Immunization and the Convention on the Rights of the Child What 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

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… »

The right to the highest attainable standard of health Art. 12 of International Covenant of Economic, Social and Cultural Rights –« The steps to be taken…shall 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… »

Causes of 10.5m early childhood (<5y) deaths World Health Report (Annex table 2, unpublished data) 2004 Circa 2003

Leading causes of early childhood vaccine-preventable deaths, Circa 2002 WHO/FCH/IVB/VAM, JUN04 (<5y, 2002 data) 72% of 2.6m VPD deaths can 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 <1% 8.Diphtheria <0.5% 9.Poliomyelitis <0.5% 10.Meningococcal<0.5%

WHO, 2006

The immunization gap WHO, 2006

Countries where less than 50% of infants are vaccinated (2005) UNICEF/WHO 2005

Five of 10 Countries with the largest population: each have more than 1 million infants unimmunized UNICEF/WHO, 2005

Development of new vaccines Norms and standards Immunization safety Regulatory processes and quality Vaccine production, supply and financing Vaccine delivery and accelerated programmes Monitoring and disease burden assessment Enhancing Immunization: from research to disease prevention

Low income countries use distinct products compared to other countries Disease Vaccine Measles Diphteria Pertussis Tetanus TBHepat. B Haemoph. Infl. B Polio Low Income Countries mono wholecell BCG mono & combo with DTPw in combo with DTPw OPV Middle Income Countries MMR wholecell in combo BCG in combo with DTPw in combo with DTPw OPV High Income Countries* MMR accelular in combo none in combo IPV in combo S. Jarrett, UNICEF Supply Division * Also use other vaccines: Pneumo., Mening., Rotavirus, Influenza, Hep. A, Varicella and others

The global vaccine market (Circa 2003) Developing countriesIndustrialized countries Population Disease Burden Vaccine market 18%82% 93% 85% T=$6 Billion/y 15% 7% Vaccine R&D T= $500 Million/y 90%10% Tarantola 2003

MP Kieny, WHO, 2006

Introduction of Hib immunization and Coverage (3 doses), 2004 Source: WHO

Accelerating disease control Polio Measles Maternal and neonatal Tetanus

WHO, April 2006

UNICEF/WHO, 2005

Neonatal Tetanus Elimination 2004 WHO/UNICEF, 2005

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

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

Moving towards universal coverage? Political commitment Health system strengthening Research and development Financing