5th Global Meeting on Implementing New and Under-utilized Vaccines, 22-24 June 2011
Panel Discussion: Crucial Conversations - Equity and Universal Coverage
Facilitator: John Wecker, PATH
Panelists:
- Mickey Chopra, United Nations Children's Fund
- Kim Mulholland, London School of Hygiene and Tropical Medicine
- Mathuram Santosham, Johns Hopkins Bloomberg School of Public Health
Background
Achieving equity is a driver of much of the work of increasing global access to new and underutilized vaccines, as well as increasing coverage rates. Previous goals driving global and national immunization strategies have been shaped by similar concepts of equity and achieving universal coverage rooted in moral, as well as evidence-based arguments. For example, "UNICEF modeling demonstrated that equity-based approaches not only are a moral imperative but also are likely to provide a cost-effective way for achieving more rapid impact ... a focus on equity that prioritizes the most disadvantaged children and families is right both in principle and practice."
Objectives of the Session
- To explore how the ethical and moral principle of equity shapes immunization policy and practice
- To understand better if it is possible and/or necessary to achieve universal coverage for all vaccines
- To explore the strategies and barriers to achieving the target of universal coverage
- To explore the role of equity and universal coverage in communication and advocacy at global and national levels
Discussion Areas
- Is universal coverage an achievable goal?
- Should this be the goal for every vaccine?
- How does the principle of equity drive us towards this goal?
- What are the linkages to other global health goals based on this principle and how can achieving immunization targets be strengthened through these linkages?
- What are the success factors for countries that have achieved high levels of coverage?
- How can we sustain the gains in coverage that have been achieved?
- What role can new vaccine introductions play in our ability to achieve universal coverage?
Outcomes
- A clear definition of "Inequity" = Inequalities that are unfair. Equity in immunization coverage would equal reaching the last 10% in a country (assuming 90% coverage is the goal), and the final push to reach the poorest two thirds of countries with high immunization coverage.
- Immunization programmes and vaccination, with their focus on monitoring of ever-increasing coverage targets and intensified strategies to "reach the unreached", are inherently pro-equity and pro-poor. However, some recent developments in the world of immunization have not had equitable outcomes:
- GAVI's 70% DTP3 coverage threshold for countries to receive funding for new vaccines results in children in the poorest countries being denied access to new life-saving vaccines;
- Countries' inability to timely deliver vaccines according to the established schedules results in children in these countries failing to be protected against rotavirus disease when a vaccine is available for this.
- But the argument of equity equalling universal coverage in a country raises other questions that are difficult to reconcile with this goal:
- Are governments and parents obliged to vaccinate all children?
- Is not vaccinating a child a violation of the child's right to healthcare?
- Are "vulnerable" or "high-risk" populations thus defined to be targeted for enhanced attention, happy to be classed as such?
- There is undoubtedly a rich discussion over the assumption that if vaccines are available to prevent certain diseases it follows that everyone should be vaccinated, but this does not account for personal preference or situation.
- In conclusion, "Equity" in immunization would be a situation in which everybody who wants a vaccine has access to it.