How health for all is possible

Not that long ago, the idea of Universal Health Coverage (UHC) - where all countries provide affordable, quality healthcare to every person, everywhere - was just a pipe dream. That we now have a UHC Day (today, in fact) is perhaps some indication of the current vision and progress towards making this Sustainable Development Goal target a reality. But if we are to succeed by 2030, then it's not what we've accomplished so far that we most need to focus on, but rather those who are still missing out.

In particular, the 10.4 million children who are still not receiving any routine vaccinations at all. These zero-dose children should be one of the main foci of the leaders of all 193 countries that signed up to UHC. Because if governments are to keep their promise of #HealthForAll, then the most effective and affordable means of achieving this is by finding ways to ensure these children get prevention strategies through the vaccines they need.

Because if children are not receiving the most widely available health intervention in the world, then it means that they, their families and communities are most likely to be missing out on everything else. When a child goes completely unimmunized they are also unlikely to have received any other essential health intervention, such as nutritional supplements, deworming or malaria prevention. It means their mother probably didn't have a trained midwife or receive maternal and neonatal care, and that their sister doesn't have access to sexual and reproductive health and education. 

The converse of this of course, is that if we can find a way to deliver vaccines to the hardest to reach, other health services will follow. Vaccines don't deliver themselves; with them comes infrastructure, such as supply chains and cold storage facilities, which are vital for a range of other medical supplies. They also bring trained health care workers, transport, community outreach, data services, disease surveillance and much more. So when communities get access to vaccination, it puts these people on the map and it is often not long before they also get access to a host of other critical services. 

For governments with weak health systems and limited resources, for whom UHC may seem daunting, this is hugely important because it provides a clear path towards that goal. By targeting efforts to reach zero-dose children with vaccines, UHC becomes not just possible; but provides countries with an inclusive pathway towards it. 

Rather than attempting to provide all health services to everyone, focusing resources and efforts on those solutions that are most cost effective and most beneficial to the poorest and most vulnerable communities means that even the most cash-strapped government can start to build on this to make other health services available too. Childhood immunization is just such a base. It is already the most widely available health intervention in the world, but through this approach, known as progressive universalism, it effectively becomes a gateway to other vital health services that strengthen primary health care and bring us closer to UHC.

But we still need to help countries figure out how to reach these zero-dose children. We may have made huge progress in recent decades, with 86 per cent of the world's children now receiving their basic vaccinations, and 90 per cent getting at least one, but universal means 100 per cent. Clusters of inequity persist where communities are still not getting access to primary health care. This makes them particularly vulnerable to infectious disease and more likely to suffer complications, because of their lack of access to medical treatment. It also means that the uncontrolled spread of disease is more likely within these clusters.

Such clusters can exist for a range of social, cultural and programmatic reasons, and by their very nature are challenging to reach. Nevertheless, Gavi is doubling down on its efforts to work with governments to help them overcome such challenges, highlighting the role these children and their communities have to play in achieving UHC and encouraging countries to make zero-dose children their primary focus. By prioritizing interventions and investments that strengthen primary health care, particularly in areas where these clusters exist, governments can keep their promise and reach more and more of them, until access to health interventions is indeed truly universal and no one is left behind.