No Child Born to Die - Health Workers

End the injustice: a fifth of children denied their right to immunization

No child should be denied their right to immunization, but millions still are. Save the Children is calling for greater world action to stop the hardest-to-reach children from being denied their right to life-saving vaccinations.

While impressive progress has been made in expanding immunization, 20% of children are still missing out. The poorest, those in remote areas, from migrant communities, particular castes, or other disadvantaged groups, are not receiving vital vaccinations as well as other basic, essential healthcare.

Routine immunization is the most significant, affordable and cost-effective child survival intervention. Every child has the right to complete basic immunization irrespective of economic status, political affiliation, geographical location, gender, caste, colour or religion. The amazing progress in child survival that we have observed in the last decade is primarily a result of ever-increasing immunization coverage.

We must now prepare ourselves to cover the final fifth of children who are still left out of this important service. These children are in the remotest places, are the poorest children, or are affected by family displacement, natural disaster, war or conflict. They are also the most vulnerable to vaccine preventable diseases.We cannot afford to miss them.

Immunization is a cost-effective and beneficial health service that should be in reach of all children. Within countries, much can be done to overcome inequalities. Strong routine immunization is crucial to achieving this. Several strategies exist to reach the unreached, and governments can learn from good practices in order to address inequalities in their countries.

Key Statistics & Recommendations


  Deaths of children before the age of 5 have dropped by over 40%, from nearly 12 million in 1990 to fewer than 7 million in 2011. Last year we saw the biggest drop in history – 700,000 in one year. (UNICEF, 2012)
    Global immunization coverage has increased from 74% in 2000 to 83% currently. In 2011, there were 10 million fewer unimmunized children, compared with a decade ago. (WHO, 2012)
    Yet, one in every five children is still not receiving even the most basic vaccines. This means that 22 million children are currently missing out on this essential intervention. (WHO, 2012)
    In some countries, coverage rates are much worse: for instance, in Nigeria only 47% of children have access to basic vaccines, and in Ethiopia only 51%. Over half of all unimmunized children are located in just three countries – India, Nigeria and the Democratic Republic of Congo (DRC). (WHO, 2012)
    In countries where inequalities are most acute, the poorest children are three times less likely than the richest children to receive basic vaccines, while a child living in a rural area is just under half as likely to receive basic vaccines as a child in an urban area. (Save the Children, 2012)


This report calls on governments, development partners, the private sector and civil society to implement the following recommendations:


  • Develop strategies to address inequalities in immunization that are integrated into national health plans and that strengthen health systems. They should be costed, funded and implemented.
  • Empower communities and engage them meaningfully as strategies are developed, implemented and monitored.
  • Where appropriate, resolve to build and invest in national R&D capacities and strengthen government regulatory capacity.


  • Make equity a top priority in the next GAVI Business Plan and revise the eligibility policy to include equity criteria.
  • Urgently realize commitment to allocate 15–25% of budget to cash-based support, promoting synergies across the continuum of care.
  • Use market-shaping with pharmaceutical manufacturers to encourage price transparency and reductions, and collaborate with partners, encouraging LMIC tiered pricing and pooled procurement for graduating countries.


  • Champion the opportunity of immunization to promote equity across primary healthcare, and ensure sufficient funding for countries to strengthen health systems, including immunization as part of the essential basic package of services.
  • Continue investment in and commitment to vaccine R&D, including building R&D and regulatory capacities in emerging markets.


  • Champion equity as the priority agenda within the Decade of Vaccines, and the opportunity of immunization to promote equity across primary healthcare, encouraging sufficient investment from country governments and donors alike.
  • Ensure meaningful civil society representation in the monitoring and accountability framework for the GVAP.


  • Prioritize R&D that responds to the burden of disease and the contexts in which the poor and marginalized live.
  • Increase transparency about vaccine prices and pricing mechanisms and be open to opportunities for pooled purchasing and tiered pricing by income level, particularly for LMICs.
  • Support capacity building of emerging market suppliers through untied technology transfers, strengthening regulatory capacity, training, etc.


  • Empower local civil society to actively participate in immunization and health systems.
  • Engage in the GVAP monitoring and accountability framework with all key stakeholders at local, country, regional and global levels.

More Information


Immunization for All   Health Workers Briefing (2011)   Vaccines for all   Missing Midwives (2011)     Women on the Frontlines of Healthcare (2010)

Immunization for All (December 2012)

No child should be denied their right to immunisation – but millions still are.


Health Workers Save Lives (March 2011)

Briefing: Ensuring a Health Worker within reach of every vulnerable child.


Vaccines for All (March 2011)

World leaders can save four million more children’s lives by 2015, by agreeing to fully fund an ambitious global vaccination plan. Find out what we're calling for.


Missing Midwives (March 2011)

How we can save the lives of women and babies by tackling the shortage of midwives in poor countries.




Women on the Front Lines of Health Care (May 2010)

How women are delivering lifesaving health care to some of the poorest and hardest-to-reach mothers and babies.

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