"Sanitation, Immunisation To Safeguard Health For All": WSSCC Chair

World Immunisation Week was marked between 24 and 30 April this year. It highlighted the critical role vaccines play in protecting lives and preventing disease outbreaks. But the goal of leaving no one behind remains unachievable because 13 million children are not receiving any vaccines and are categorized as the "zero-dose" children.

In this Interview, Hind Khatib-Othman, WSSCC Chair, highlights the importance of sanitation and hygiene as a major building block to prevent disease outbreaks and safeguard the "zero-dose" children.

Who are the "zero-dose" children?

"Zero-dose children" are those under the age of five that have never been vaccinated. Many of these children live in the poorest and marginalized communities and are more susceptible to diseases because they are living below the poverty line. These are the children who are living below the poverty line are less likely to have access to other basic health services such as sanitation and hygiene and most probably are the communities which could be the epicentre of epidemics that threaten global health security.

Immunisation has been described as an essential ingredient for most SDGs, including SDG 6.2 on sanitation and hygiene. Can you explain the interlinkage between immunisation, SDG 6.2 and the "zero-dose" children?

This is true as healthy children and families could mean increased prosperity and healthy lives and well-being, but we should also know that vaccines should be complemented with other important strategies such as access to drinking water and basic sanitation and hygiene. For example, if we look at diarrhoea, we need a combined strategy of vaccines, along with clean drinking water, sanitation and hygiene to prevent diarrhoeal diseases – a leading cause of child mortality in developing countries. Investments in oral cholera and rotavirus vaccines need to be complemented with equal investments in WASH and health systems to help eliminate diarrhoea.

So, how do you protect that investment, which is critical to saving hundreds of millions of lives of children?

Protecting this investment requires investments in prevention strategies, which is mainly the provision of safe drinking water and adequate sanitation and hygiene. We have seen the significance of sanitation and hygiene as a critical prerequisite in disease prevention. This was amplified with the spread of COVID-19 across the world. With no treatment or vaccines available for coronavirus, the first message was "wash your hands with soap." So, these are clear linkages, and we need to make sure that investments are made to improve sanitation and hygiene situation in developing countries.

Many countries, especially in the developing world, continue to face the threat of vaccine-preventable diseases such as polio, cholera, hepatitis E caused by poor sanitation and hygiene. What steps are needed to ensure that immunisation coverage gaps are closed and no one is left behind?

To close the immunisation gaps, there are a number of strategies which need to be tailored based on the country context as there is no one size fits all. Often infants who are missing out on vaccinations live in rural, isolated communities and urban slums in some of the world's most impoverished communities. Many also live in areas that are severely affected by conflict or insecurity. Adapted strategies and strong accountability of all relevant stakeholders, including governments, are critical.

Sanitation and hygiene should be seen as an integral part of health improvements and prevention of infectious diseases. The vaccine prevents infectious diseases, and so do adequate sanitation and hygiene services. Investments should be equally made in sanitation and hygiene and be seen as safeguarding investments in immunisation and primary health care. We know that there are millions of people globally lack adequate wash services and consequently suffer from a multitude of preventable illnesses.

WSSCC: How can sanitation and hygiene improve the gaps in vaccine-preventable diseases?

Although vaccines and immunisation programmes are critical to reaching every child around the world, they need to be delivered alongside crucial preventive WASH interventions. And a multi-pronged approach is vital for many of the infectious diseases, for instance, cholera. Long-term investments in universal access to WASH will be essential in both the immediate response to the growing threat of COVID-19 and in building up communities' resilience to the future.

When you reach people with sanitation, you are creating awareness because sanitation doesn't go without awareness creation, without efforts to boost behavioural change and a better understanding of infectious diseases. For example, when I went to Uganda for WSSCC in February, what was heartwarming to me was when ladies from different age groups were relating to the importance of sanitation and hygiene to the cholera outbreaks which impacted their communities.

WSSCC: In the face of COVID19, GAVI is calling for scaling up investments for immunisation through Universal Health Coverage. How does that investment go hand in hand with investments in sanitation and hygiene?

COVID-19 has disrupted routine immunisation, and this will likely have a devastating impact on immunisation programs in the world's poorest countries. We know that in addition to the disruption of the routine immunisation programmes, a number of vaccination campaigns against polio, measles, cholera, HPV, yellow fever and other diseases have been postponed as health care workers are redeployed to other services to contain the spread of COVID-19.

To put the immunisation back on track and to support the response of countries during COVID-19 requires additional effort in data management and coordination, media and advocacy, training and technical support including training through online platforms, which will require additional investments for Gavi Alliance. While GAVI seeks to increase its investments. We at WSSCC want to double investments in sanitation and hygiene.

When communities that are susceptible to diseases are provided with adequate sanitation and hygiene services, they become less vulnerable to diseases. Access to handwashing facilities, basic sanitation services at household and community level is critical for the well-being of people. We need investments to protect lives.

What is your message for World Immunisation Week?

My message is that vaccine is a great investment. Immunisation is one of the most effective ways to save lives and improve health. The world should continue in supporting GAVI and its partners in ensuring they leave no one behind. And equally, they should look at sanitation and hygiene as an important SDG target to protect health and well being of people, and a major sector which contributes to prevention to the spread of infectious diseases. So while vaccines are critical, sanitation and hygiene are equally important. It is the centrepiece for human rights, for dignity and for the well-being of people.

Also Read: Achieving Public Health Equity Start With Sanitation And Hygiene For All