A Save the Children nurse prepares to vaccinate Abdirahman (3 months) while his mother Lucky (29) holds him

Lucky, 29, lives with her husband and five children in a small town in Somalia. Lucky’s community is currently experiencing severe water shortages and drought-like conditions, fuelling livestock loss and hunger. Lucky’s husband is a builder and his business has been impacted by the drought because no one has any money to build homes anymore. The drop in income means they can no longer afford to rent their house and they spend almost all their money on food. They also regularly have to choose between buying food and buying clean drinking water. After Lucky’s three-year-old son was Munsin was diagnosed with malnutrition, Lucky joined Save the Children’s mother-led malnutrition screening programme. The programme provides training for women in the community on how to assess children for malnutrition and information on the importance of breastfeeding and vaccines. Once trained, the women go door-to-door in their communities assessing children and referring those with malnutrition to Save the Children’s Maternal and Child Health (MCH) clinic where they can receive treatment. The programme is a new initiative designed to empower women in the community and to reach marginalised children and those living in remote areas. Families like Lucky’s have experienced an increasing number of climate-related disasters over the last few decades, ranging from long-lasting droughts to devastating floods, locust infestations and even cyclones, sometimes all experienced in the same region within months. This growing climate crisis has led to food insecurity, a heightened risk of famine, increased water shortages, widespread disease outbreaks, displacement and a drastic reduction in household incomes. Children and their families cannot cope as they have no time to recover before the next crisis hits. In 2021, Somalia is facing reduced rainfall, critical water shortages and drought-like conditions, pushing the number of children and adults who need critical support to 5.9 million – a third of the population and an increase of 700,000 people compared to 2020. A Save the Children assessment conducted in February 2021 found that more than 70 percent of families surveyed didn’t have access to clean drinking water and that more than 50 percent didn’t have enough food to eat. Save the Children continues to prioritise the needs of the most vulnerable and marginalised children and is ramping up its humanitarian response. We’re providing water for drought-stricken communities; therapeutic food for malnourished children; emergency healthcare for pastoralist and hard-to-reach communities; cash and voucher assistance to families facing economic stress; and student food and water programmes to support schools to stay open. Save the Children is also continuing to work with local governments to build the long-term resilience of communities to cope with climate shocks. Sacha Myers / Save the Children

Leaving no one behind: Universal Health Coverage agenda at UN General Assembly must deliver action on lifesaving vaccines

6 min read

20 Sep 2023 Somalia South Sudan

Blog by Healthy Start In Life Team

Save the Children International

Pneumonia and diarrhoea remain the biggest killers of children under 5 years of age.

A Save the Children nurse prepares to vaccinate Abdirahman (3 months) while his mother Lucky (29) holds him. Save the Children.

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Even though effective vaccines and low-cost treatment have been available for decades, pneumonia and diarrhoea remain the biggest killers of children under 5 years of age. Every hour, more than 140 children die from pneumonia and diarrhoea - a devastating 1.2 million largely preventable deaths annually[1].

The majority of these deaths occur in African countries with relatively low resources, under-resourced healthcare systems, and ongoing conflicts.

Preventing this tragic loss of children’s lives is possible by making sure that two types of common vaccines are available and accessible to children everywhere: the pneumonia-fighting Pneumococcal Conjugate Vaccine (PCV) and the diarrhoea-treating Rotavirus Vaccine (RVV). However, in 2021, just 51% of children globally received PCV and only 49% were given RVV[2]. It doesn’t have to be this way.

As global leaders meet in New York this week as part of the United Nations General Assembly (UNGA) High-Level Week, with the stated aim of putting “the 17 Sustainable Development Goals (SDGs) back on track”, it’s clear that more urgent action and investment are needed to scale-up access to life-saving vaccines.By addressing this issue now, we will be able to accelerate progress towards the Sustainable Development Goal of reducing under 5 mortality rates in every country to 25 or fewer deaths per 1,000 live births by 2030.

By the numbers: vaccines save lives

54 –countries with high under 5 mortality rates that are currently set to miss the child survival SDG 3.2 target by 2030, including Somalia and South Sudan
112 – children out of every 1,000 born in Somalia who die before reaching their fifth birthdays. In South Sudan, the figure is 99 for every 1,000 children born[3].
111,000 – the number of children lost every year in Somalia (80,000) and South Sudan (31,000), mostly to preventable diseases [3].
PCV and RVV vaccines have the potential to avert more than a million cases of pneumonia, meningitis, and diarrhoea among children between 2024 and 2030 in Somalia and South Sudan[4].

Their use could help reduce suffering among children and the weakening oftheir immune systems due to repeated episodes of pneumonia and diarrhoea. They can also lower the risk of malnutrition and poor growth and development outcomes. Averting cases of pneumonia and diarrhoea will also reduce the financial burden on families and local healthcare systems.

Furthermore, according to the International Vaccine Access Centre’s Lives Saved Tool analysis, introducing and scaling up PCV and RVV vaccines could potentially save the lives of almost 19,500 children in Somalia and 7,000 children in South Sudan by 2030[4].

Unfortunately, both Somalia and South Sudan are yet to introduce the PCV and RVV innational immunization programmes.

Children in these countries should not have to wait for almost two decades to have access to lifesaving vaccines against pneumonia and diarrhoea. The global health community must step up to deliver this now.

Community health worker Kim carriess a cold box storing vaccines to a remote community in Akobo West, South Sudan. Save the Children Esther Mbabazi / Save the Children

Our work so far

Save the Children’s Pneumonia Centenary Commitment (2017-2022) focused on pneumonia control measures in Somalia and South Sudan to improve diagnosis, treatment and access to care. As part of this effort, Save the Children has worked with partners for changes to global vaccine introduction policies in fragile and conflict-affected countries,and successfully advocated for a waiver of Gavi’s co-financing requirement for the introduction of PCV vaccines in Somalia and South Sudan.

Save the Children also supported advocacy efforts to include pneumonia into the larger child survival agenda during the first and second Global Forum on Childhood Pneumonia in 2020 and 2023, and convened the Global Steering Committee on Pneumonia and Pneumococcal Conjugate Vaccine sub-group to voice the rights of millions of children to have access to lifesaving vaccines in countries facing conflict and fragility.

Nationally in South Sudan, Save the Children worked with the health ministry to develop South Sudan’s first Child Health Strategy, updated Integrated Management of Newborn and Childhood Illness (IMNCI) and nutrition guidelines to include pneumonia, and supported IMNCI roll out and training.

In Somalia, Save the Children supports primary healthcare projects in 14 out of 18 regions with projects to reach zero dose children, providing technical support for the national Expanded Programme on Immunization (EPI) and the integration of Covid-19 vaccinations in routine immunization programmes.

In Somalia, in collaboration with the health ministry and London School of Hygiene and Tropical Medicine UK, Save the Children is also implementing the Evaluating Strategies for Pneumococcal Immunization Campaigns in Crises (ESPICC) study to identify optimal vaccination strategies for children affected by humanitarian crises and use learning from the Pneumococcal Conjugate Vaccine campaign to support the introduction in 2024.

Supporting the introduction of vaccines in Somalia and South Sudan

Over the last few years, the governments of Somalia and South Sudan have shown decisive leadership and commitment for the introduction of the Pneumococcal Conjugate Vaccine and the Rotavirus vaccine.

Through the Pneumonia Centenary Commitment effort and beyond, Save the Children is working closely with the health ministries in Somalia and South Sudan and partners to ensure that introduction and scale up of the vaccines is achieved in 2024.

Save the Children along with the Mérieux Foundation, Every Breath Counts, Malaria Consortium, and the International Vaccine Access Center, broughtthe health ministries of Somalia, South Sudan, Chad, and Guinea together for an “Introducing PCV and Rotavirus vaccine” workshop from 13-15th September in N’Djamena, Chad, to brainstorm strategies to address financing, procurement, vaccine delivery, and health workforce capacity challenges for PCV and RVV introduction.

This is what translating commitments for delivering on child survivalinto action looks like.

Health worker Ahmed vaccinates a child - MHC, Burao Somalia. Mustafa Saeed/Save the Children. Mustafa Saeed / Save the Children

A global call

While progress is being made by Save the Children and our partners, it is essential that global leaders at the UNGA ensure every dialogue, every declaration keeps child survival at its core. All representatives should strive to translate high-level policies into tangible actionsfor children at national and sub-national levels.

Children in countries such as Somalia and South Sudan need the global health community to come together and gear-up the implementation of Universal Health Coverage to achieve the child survival Sustainable Development Goal. Access to lifesaving vaccines for every child, everywhere is a key part of this – and what’s more, it’s fully achievable.

References

Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals, Lancet Child Adolescent Health 2022.

2022 WHO/UNICEF Estimates of National Immunization Coverage

UN Inter-agency Group for Child Mortality Estimation 2022.

International Vaccine Access Centre, Johns Hopkins Bloomberg School of Public Health estimates of lives saved & cases averted from introducing PCV & RV in Chad, Guinea, Somalia and South Sudan using the LiST toolunder Global Advocacy for PCV (GAP) Project, June 2023.