Immunization and the Convention on the Rights of the Child What would it take to achieve universal coverage?

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Immunization and the Convention on the Rights
of the ChildWhat would it take to achieve
universal coverage?

• Daniel Tarantola M.D.
• Professor of Health and Human Rights
• School of Public health and Community Medicine
• University of New South Wales

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Child Health

• CRC Article 24 Focus on primary health care
•  States Parties shall pursue full implementation
  of this right and, in particular, shall take
  appropriate measures
• (c) To combat disease and malnutrition, through,
  inter alia, the application of readily available
  technology
• (f) To develop preventive health care 

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The right to the highest attainable standard of
health

• Art. 12 of International Covenant of Economic,
  Social and Cultural Rights
•  The steps to be takenshall include,,,
• (c) The prevention and treatment and control of
  epidemic, endemic, occupational and other
  diseases 
• General Comment 14  The control of diseases
  refers to the implementation or enhancement of
  immunization programmes

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Causes of 10.5m early childhood (lt5y) deaths
Circa 2003
World Health Report (Annex table 2, unpublished
data) 2004
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Leading causes of early childhood
vaccine-preventable deaths, Circa 2002
72 of 2.6m VPD deathscan be prevented with 5
vaccines

1. Pneumococcal 28
2. Measles 21
3. Rotavirus 16
4. Hib 15
5. Pertussis 12
6. Tetanus 8
7. Yellow Fever lt1
8. Diphtheria lt0.5
9. Poliomyelitis lt0.5
10. Meningococcallt0.5

WHO/FCH/IVB/VAM, JUN04 (lt5y, 2002 data)
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WHO, 2006
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The immunization gap
WHO, 2006
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Countries where less than 50 of infants are
vaccinated (2005)
UNICEF/WHO 2005
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Five of 10 Countries with the largest
population each have more than 1 million
infants unimmunized
UNICEF/WHO, 2005
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Norms and standards
Development of new vaccines
Regulatory processes and quality
Enhancing Immunization from research to disease
prevention
Vaccine production, supply and financing
Monitoring and disease burden assessment
Immunization safety
Vaccine delivery and accelerated programmes
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Low income countries use distinct products
compared to other countries
Diphteria
Disease
Haemoph.
Measles
Pertussis
TB
Hepat. B
Polio
Infl. B
Vaccine
Tetanus
mono combo with DTPw
in combo with DTPw
Low Income Countries
mono
BCG
OPV
wholecell
in combo
in combo
Middle Income Countries
wholecell in combo
MMR
BCG
OPV
with DTPw
with DTPw
High Income Countries
accelular in combo

IPV in combo
MMR
none
in combo
in combo
S. Jarrett, UNICEF Supply Division
Also use other vaccines Pneumo. , Mening.,
Rotavirus, Influenza, Hep. A, Varicella and others
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The global vaccine market (Circa 2003)
Developing countries
Industrialized countries
85
15
Population
Disease Burden
93
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Vaccine market
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82
T6 Billion/y
Vaccine RD
T 500 Million/y
90
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Tarantola 2003
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MP Kieny, WHO, 2006
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Introduction of Hib immunization and Coverage (3
doses), 2004
Source WHO
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Source WHO
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Accelerating disease control

• Polio
• Measles
• Maternal and neonatal Tetanus

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WHO, April 2006
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UNICEF/WHO, 2005
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Neonatal Tetanus Elimination 2004
WHO/UNICEF, 2005
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State Obligations

• Highest attainable standard of health
•  Every State Party undertakes to take steps,
  individually and through technical assistance and
  cooperationto the maximum of its available
  resources, with a view to achieving progressively
  the full realization of the rights 
• Art. 2 ICESCR

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Child rights and other human rights instruments

• Governmental obligations
• To respect human rights
• To protect human rights
• To fulfill human rights
• The value of human rights
• Enshrined in national laws
• Human rights principles help shape and monitor
  policies and programmes
• International assistance and cooperation

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Moving towards universal coverage?

• Political commitment
• Health system strengthening
• Research and development
• Financing