of the COVID-19 pandemic, to achieve vaccine equity and health equity. ACTION partners work very hard every day across the globe to decrease inequities that make us all vulnerable to vaccine preventable diseases. India is a critical example. This devastating second wave has claimed the lives of around hundred thousand people and is deeply affecting the country’s health system.” — Dr. Vineeta Gupta

On April 20, a virtual conversation on the ways policymakers, civil society organizations (CSOs), government officials, and funders can create an integrated, equitable approach to immunization was hosted by Gavi CSO Constituency in partnership with Gavi, the Vaccine Alliance, RESULTS UK, ACTION Global Health Advocacy Partnership, and Save the Children UK.  

Dr. Vineeta Gupta, director of the ACTION Secretariat, led the discussion on urgent questions facing us on vaccines. How do we make sure that no one is left behind — that everyone has access to vaccines? With the roll-out of the COVID-19 vaccines, equity is a hot topic across the world. While access to COVID-19 vaccines is very limited especially in low- and middle-income countries (LMICs), the detrimental effect of the pandemic and singular focus on COVID vaccines threatens to disrupt critical life-saving routine immunization. An estimated 19.9 million children still do not have access to a full course of the most basic vaccines, and only 7% get all 11 vaccines that the World Health Organization (WHO) recommends for infants in all countries.

Experts from across the world sent the same message: Vaccine access is about equity, community, and trust. Dr. Chizoba Wonodi, Nigeria country director for the Johns Hopkins International Vaccine Access Center, outlined the Immunization Agenda 2030. IA2030 is an ambitious global strategy to expand vaccine coverage over the next decade and create a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being. The goal of IA2030, Dr. Wonodi said, is: “Leave no one behind.”

Mirafe Solomon, health and nutrition specialist for Save the Children Ethiopia, noted that vaccinations should be integrated into other interventions, providing more holistic health care for vulnerable populations. Dr. H.M. Agus Samsudin, chair of the Muhammadiyah COVID-19 Command Center in Indonesia, and Maki Igarashi, coordinator for emergency health at the IFRC Regional Office MENA, both emphasized the role of the community in increasing vaccine access. Dr. Samsudin called for engaging the community not just for COVID-19 but for all vaccinations. Igarashi said that one of the greatest challenges is not just access, but convincing people to get vaccinated, and that trust is a key tool in closing equity gaps.

All the speakers noted that scaling up immunization campaigns, and especially the fast-paced roll-out of COVID-19 vaccines, is not something governments can do by themselves. While funding for vaccines needs to be increased, it’s just as important to build trust with local organizations and communities, create strategic partnerships, and empower the community. Dr. Gupta said: “Indeed, 1 million vaccinations a day cannot be done by the government itself; it needs multi-stakeholder engagement.”

Dr. Ephrem Lemango, from the WHO Regional Office for Africa EPI-Essential Programme on Immunization, noted that one result of the coronavirus pandemic is that children aren’t getting other necessary vaccines. Remote communities that don’t have consistent access to essential services like primary healthcare were shut off from vaccines along with other healthcare, and close to 25% of children in Africa are “zero-dose,” meaning they haven’t received even the most basic of vaccines over the past year. If we’re going to tackle vaccine access, we have to strengthen primary healthcare systems.

Dr. Peter Singer, special advisor to the director-general at the WHO, said that there are three lessons to be learned from the COVID-19 pandemic: “Equity, equity, and equity.” He also noted that we can’t call the pandemic over until both high-income and low-income countries have access to the vaccine, and for that to happen, these countries need the “three Ds”: dollars, doses, and domestic manufacturing.

While the COVID-19 pandemic is shining a light on the importance of public health and vaccine access, it’s critical to remember that there are communities that have lacked consistent access to healthcare and life-saving vaccines all along. With the increased attention, we have an opportunity. By leveraging data, building strong partnerships, and working with local communities, we can create a world where everyone, everywhere, at every age has access to this most basic healthcare service.