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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

Breasts, belly, bottom, hair: is that all you think women are?

These are the four images on an enormous bronze relief chunk of public art in central Bristol.

22:22:48 Off Up

"The more voices the better!" A wonderful young feminist writes

I am a young women who has always been a feminist but only recently has really started educating myself more in the history of the movement and as such am trying to read lots to better my understanding of the many issues involved.

I am trying hard to stay positive but it is depressing to find that after so many years, it really feels like in much of the world - steps backwards are being taken at the moment! 

For my age group (I am 24) the most shocking thing for me is how many of my peers don't even recognise sexism around them. They don't identify with feminism because they no longer believe it is relevant. A whole generation (and generations to come) are being brainwashed into accepting 'low-level' sexism (adverts, 'jokes') which is quietly feeding into a culture where a woman is usually blamed for the bad things that happen to her - right up to rape! The amount of women who believe some of the fault of rape lies with the victim is astonishing. How is this the case in the 21st century. 

I could go on and on but there's obviously no need to preach this you. But, well, I just want to share with you that I see there is no difficulty in getting women my age to stand up and shout and fight against the injustices they see - the terrifying issue is really that many don't see what is happening to them in the home, in work, through the media, by our government as even is affecting them let alone oppressing them. I see that as the big issue in keeping the fight for women's rights alive and kicking (and taking steps FORWARD) in my generation.

I replied:

OK, first off, the book [I recommended at an event] is by Lydia Cacho and it's called Slavery Inc. It's not quite autobiographical, more of an investigative study - but she's an absolutely amazing woman. The publishers' blurb is here: http://portobellobooks.com/slavery-inc If you ever get the chance to see her talk, she is fab - hilarious, cool, inspiring. If you read Spanish (or other languages) her previous book was called Demons of Eden, about child trafficking and child abuse amongst the Latin American elite (politicians, cultural leaders, business leaders). Again, unmissable but saddening. 

The very fact that you're writing to me and articulating everything so brilliantly gives me total hope - many, many women of all ages feel as we do and we're in the middle of a great groundswell of activism, thinking, talking about gender (and confronting the really hard stuff: rape, other kinds of violence. We just notice the ones who don't because we want to hit them over the head with a frying pan to get them to see sense! The world has only ever been changed by a small minority of people who feel strongly about things - we must make the change for everyone and our daughters and sons will thank us! But yes, of course I too feel despairing when I see complacency - because the adverts, the jokes, the casual sexism of course all create a culture where we view rape and other violence as par for the course, even natural and inevitable, and consequently we blame victims and are lenient to perpetrators.... 

Sigh.... 

...But seeing so many amazing women of all ages in the audience actually lifted my heart, Come again! And, reading-wise, I'm sure you know all this stuff but....

• The Whole Woman, Germaine Greer
• Delusions of Gender, Cordelia Fine (amazing)
• Female Chauvinist Pigs, Ariel Levy
• The Equality Illusion by Kat Banyard
• Anything by Catherine MacKinnon
• Anything by Aisha Gill
• Manifesta by Jennifer Baumgardner and Amy Richards 

I wondered if you might let me excerpt a bit of your email anonymous for my blog? It articulates your ideas so well and will I'm sure strike a chord with many readers.

She answered:

Of course you can use anything from my email. I absolutely will be getting involved in more talks, lectures etc. 

A few years ago I read From Madness to Mutiny, about the American family law system - my mother went through absolute hell through that system. She quickly learnt that the worst thing you can do is tell the truth about an abusive relationship. Divorce and try for custody on any other grounds but mention abuse and you anger the (male) judges - my mother had to go on the run. So here we now are in Britain (all legal and safe now I should add) all settled now, but my early years spent in women's refuges and living (pretty much hiding) out in countryside communes. My mother - a city girl through and through learnt to work the land; pick fruit, chop wood and get by... She is amazing! 

I read Who Cooked the Last Supper, fairly recently and that has sort of spurred me on to get cracking on further reading and really get involved. 

With the legal aid situation and how that's going - women and children are at even greater risk in many situations. It's such an important topic - but not a 'sexy' one for the media to cover! 

Police - well when you've got Scotland Yard Chief Sir Bernard Hogan-Lowe saying that members of the Sapphire unit pressurising rape victims to drop statements in 2008 and 2009 is a 'relatively historic' issue! Oh my - my jaw dropped to the floor watching that interview on channel 4 a few days ago. If someone had done a robbery, or hit and run etc but the crime had been buried - but then brought to light a few years later - the police wouldn't say - oh well that's just history now. You'd find the person who ran someone over leaving them disabled for the rest of their life! You would find them and charge them! These women are scarred for the rest of their life and a CRIME took place. Man it boils my blood. It is completely irresponsible and SICK that a chief of police in 2013 went on television to completely disregard rape victims because it took place a few years ago. I couldn't believe what I was seeing. 

When asked about the officers in charge who got promoted after and what action should be taken against them - basically nothing; 'It's an unfortunate symbol' - any other crime, if police officers pressured a victim/witness to back down from a statement this would be taken seriously. 

Sorry I'm sure you are well aware of this happening the other night but I just could not believe it. If that's the attitude at the top.... 

Also, the fact they aren't even bright enough to cover up their misogyny - oh god - or is it worse that they don't even know they're doing it. How can they possibly help women when don't even understand that anything has really happened to them. 

Right - rant over! 

I'm off to buy books and read and get motivated! 

Use anything I've said - the more voices heard the better!

Six Pillars to Persia: the best Middle Eastern music, discussion, reviews and profiles on the radio

Broadcasting from Art Dubai from March 19th-24th, Six Pillars to Persia will be sent to London (and then the world, through its podcasts) via the ever-brilliant Resonance FM. Created by  Eavesdropper/Falgoosh Radio, Six Pillars offers Middle Eastern music, discussion, reviews and profiles downloadable onto a phone, iPad or iPod. Contribute to Six Pillars on the website or on air, via a new submissions section on their new website or write to them at sixpillarstopersia@resonancefm.com

New podcasts for download:

• Satellite Jamming in Iran
• Nassim Soleimanpour
• Record Reframe Resist
• Charles Esche - Triangle Conference London
• New Music from Iran
• Iraqi Arts
• Nadim Karam
• Artist Ahmet Ögüt
• P21 Gallery

And...

• Check out the Six Pillars to Persia Facebook page

(c) Radio Falgoosh

"My last attack before I got away from my abuser lasted 4 days."

From Mandy Thomas, writing for Women's Aid the day before Mother's Day:

"I have used many Women's Aid services over the years, seeking a place of safety with my children. Sadly, the last service that I used is now closed due to a lack of funding. This is why we need to support Women's Aid now, to help them campaign to protect their member services all over the country.

When it comes to using domestic violence services, I have been there, done that, got the T-shirt. I have been through the system and spoken to people who don't work in specialist domestic violence services and simply don't understand the issue or have any compassion for victims. That is why it is particularly alarming that itis the specialist services that are being hit the hardest by the economic crisis and cuts to public spending. 

The result of our experience of domestic violence, and the traumatic ongoing effects on our family, have meant that I have faced a mother's worst nightmare and buried one of my children, my eldest son Daniel, This should not have happened. He took nightmares to his grave of the things he witnessed. He could not visualise or believe in a change, be it help, or a way out. We need to make a united stand to make the changes happen to save lives.  

Victims need proper support to rebuild their lives. 

My last attack before I got away from my abuser lasted 4 days. I was tortured - beaten black and blue to the point where my children could not recognise me. Cut with knives and broken glass, punched, kicked and bitten, then dragged through the house naked by my hair, burnt with a blowtorch and raped. 

We need to make a change right now so that future generations will not be subjected to such horrific abuse. Our children look to us for protection and guidance. In a way, I was lucky. Two women every week die from domestic violence in England and Wales alone. And that's just what is reported as domestic violence. Domestic violence costs our government £178 billion every year. The cost of the aftermath is huge - hospitalisation, medical treatment, and counselling is needed to help victims deal with the impact domestic violence has on their physical and mental health. 

More specialised domestic violence services are needed, not less. These services really do save lives."

• Donate now: Women's Aid

One query from me: why is Gordon Ramsay an ambassador for Women's Aid, listed alongside Tana Ramsay, the woman he sadistically and selfishly betrayed, lied to, tricked and deceived for years, at the same time as pretending to be a family man? He has shown by his behaviour that he is not capable of treating women as human beings worth of basic respect and his presence as an ambassador to this incredibly important charity gives me pause every time I donate to it.