Vaccines and immunisation: don’t leave a fifth of the world’s children behind

“The hospitals are filled with children with vaccine preventable diseases.”

Johanna Sekennes, Médecins Sans Frontières, Head of Mission, Mali

The rain’s falling thickly onto the roads in rural eastern Mali, preventing cars from passing and making travel by foot virtually impossible. Yet – as a beautifully shot yet hard-hitting new short film, A Preventable Fate, by Venetia Dearden, makes clear – the rainy season does not mean a halt to all industry.  Instead, it coincides with the farming season. Hard-working women, many with children on their backs, labour in the fields to ensure a good crop and a good livelihood. Their responsibilities to the land, to their families and to the sustainability of their agricultural practices, combined with environmental and other external factors, are just some of the complex obstacles standing in the way of them accessing adequate healthcare for themselves and their children. In the first year of their lives, children must receive vaccines five separate times – a tough ask for women given the distance that sometimes needs to be covered, the cost or difficulty of the journey and the other labour-demands a woman is subject to for survival.

The images of rural life in Dearden’s film have a liveliness, community spirit and wholesomeness which belie the tougher realities of under-resourcing in the area and generally in rural and economically disadvantaged regions across the developing world. A Preventable Fate is part of a series of six films around the theme of Fatal Neglect, produced by Doctors Without Borders to highlight the obstacles faced by millions of people worldwide in accessing quality healthcare. The series also includes a study of treatment-resistant TB and three neglected tropical diseases.

In looking at the issue of vaccinations and immunisation in Mali we see that the women working so hard in the fields do not have a day to spare to take their children to be vaccinated – a journey which is difficult even by car, let alone on foot. If a woman happens to live in a village where there is no local vaccine campaign, she may have to go even further away. A Preventable Fate features a woman explaining to a doctor at a vaccine project that she has two children and came to visit the project by bike, “and I got a flat tire. So I had to walk. It’s very difficult.” It is too much to demand of a mother or other caregiver that they take each child to a vaccine campaign outpost at least five times within that child’s first year, when shortages of vaccines may mean that repeat visits are necessary, and that trips are made without knowing whether the vaccines will be available. For those children who receive perhaps two or three of their five shots in the first year, few workable systems are in place to record, trace and make up for the vaccines they have missed when they are a little older.

Photograph (c) Medecins Sans Frontieres

 In addition to the challenges of time, distance and work neglected are problems with establishing vaccination campaigns themselves, in terms of personnel alongside the stocking, transportation, safety and sustainability of medicines. More health professionals who can administer the vaccines are needed; the ideal thing would be to have locally-trained, locally active nurses not just providing vaccines by operating as a reliable and stable way of raising awareness amongst communities. The vaccines must also be transported correctly; a challenge when considering that many require something called a ‘cold chain’, that is refrigeration at a specific temperature otherwise they become invalid. This requires the useage and maintenance of refrigerators and icepacks to store and transport vaccines.

Thus the seemingly simple question of providing vaccines becomes complicated in areas where electricity provision and consequently refrigeration is sporadic, healthcare professionals are scarce, distances between services and users are long, natural temperatures are high and road quality is variable. What is required is the development of vaccines which are easier to deliver and easier to administer to children.

In May 2012 the 65^th World Health Assembly designed a Global Vaccines Action Plan to kickstart a well-funded Decade of Vaccines project working towards global vaccination. However, as the Fatal Neglect project makes clear, all major health initiatives must be sensitive to the particular challenges and particular contexts in which healthcare initiatives are established and provided – with a particular focus on those who are being left out due to issues to pricing, the adaptation of medicines and logistical barriers. MSF’s report The Right Shot: Extending the Reach of Affordable and Adapted Vaccines explains some of these issues in detail. They suggest that instead of developing countless (and expensive) new vaccines such as those against pneumococcal disease and rotavirus, the basics of existing routine vaccine systems should be perfected and adapted to theenvironments in which they will be used so that they can benefit the most children, especially in remote, rural, civically fragile/unstable or economically disadvantaged areas. In India’s state of Bihar, for example, 60% of babies are not fully vaccinated. The MSF points out that failure to perfect the access, ease, stability and application of the most basic vaccine programmes have resulted in recent outbreaks of preventable diseases, like the 2010 measles outbreak in 28 African countries. In the Democratic Republic of Congo (DRC) alone, 100,000 cases were reported between January 2011 and October 2011. Although there are many factors affecting the pricing of vaccines, a cynical reading could conclude that the basic, inexpensive vaccines programmes are not being perfected because there is little financial incentive for pharmaceutical companies to tailor their vaccines to help those populations who have little purchasing clout as consumers themselves.

The message on vaccines and immunisations is clear, but tough to swallow. At the moment, 20% of all babies born in the world – that is 22 million children born last year alone - are not receiving protection against basic yet potentially fatal diseases such as measles, meningitis, diphtheria and yellow fever.  Underpinning the moral argument that all children born worldwide deserve the basic human right to life, health, protection and the best start in life, since medicine should not be a luxury is the transformative future effect we can envisage on already-pressurised global healthcare initiatives. Universal vaccination would drastically reduce pressure on hospitals, child mortality rates and sickness rates.  Vaccines must be researched,developed, produced and delivered in such a way that they are easier to use, easier to administer, more temperature-stable, easier to transport, adapted to developing countries’ environmental factors and also the medical factors – that is, the specific strains of the diseases found in the countries in which they will be used. Single dose vaccines which do not required difficult multiple visits; vaccines which are administered orally rather than by injected; well-trained, numerous and either highly mobile or strongly rooted and dedicated local healthcare professionals; vaccines which are affordable to all countries in the long run and not just those which rely on finite donor support through the Global Alliance for Vaccines and Immunisation (GAVI)  to pay for them; and vaccines which do not degrade in variable temperatures would be just some of the ways forward, or more that 22 million children will pay the price.

Photo (c) Medecins San Frontieres

"Nothing for us, without us." Women rise in Afghanistan, Malawi, Nepal, Zambia, Zimbabwe and Ghana.

In February Womankind Worldwide welcomed their partner women’s rights activists from Africa and Asia to London to share their experiences and expertise of women’s leadership and political participation. Further images from the day, all taken by Abi Moore, can be viewed at the bottom of this article.

At the Emmeline Pankhurst statue with Seema Malhotra MP

From countries as diverse as Afghanistan, Ghana, Nepal and Zimbabwe, participants faced a similar challenge – how to overcome the exclusion of women from political and public life.  Despite their different contexts, cultures and political systems, the women highlighted some common problems and common solutions.

Women’s voices must be heard from every corner and at every level. Women are not a homogenous group, and their participation in politics must reflect their diversity.  Durga Sob, founder of the Feminist Dalit Organisation of Nepal said, 

“Dalit women are doubly discriminated against in political parties – Dalit forums are run by Dalit men, and women’s wings of parties are run by ‘high-caste’ women."  

Young women, disabled women, women from ethnic and religious minorities often face multiple barriers to accessing decision-making spaces, and they must be supported.

The women were united in their commitment to focusing on local as well as national politics. Local level is where many of the decisions affecting women’s daily lives are made, and as Wangechi Wachira from Kenya’s Centre for Rights and Awareness said, 

“to be a leader, it starts at family level, and then changes happen at community level.”

 Civil society, and in particular women’s right organisations, provide fertile training ground for women’s leadership, and enable women’s voices to be heard.  Maryam Rahmani, of Afghan Women’s Resource Centre, said,  

“we need to find space for women to speak about the issues that affect them, even when it’s difficult." 

In Afghanistan, where 87% of women have experienced some form of violence, and women activists and politicians are routinely threatened, attacked and killed, this work is vital and dangerous.

Women’s rights organisations help to build women’s confidence and skills, create opportunities and access to political spheres. When women do get into positions of influence and power they are supported to negotiate corridors of power, build networks, and advance women's rights.

The activists were unanimous in the need for affirmative action to level the playing field between women and men.  Whether through political parties, reserved seats or quota systems, the only countries that have made significant progress are those that have taken specific measures.  And compared to those countries, the UK does not perform well.  In Afghanistan 28% of MPs are women, in Rwanda it’s 56% and Mozambique 43%, compared to the UK’s paltry 22%. 

The voices of women from all walks of life need to be heard in all places of power. From community forums to the halls of national parliaments, and on the international stage, as Fanny Chirisa from Zimbabwe’s Women in Politics Support Unit said, 

“Nothing for us, without us."

*****

The organisations attending were as follows:

• Afghanistan: Afghan Women Resource Centre (AWRC)

The Afghan Women Resource Centre provides practical education to girls and women who were forbidden to learn under the Taliban.Their programmes allow women to learn in a safe environment, with a focus on vocational subjects including journalism, business skills and tailoring, in order for women to be able to earn an income and live independently. They also teach literacy, civil & political rights, and women & family law.

Attending: Maryam Rahmani, Country Representative. Maryam got involved with AWRC by doing short management courses when she was at school in Peshawar, Pakistan. In late 2002 her family came back to Afghanistan, where AWRC had opened a sub-office, where she began working. In the meantime Maryam passed her exams and joined Kabul University, eventually graduating with an economics degree in 2007. The
university faculty board wanted to recruit Maryam as assistant to a professor but only on the condition that she left AWRC. Maryam refused as she wanted to continue helping women.

- Case study 1: Campaign: Don't Silence Afghan Women

- Case study 2:  Take Action to Help Afghan Women

• Malawi: National Women’s Lobby Group (NAWOLG)

Potential female political candidates in Malawi often struggle with lack of funds, social pressures to stay at home and patriarchal political organisations. NAWOLG’s goal is to get more women to become involved in the democratic process as voters and representatives. It has a team of professionals specialising in gender, human rights and civic education issues, who help provide training and support to women inside and outside of politics.

Partners attending: Faustace Chirwa, Founder/Executive Director. A gender and women’s rights activist for 17 years, Faustace continues to promote women’s participation in the socio-economic development of Malawi and in political decision making.

And Atupele Chirwa, Acting Executive Director. Atupele started off volunteering with NAWOLG in 2003 and is now acting Executive Director. She focuses on sexual reproductive health and rights issues of young people in Malawi.

• Nepal: Feminist Dalit Organization (FEDO)

The Feminist Dalit Organization was founded in 1994 by a group of Dalit (low caste) women aiming to fight for their rights and overturn caste and gender discrimination which causes women and especially Dalit women to be treated as second class citizens facing very high levels of sexual and domestic violence. FEDO educates women on their rights, offers counselling and organises mass protests and community events to raise awareness.

Partner attending: Durga Sob - FEDO. Durga Sob is a Dalit woman who founded the Feminist Dalit Organisation in 1994 to combat caste and gender-based discrimination in Nepal. Durga is renowned as a passionate feminist and activist in defending the rights of Dalit women in Nepal. She says,

“There used to be no Dalit women in positions of power. Now 25 Dalit women have been
elected as members of the Constituent Assembly and this is one my happiest achievements”.

- Case study: Pabitra's Story

- Example of the kind of context they’re working in:  Women Human Rights Defenders Beaten and Detained

• Zambia: National Women’s Lobby (ZNWL)

ZNWL aims to promote the representation and participation of women at all levels of decision-making through lobbying, advocacy and capacity-building. It provides education, runs community forums, provides leadership courses in schools to boys and girls through their innovative ‘Girl’s Leadership Clubs’, monitors elections and provides support to women involved in politics, for example through Women’s Radio Clubs, supporting isolated rural women to gather to listen to news about politics and current affairs and discuss together so that they’re better equipped to take part in the democratic process.

Partners attending: Juliet Kaira Chibuta, Executive Director. Juliet is a development specialist and a journalist by trade. She worked for national print media organizations including the Zambia Daily Mail and National Mirror where she held various positions including editor. Ms Chibuta has also sat on various boards of media and women’s organisations.

And Beauty Katebe, National Chairperson. Beauty is a human resource expert and works in Zambia’s Ministry of Health. She has vast experience in women and youth issues, democratic processes, capacity building of women, governance and elections issues. She is the current National Women Council Chairperson of the Agriculture, Technical and Professional Union of Zambia.

- Example project More Than Education for Girls

• Zimbabwe: Women in Politics Support Unit (WiPSU)

The Women in Politics Support Unit (WIPSU) provides support to women in politics in Zimbabwe to help increase their participation and influence. It does this by providing leadership and election training for candidates; educates women MPs and councillors about their roles, connecting them with female constituents; organises community forums; and lobbies political parties to implement gender quotas.

Partner attending: Fanny Chirisa, Director. Born in Mutare, Fanny has worked with The Federation of African Women’s Clubs, The Voluntary Organizations in Community Enterprise, Red Banner, Zimbabwe Women’s Resource Center & Network and WiPSU. During the outreach process of the current Zimbabwean Constitutional Reform Process, Fanny was invited to be team leader representing civil society.
They led teams of reporters capturing the views of citizens across the country.

- Case study: Not Service But Power

• Ghana: Women in Law and Development in Africa (WiLDAF)

Since its inception in Harare, Zimbabwe, in 1990, the network has grown to encompass 31 countries, 500 organisations and more than 1,200 individual members. At the national and international levels, the WiLDAF network lobbies for laws that promote women's rights. In Ghana, WiLDAF offers free legal counselling as well as training in legal literacy.

Partners attending: Bernice Sam, Executive Director (Ghana branch). Bernice Sam is a lawyer and human rights activist. She spearheads the campaign for the participation of vulnerable groups in democratic processes including organising women’s dialogues with presidential candidates. She also led the struggle for the protection of the rights of people in non-formalised relationships. Bernice has written and co-authored books on HIV/AIDS, violence against women and the property rights of women.

And Frank Bodza, Programme Manager for Governance (Ghana). Frank has more than nine years’ experience in both local and national governance; having worked with an MP for four years prior to joining WiLDAF in 2005. He is a gender and human rights activist who had carried out numerous public education programmes on women’s rights issues. He is experienced in capacity-building, mobilization, networking and coalition-building and was part of groups that observed the December 2012 general elections in Ghana. He is married with two children.

Richard Sam, Programme Assistant for Governance (Ghana). Richard did his national service with the Ministry of Local Government and Rural Development for one and half years before joining WiLDAF in 2009. He is a volunteer from WiLDAF Ghana on the Coalition of Domestic Elections Observers (CODEO) and the Civic Forum Initiative. Both groups have observed various elections including the December 2012 general elections in Ghana.

- Case study:  Ghana Elections: Time for Women to Rise, Not Fall

- Context can be found here.

• Ghana: The Gender Studies and Human Rights Documentation Centre (GSHRDC)

The Gender Studies and Human Rights Documentation Centre works to promote and protect women’s rights, running a number of projects in rural Ghana working to end violence against women and reduce women’s vulnerability to HIV infection.

Partners attending: Dorcas Coker-Appiah, Executive Director. Dorcas Coker-Appiah is a lawyer by profession and a feminist. She is a women’s rights activist in Ghana and a member of a number of women’s rights organisations. Dorcas has a lot of international experience, having served two terms as a member of the United Nations Committee on the Elimination of Discrimination against Women.

- On work to end the practice of ‘widow inheritance’ read this piece here.

• Kenya: Center for Rights Education and Awareness (CREAW)

CREAW’s mission is to transform Kenyan society through the promotion and expansion of women’s human rights, rule of law and social justice. They provide legal aid and health services to thousands of female survivors of rape and domestic violence, produce informative radio shows and give training and support to community organisations.

Partner attending: Wangechi Wachira, Executive Director. Wangechi Wachira has more than 10 years of experience in senior management. She has experience in lobbying and advocacy, gender integration and inclusion, human rights and development issues.

- More info here on the Center for Rights Education and Awareness

Dorcas Coker Appiah 

Atupele Chirwa

Fanny Chirisa

Frank Bodza

Faustace Chirwa

Maryam Rahmani

Wangechi Wachira

A special post (c) Sarah Jackson at Womankind Worldwide with enormous gratitude and admiration