Health and Healthcare Systems

Childhood vaccination needs ambitious investment now. This is why

The COVID-19 pandemic vaccination response offers hope, but we mustn't be complacent.

The COVID-19 pandemic vaccination response offers hope, but we mustn't be complacent. Image: Reuters/Tiksa Negeri

Seth Berkley
Chief Executive Officer, Gavi, the Vaccine Alliance
Etleva Kadilli
Director, Supply Division, UNICEF
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This article is part of: Centre for Health and Healthcare

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  • Hundreds of thousands of deaths from what should now be preventable diseases continue to occur, despite vaccinations being available.
  • Global vaccination rates are stagnating, with childhood immunizations currently facing the largest backslide in three decades.
  • We must build on vaccination efforts made during COVID-19, prioritize health systems and invest in the human capital key to their success.

By the end of this decade, it is projected that vaccines targeting cancer and heart disease could save millions of lives. Yet today, decades after safe and effective vaccines have been introduced and made publicly available, hundreds of thousands of deaths continue to occur from what should now be universally preventable diseases.

Why? Because vaccine technology alone does not save lives; for that, they also must be manufactured, procured, safely delivered along the supply chain and administered to individuals.

So, despite the incredible progress that has been achieved in recent decades against childhood diseases, with vaccines contributing to a more than 50% reduction in child mortality, serious gaps in global immunisation coverage continue to persist.

What’s more, the impact of the COVID-19 pandemic on health systems, particularly in lower-income countries, has widened these gaps further.

Even before the pandemic, global immunisation rates were stagnating. Today, children face a world that is experiencing the largest backslide in childhood immunisation in 30 years and at risk of even further declines.

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However, what unfolded during the pandemic also offers hope. In the bid to ensure that COVID-19 vaccines reach people in all corners of the world, the response clearly demonstrated that when strong political will and funding are there, it is possible to bridge gaps quickly and effectively.

The pre- and pandemic-era investments accelerated support to lower-income countries to ensure their vaccine delivery systems were able to manage large volumes of COVID-19 vaccines such that they were able to deliver more than 5 billion doses.

From the scaling up of cold storage facilities in Ghana or the digital register in Uzbekistan that integrates immunization and civic data, to the distribution platform for COVID-19 vaccines in Tanzania that is also helping with routine immunization, these investments have strengthened vaccine delivery systems in ways that extend well beyond COVID-19 and have the promise to continue as long-term, sustainable gains.

Investment in vaccination systems needed

We must urgently continue to build on this momentum. Only with sustained investment in these systems can we overcome the systemic barriers that have historically hindered access to a range of life-saving vaccines for millions of vulnerable children.

According to UNICEF’s 2023 State of the World’s Children report, one in five children have missed out entirely or partially on routine immunization. These ‘zero-dose’ children typically live in some of the most impoverished and marginalized communities in the world, and face barriers that impact access to not only immunization, but many other basic services too.

They may lack access to clean water, education and primary health care. They are more likely to live in conflict-affected and fragile settings and may be exposed to violence and food insecurity. These children are not just the last to be reached, they are often also the hardest to reach.

When strong health systems and supply chains are in place, national governments are better equipped to address these multiple depravations in a holistic way. They are also better equipped to respond to emerging health threats such as cholera outbreaks, as well as to introduce and scale up vaccines into their national immunization programmes – for example, human papillomavirus (HPV) vaccines in support of cervical cancer elimination, or the new malaria vaccine for those at risk.


Together, UNICEF and Gavi make up the world’s largest buyer of childhood vaccines, reaching about half of the world’s children under age five each year. Through our collaboration that has spanned more two decades, we have helped to immunize more than a billion children and save an estimated 16 million lives.

With our joint expertise and purchasing power, we offer financing solutions for governments to build and strengthen their national immunization programmes. And we work with manufacturers to create healthy markets that offer vaccines at affordable and sustainable prices.

We are committed to working end-to-end along the supply chain, along with partners, governments and donors. Together with the World Health Organization (WHO) and CEPI, our joint COVID-19 response known as COVAX benefited from years of investment in strengthening vaccine cold chains in lower-income countries.

We were also challenged to rapidly address a range of complexities on an enormous scale, including data systems, surveillance networks, training health care workers, establishing legal frameworks and addressing vaccine hesitancy.

Pandemic lessons can help us prepare for future

With the acute phase pandemic now behind us, the learnings and know-how will help us prepare stronger and better for the future. But this is only possible if we maintain the momentum, reverse the backsliding, and aspire to do more. We know this is possible as some countries, already, have restored immunization to pre-pandemic levels or beyond.

But this needs to be the rule rather than the exception, and that means building on investments from the pandemic response, and prioritizing supply chains and health systems for the years to come.

We must also invest in the human capital behind these systems – including health workers, supply chain experts and logisticians. And we must continue to invest in risk communication and community engagement to maintain trust.


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We also need continued innovations in vaccine technology and call on industry to accelerate ambition and aim high. This means improving upon existing vaccines to optimize their delivery systems and efficacy, and strengthening platforms to develop new vaccines for evolving or emerging diseases that the climate crisis is making evermore threatening.

Equity must be the mantra at every stage of a vaccine’s journey – from development to delivery. Only with dedicated focus and investment along the entire supply chain, can we ensure readiness to cope with ongoing and future diseases, turn vaccines into vaccinations and reach the most marginalized.

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