As world governments get ready to endorse a ten-year, $10 billion action plan for global vaccination, backed by the Bill & Melinda Gates Foundation, the international aid agency Medecins Sans Frontieres (Doctors Without Borders) has expressed concern that millions of children are still not even receiving the most basic shots, for diseases such as measles and polio.

A ‘Global Vaccines Action Plan’ has been designed to implement the ‘Decade of Vaccines’ project and will be considered by health ministers  next week in Geneva at the World Health Assembly. However, while MSF says it welcomes the initiative, it believes "some key challenges are being glossed over".

Estrella Lasry,  a doctor working as tropical medicine advisor for MSF, says the new plan "works on the assumption that basic vaccination programmes are going well, and that's just not the reality in many places where we work”. She adds that "focusing on the newest vaccines without boosting existing systems is not a strategy that will benefit the most children: we can’t just keep piling on new vaccines and fail to get the basics right".

The agency notes that most vaccines are administered as injections requiring trained health workers, which can be difficult in countries with limited health staff. To be fully vaccinated, infants and their caregivers need to come to vaccination points five separate times in their first year of life, which can be complicated for those who live far away or can’t afford transport.

Refrigeration problem

Also, most vaccines must be kept at cold temperatures, which is logistically challenging in countries with limited refrigeration and unstable electricity supply. MSF notes that in 2010, there were measles outbreaks in 28 African countries and in the Democratic Republic of Congo alone, 100,000 cases were reported from January through October 2011. During that period, MSF vaccinated four million children against measles just in DRC.

The agency claims that 20% of all the babies born in the world each year are not getting the basic vaccines and it cites India’s Bihar state, where 60% of babies are not fully vaccinated. Kate Elder, vaccines policy advisor at MSF’s Access Campaign, said that "countries are about to endorse a plan that does not go nearly far enough”, adding that governments "need to pay more attention to boosting routine immunisation and insisting that products are adapted to make them easier to use".