Some 1.5m deaths could be prevented each year if simple vaccinations were administered more widely, says Radhika Batra

A FOUR-YEAR-OLD girl recently came to the emergency room where I work as a resident doctor. She was writhing in pain, her body convulsed with seizures. My team and I moved fast to activate seizure protocol, secure her intravenous drip, and deliver all appropriate medications.

We then performed a test: I blew air toward her, and she collapsed in pain; I offered her water, and her agony intensified. The diagnosis was clear: she had rabies, and it was too late to save her.

The girl’s family knew that a dog had bitten her, but they had been told that traditional herbs would heal her, so they had delayed taking her to the hospital.

She died after less than a day in our care. She would still be alive, had her parents immediately taken her to a hospital for the anti-rabies serum and the appropriate vaccination. Her grief-stricken mother’s tormented screams still echo in my mind.

As a resident doctor in paediatrics, I am no stranger to death. But watching an innocent child succumb to an ailment that is so easily prevented by a simple intervention takes a severe toll. After all, the little girl I watched die that day was hardly an anomaly.

Despite significant progress on expanding global immunisation, the World Health Organisation reports that coverage has stalled at 85%. According to Unicef, 20m children under the age of one did not receive the three recommended doses of DPT (the vaccination for diphtheria, whooping cough, and tetanus) in 2017, and 21m did not receive a single dose of measles vaccine. The WHO estimates that 1.5m deaths could be avoided each year if global immunisation coverage improved.

Moreover, there have been persistent shortfalls in delivering vitamin A supplements, an important component of immunisation protocols and often administered alongside routine vaccines. This has contributed to blindness in 1.4m people, 75% of them in Asia and Africa.

The story in my country, India, is consistent with this global reality. India has a strong healthcare system. And in 1985, the government established the Universal immunisation plan to provide at least 85% coverage.

Yet, according to Unicef, India’s national average for immunisation stands at just 62%, with little progress having been made in recent years. India has more non-immunised children — 7.4m — than any other country.

As is so often the case, immunisation coverage reflects deep inequities. Children in rural areas are less likely than their urban counterparts to have received a complete set of vaccinations; girls receive far fewer vaccines than boys; and poor children fare far worse than wealthier ones.

The hospital where I work is in the slums of Ghaziabad, India, which has a huge population of migrants who have left their villages in search of employment. Conditions are difficult: overcrowding, poor sanitation, and an erratic and low-quality water supply undermine the health of all residents, especially the children. Substance abuse is rampant.

In many cases, both parents must work long hours to make ends meet. They lack enough money for healthy and diverse foods, leaving their children eating primarily the lowest-quality rice.

Unsurprisingly, they have little time or resources to dedicate to meeting their children’s routine healthcare needs, such as immunisation.

This injustice is indefensible. It is only when we delve deeper that we realise the magnitude of atrocities in the world. Children falling ill, becoming disabled, or dying from preventable causes are among humankind’s most shameful failings. No single preventive health intervention is more cost-effective than immunisation, according to the WHO.

While expanding immunisation coverage is undoubtedly challenging, there is no excuse not to be making progress with low-cost, scalable, and sustainable solutions.

To take top-down immunisation schemes to the doorsteps of the disadvantaged, governments and civil society must work together to establish and expand efficient, last-mile channels for vaccine delivery, accounting for barriers ranging from lack of awareness to out-of-pocket cost.

Had she been vaccinated against rabies, that four-year-old girl could have lived, gone to school, made friends, fallen in love, experienced heartbreak, fallen in love again. She might even have decided to dedicate herself to studying to become a doctor. Instead, she died, having barely lived, in searing agony.

Persistent gaps in vaccination coverage must be addressed on a war-like footing. Children will continue to suffer and die — and devastated mothers will continue to weep over them — unless we embrace the battle. If not, we shall continue to lose innocent lives and mothers will mourn, loud and long. We cannot be blind to their plight any longer. We cannot turn a deaf ear to their laments.

Radhika Batra, a medical doctor, is founder and president of Every Infant Matters, India. project-syndicate.org