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Fall 2015


Closing the Gap

#VaccinesWork for the eighty percent of children globally who’ve been vaccinated. How can we close the gap and immunize the rest?

Ambassador Edition



illions around the world are alive and thriving today because of the diseases they didn’t get as children. Polio, once a feared, crippling disease, is now under control. And a worldwide immunization campaign last century finally eradicated the disease smallpox in 1980. At that time, only one in five children worldwide was immunized against other preventable diseases. Vaccines, while inexpensive and extremely effective, just weren’t widespread in developing countries. In the 1980s, UNICEF was part of a major effort to vaccinate children. By the end of that decade, nearly four in five children worldwide were immunized. Over the next 25 years, this improvement contributed to a halving of the number of children under five who die each year. Still, over 6 million children died in

Contents Fall 2015

N ew s i n B r i e f

Immunization: The (Nearly) Universal Life Preserver


Turning Point in History: The 1980s



The Immunization Gap


Observer’s Notebook: What I Saw 5 FIN DI N G S O L U T I O N S

Closing the Gap


Meanwhile at Home


Disease Dossier


Profile: Annajulia Santa Elena



Here are some of the diseases that vaccines protect us against:

Severely weakens the immune system, causing disabilities and death

1,237,000 Lives saved by vaccination (annual)

Triggers coughing spells that cause labored breathing and Pertussis life-threatening complications

UNICEF works in more than 190 countries to help kids survive and grow. UNICEF supplies medicines and vaccinations, clean water, nutrition, shelter, and education. UNICEF also responds when emergencies occur, such as earthquakes, floods, and war.

(whooping cough)

1,042,000 Lives saved by vaccination (annual)


Causes severe muscle spasms; while adults recover, most infants die a painful death


Lives saved by vaccination (annual)

UNICEF ACT is a publication of TeachUNICEF, the Education Department of U.S. Fund for UNICEF. Visit for additional resources.


Damages nerve cells, causing paralysis of limbs and sometimes breathing muscles

© U.S. Fund for UNICEF, COVER PHOTO: © UNICEF/ NYHQ2015-1540/Mugabe


Lives saved by vaccination (annual)


UNICEF ACT n Fall 2015

A health worker vaccinates a toddler against measles in Indonesia.

2013 from preventable causes. Many of those children were among the one in five still not immunized. We have the power to save even more by vaccinating that fifth child. There’s a Global Vaccine Action Plan that calls for getting halfway there by 2020. And the new Sustainable Development Goals call for an end to epidemics of major diseases by 2030. We already did it for smallpox and largely for polio. We can do it for the rest, everywhere, with a simple tool: immunization. n

TERMS TO KNOW Developing countries: Countries still working to develop good health, clean water, electricity, and industry Eradicate: Destroy completely Immunization: Treatment to protect from a disease Smallpox: A disease marked by fever and a skin rash Sustainable Development Goals: Set of 17 commitments made by UN members in 2015 to end poverty and improve lives measurably by 2030 Vaccine: Drug that protects against a disease or infection

© UNICEF/NYHQ2006-1800/Estey

© UNICEF/NYHQ2011-2159/Esteve


Immunization: The (Nearly) Universal Life-Preserver

Turning Point in History: The 1980s # of Deaths 3,000,000

The evidence is overwhelming: Immunizations are the most effective way of preventing deaths affordably. While widespread in industrialized countries, immunizations did not keep pace in the developing world for most of the last century. As recently as 1980, measles was still causing 2.6 million deaths each year. But in the 1980s, developing countries vastly prioritized immunization. The payoff? Reductions in illness, disability, and death from numerous diseases, and an immensely increased quality of life.

Before 1980: A Silent Emergency The average level of immunization in most developing countries was still between 10 percent and 20 percent. Despite great advances in health care, 15 million children were dying each year before their fifth birthday.

■ 1980 ■ 1990 ■ 2002 ■ 2013

2,500,000 2,000,000 1,500,000 1,000,000

1,500K *Figure for 1980-1981


430K 145,700





Neonatal Tetanus

1989 © UNICEF/BANA2006-00173/Noorani


The 1980s: UNICEF and its partners began calling for immunization as part of a new effort to prevent child deaths. Developing countries began an allout drive to vaccinate every child.



© UNICEF/NYHQ2012-1642/Pietrasik

1980 © UNICEF/NYHQ1991-0293/Asabe



Total Deaths from Leading Diseases

End of the 1980s: The immunization coverage rate rose to about 76 percent. It was described as perhaps the greatest mobilization, or rallying of efforts, in peacetime history. An estimated 12 million children’s lives were saved.


Since then: Diseases such as measles and tetanus have seen huge drops, and polio is nearly eradicated. With immunization saving up to 3 million children’s lives each year, it is clear that #VaccinesWork!



Use the text and graphs to answer the following questions on the impact of vaccines:

 1 Between which two bars on which graph is shown the single greatest numeric decrease in deaths? What was the decrease?  2 Of the two diseases shown, which shows the greatest percentage decrease between 1980 and 2013? What was the decrease? UNICEF ACT n Fall 2015


IN Focus


The Immunization Gap

our-fifths. What could that stand for? Fourfifths of the school week means one day until the weekend. Eighty percent on a hard test is an admirable grade. In football, it’s a 12–3 record and leads to a spot in the playoffs. All good things. When it comes to children’s health, though, four-fifths means

one out of every five infants still missing out on basic vaccines. That’s over 22 million at risk of catching preventable diseases. Four-fifths means hope for most, and that’s good. But good is not good enough when children’s health and lives are at stake. The immunization gap is the space between those four children who receive

immunizations and the fifth, who remains unprotected. In the picture below, the health worker (syringe box in hand) may be pondering that gap on her journey to help vaccinate children in the village across this wide valley. Read below some of the main reasons why the gap exists:

 REASON #1 Exclusion of some groups: Taking measles as an example, vaccine coverage tends to be very low among groups suffering discrimination—for example, poor urban migrants and indigenous* populations. • REASON #2 Distance from health centers: In some countries, the coverage of the measles vaccine in rural areas can be 33 percent lower than in urban areas. For people in the countryside, getting to a health center might involve a half-day walk. REASON #3 Weak immunization systems: Vaccines must be preserved by a cold chain—the technology that keeps them at a steady, low temperature. Expensive equipment and long, treacherous delivery routes make cold storage a challenge.

Fazila, a female health worker, looks downhill to trace her long journey through the mountains in northeast Afghanistan.

* Indigenous refers to the original population, who are often pushed out by newcomers.

The immunization gap means vulnerability to killer diseases—that is, an increased risk. There’s a saying in football, “The best defense is a good offense.” We need to go on the offensive against preventable child deaths. We must make sure all children—especially the poorest and hardest to reach—have access to the vaccines they need. We must close the gap. n


UNICEF ACT n Fall 2015

© UNICEF/AFGA001269/Slezic

REASON #4 Mothers with low education levels: Sadly, girls are frequently denied a full education in developing countries. Without it, they may not know vaccines are available or understand the importance of them.

Observer’s Notebook: What I Saw

015/Sutter for UNICEF/2 © U.S. Fund

We saw teams of Nigerian women (above) pick up vaccine carriers in the morning. They literally went to one house after another looking to vaccinate every single child. After immunizing the children, they marked their pinkies purple.


Michael Sa Courtesy of

They literally went to one house after another looking to vaccinate every single child. There was so much positive energy there. Twelve-year-old Omar (below), despite having a polio-weakened leg, rides his bike everywhere. His father builds special adultsize tricycles so other polio survivors can get around. And thousands upon thousands of Nigerian volunteers are not giving up until every child is immunized against polio. Nigeria achieved a year without polio on July 24, 2015. With continued efforts, I am confident that UNICEF and its partners will #EndPolio in all of Africa.

 1 Why would purchasing more vaccines not be enough to close the immunization gap?  2 How are the different parts of the immunization gap being addressed in Nigeria? Which way is the most impressive to you? Why?

© U.S. Fund for UNICEF/2015/Sutter


e drove under the hot sun on dirt roads filled with potholes. Many of the villages we passed lacked electricity. But we knew the immunization teams were managing to get vaccines from cold storage to the most remote villages, by whatever means it took: motorcycle, camel, whatever.


In spring 2015, Nigeria was about to be polio-free for one year. The U.S. Fund for UNICEF’s Michael Sandler (right) traveled to the last polio-affected area in northern Nigeria to document the end of the fight there. This is what he saw.

At press time, the last case in all of Africa was August 11, 2014. If no new cases arise for three years after that, Africa will be declared polio-free. n

UNICEF ACT n Fall 2015


© UNICEF/GHAA2015-01044/Quarmyne

UNICEF workers cross a makeshift bridge in eastern Ghana to monitor a polio eradication campaign.

Finding Solutions

Closing the Gap

Expanding childhood immunization programs in 72 of the world’s poorest countries has benefits that vastly outweigh the cost. It could save 6.4 million lives and over $150 billion in treatment costs and lost work over a decade. For that to happen, the immunization gap must be bridged in the following ways:

Getting the vaccines:

This is no simple effort. It takes much knowhow to determine how many vaccines are needed, to buy the vaccines, and to get them into countries.

Maintaining the cold chains: These systems must be provided and strengthened, and then readied for many years of service when handed over to local authorities.

Training health workers:

Confronting resistance:

Local professionals are key to success. They must be recruited, trained, and motivated to deliver vaccines even when children are hard to find or get to.

Traditional or religious beliefs may lead people to be suspicious of modern medicine. Efforts must be made to reassure people with these beliefs.

We know how to get the right vaccines to the right children at the right time. New techniques and strategies are being deployed to increase vaccine coverage and improve health systems in the process. We are closing the gap!


SOUTHEAST ASIA | Country: Laos (pop.: 6.2 million)

SUB-SAHARAN AFRICA | Country: Democratic Republic of the Congo (pop.: 79.4 million)

Exercise Your Rights

Real-time digital monitoring of the cold chain: What if you improve the technology that chills vaccines, but one link in that cold chain fails? With monitoring devices like the one pictured here, help is on the way. It sends temperature data on vaccines to health authorities, activating a response to keep vaccines cold.

Engaging the whole community around vaccination: In a huge country with a weak government, it takes a whole village to make vaccination happen. There’s a new emphasis on encouraging vaccination wherever local populations assemble: church, school, even funerals. Emmanuel (pictured here) even gives his sixth-graders notebooks just for information they can share about upcoming immunization activities.

Promote the right to health—and your right to free speech—in a letter to the editor. On a separate sheet, write a letter urging people to make donations to help close the immunization gap. Use both evidence and emotion in your writing.

UNICEF ACT n Fall 2015


Courtesy of Daniel Toole, UNICEF EAPRO

Closing the Gap in ...

Meanwhile at Home

It’s Up For Debate

achieving herd immunity. That’s important, especially for babies who are too young to get shots. Measles misinformation. Measles is one of the most infectious diseases around. In places such as California, though, misinformation has led some parents to refuse or delay their kids’ vaccination. This reduced herd immunity and sparked a measles outbreak in 2014 centered at the Disney theme parks in California. It was the largest measles outbreak in the U.S. since 2000, and it affected 8 states. Among California’s 110 measles patients, 49 were completely unvaccinated, including 12 infants. The outbreak

even took one Washington State woman’s life, the first measles death in the U.S. since 2003. The measles vaccine is safe, effective, and nothing new—we’ve had it for more than 50 years. But 17 U.S. states have measles vaccination rates lower than the recommended 90 percent. Measles and other diseases are still here. How much risk do we want to take by avoiding vaccinations? n

© Jamie Bernstein, CC BY-NC-ND 2.0 (, via Flickr


ou probably hate injections. But shots have taken away the very real fear of death from childhood disease in the United States. Shots may be unpleasant, but they’re far better than the misery and deadliness of diseases such as measles. We succeed together. It’s a relief to be immunized against a disease. It also helps your community. For reasons including poverty and lack of access to health care, it’s unlikely everyone will get all their shots. But if a high level of vaccination is reached, there aren’t enough people to infect, and a disease loses steam. Effectively, the whole community is protected by

A girl smiles for the camera after a “Hug Me, I’m Vaccinated” event in Las Vegas, Nevada.

The UN Convention on the Rights of the Child establishes the right to a safe and healthy environment for all kids everywhere. Parents have the right, too, to question the drugs going into their children’s bodies. Should vaccination be mandatory for all children to achieve herd immunity?

TEST YOUR VOCAB Complete each sentence below with the appropriate vocabulary term from the term bank. Term Bank

cold chain eradicated mobilization smallpox

herd immunity vaccines

immunized vulnerability


Before _________________, childhood diseases caused much death and suffering.


_________________ protects an entire community, even if everyone’s not vaccinated.


The __________________ preserves vaccines, from storage to delivery.

4 Immunization _________________ a killer disease in 1980.

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Annajulia Santa Elena is a senior at Del Lago Academy in Escondido, California. She is a member of her school’s UNICEF High School Club, as well as the Key Club, the service organization for teens offered by Kiwanis International. In her words …


he Eliminate Project is UNICEF and Kiwanis’ fundraising campaign to eliminate maternal and neonatal tetanus (MNT). MNT is a disease caused when bacteria come into contact with open cuts during childbirth. MNT kills one baby every 11 minutes, and it kills mothers, too.

But it’s easy to save lives from MNT; in fact, it takes only $1.80 to buy the vaccines that protect a mother and her baby. As an MNT Eliminator, I share this information around my school. I also collect donations from my classmates by having a coin drive at my school; the change from anyone’s pockets

a Santa Elen Annajulia Courtesy of

Kids Helping Kids

can easily be enough to protect a family or more. It’s easy to make a difference! Kiwanis International ( has been dedicated to serving the children of the world since 1915. Its more than 600,000 members raise money and volunteer their time to benefit their communities and The Eliminate Project.

More Kids Helping Kids, through… Rotary International ( Rotary has been tackling the world’s most pressing humanitarian challenges since 1905. Its global membership of 1.2 million volunteers helps families in need in their own communities, and it works with UNICEF toward a polio-free world. Its “Interact” service clubs are organized and sponsored by Rotary clubs for youth 12–18 years old.

It’s Your Turn to

Share Voices for Vaccine’s “Kick the Flu out of School” toolkit (at with a teacher and get started! Visit and read about the many ways to help provide vaccines where they are most needed. Join your local Rotary Interact or Kiwanis Key Club. Have a UNICEF fundraiser for lifesaving items at inspiredgifts. For example, each $31−$37 contributed can provide 100 measles vaccines, 200 polio vaccines, or 400 tetanus vaccines.


UNICEF ACT n Fall 2015

Immunizations: Closing the Gap, Ambassador Edition