We all have a stake in global health security

At a time of increasing nationalism and a rejection of globalism, infectious disease is a reminder that we are interconnected and all have a stake in global health security. When Pakistan has an outbreak of extensively drug-resistant typhoid, cases are seen popping up in Canada, Denmark, the UK and the US.

Those living in the northern hemisphere track the seasonal influenza epidemics in the southern hemisphere, not for academic interest, but because the viruses circulating there are the most likely to reach the northern hemisphere during the next flu season.

These risks have been recognized and systems have been set up to track these diseases to reduce the risks of spread. But as the world becomes ever more interconnected, if we want to stop these threats from increasing in the long-term, then we need to prevent them in the first place.

Globalization multiplies risks

An outbreak anywhere is a risk everywhere. So, by increasing our focus on the world’s most marginalized and vulnerable people, those who are still missing out on essential preventative health interventions, we can more effectively reduce the risks posed to everyone. This, however, poses a challenge. In a world of raging inequalities, every country has those “left behind”. They may be stigmatized, living in geographically difficult to reach places, migrants or living below the radar, undocumented in urban slums. This is why one of the tenets of the Sustainable Development Goals (SDGs) is to “leave no one behind”. But how do we identify who they are so we can reach them?

Prevention - the best medicine

Childhood vaccination offers one of the simplest and most cost-effective solutions. Of all health interventions vaccination already has the highest coverage. Today around 90% of children in the world receive a first dose of a diphtheria-tetanus-pertussis containing vaccine – a vaccine that is provided through the routine health system. But for the 10% that are still missing out, zero doses of vaccines also usually means zero of many other things.

Often these zero-dose children, of which there are 10.4 million living in the world’s poorest countries alone, and their families live in communities with limited access to any health interventions. By bringing these families into the routine health care system, immunization can act as a gateway to other essential health services.

A route to wider healthcare

That’s because vaccines don’t deliver themselves. With vaccines come supply chains, infrastructure and transport, all of which are essential for other health interventions. They also bring trained health workers, community outreach, data services and disease surveillance, which can help improve the detection of, and response to, disease outbreaks. So, by improving the reach of immunization we effectively help shine a light on these communities, the deprivations they suffer and create a gateway to stronger primary healthcare that can help these communities, while also helping to mitigate against threats to global health security.

Reaching the last 10%

Reaching this last 10% will be challenging because usually they are not only the last to be reached, but also the hardest to reach. Often these children’s families live in clusters of inequality, with two-thirds living below the poverty line with little or no access to education, healthcare and security.

Many are in remote rural villages, but also increasingly in urban slums with limited water or sanitation, or are displaced because of conflict, poverty or the impact of climate change. These are the places where people are often most exposed to the risk of disease outbreaks, yet the ability to detect or respond to them can be almost non-existent.

This is a double tragedy, since these families are more prone to disease and more likely to suffer complications if they get sick. If they are not receiving basic vaccinations, then they are also unlikely to have access to the basic medical treatment they would need if they do become sick.

Localized healthcare failings writ large

As a result, the potential for uncontrolled spread of disease in these clusters increases. In a world where disease knows no boundaries and where global trends like urbanization, human migration and climate change have the potential to increase such threats to local and global health security, this is not a problem any of us can ignore.

Helping the zero-dose child

By working together cohesively through organizations like Gavi, the Vaccine Alliance, global health stakeholders have already helped vaccinate more than 760 million children, protecting them against killers like pneumonia, diarrhoea and measles. Since the Alliance was founded at Davos in 2000, it has helped prevent more than 13 million deaths, reducing vaccine preventable disease deaths by 71% and protecting an entire generation of children. But if we are to be true to the SDGs, then our goal should be to reach everyone by 2030.

That means working with the governments to help them increase their focus on strengthening primary healthcare for low coverage communities and prioritizing interventions and investments that most benefit zero-dose children, to ensure they get a complete course of all the vaccines they need. That means all global health stakeholders must work towards this goal, recognizing that the last mile should be our priority.