“Zero dose” children: how vulnerabilities produce vaccine exclusion

The 77% coverage against polio indicates that practically one in four babies did not receive this vaccine in 2022 in Brazil – a proportion far from the target of 95%. The achieved goal of vaccinating 90% of babies with BCG, despite being positive, still indicates that one in ten did not receive this important protection against tuberculosis.

Although they are the main parameters for monitoring immunization, coverage hides the fact that a group of children accumulates all kinds of vulnerabilities and is exposed to all vaccine-preventable infectious agents, due to social, racial and economic inequalities.

To shed light on this invisibility, international organizations work with the concept of “zero dose” children. Worldwide, more than 14 million children fall into this situation and are considered completely excluded from immunization actions and programs.

Despite the name, the concept does not necessarily mean that these children did not receive any dose of vaccine. The first dose of the DTP vaccine, against diphtheria, tetanus and pertussis, is taken as a reference for this measurement. As it is a low-cost vaccine, with decades of use, adopted practically throughout the world and prescribed for the second month of life, scientists consider that a child who did not have access to dose 1 of DTP in the first year of life is a child zero dose.

Global goal

In Brazil, immunization with DTP is included in the pentavalent vaccine, which adds protection against hepatitis B and the haemophilus influenza B bacteria, which causes a type of meningitis. Despite having the largest public health system in the world, the SUS, and the most extensive free immunization program in the world, the PNI, the country has more than 430,000 children in this situation, ranking eighth in the world in absolute numbers.

Member of the World Health Organization (Sage/WHO) vaccine advisory group, Cristiana Toscano explains that the zero dose indicator is currently the main measure of inequity in access to vaccines. The 2030 Immunization Agenda, outlined globally with ambitious objectives, aims to reduce this group of children by half by the end of the decade.

“This data means that the child did not have access to vaccination. There are those who are undervaccinated, but zero doses are an extreme marker of inequality. That’s why this is a very important goal”, he defined, in a presentation at the National Immunization Day, held by the Brazilian Society of Immunizations (SBIm) in Florianópolis.

Even though there has been an improvement compared to last year, when there were 18 million children receiving zero doses, the world is still far from meeting this target. In 2019, when the agenda was agreed, there were almost 13 million children without dose 1 of DTP, which means that the efforts made so far have not only not reduced inequality but also increased in the period, marked by the covid-19 pandemic. .

Pockets and peripheries

These children are not only in lower-income countries, but also in conflict zones and pockets of poverty in middle-income and even high-income countries. The head of health at the United Nations Children’s Fund (Unicef) in Brazil, Luciana Phebo, says that, in Brazil, they are not necessarily in the poorest states and municipalities, but also on the outskirts of the country’s richest cities.

“In Brazil, they are mainly in the most populous states, on the outskirts. São Paulo and Rio de Janeiro, despite being richer, are also more populous. The number zero dose brings this combination of the highest number, and that is why Brazil is in the rankingbut also from poor countries and poor territories.”

In this context, the head of health at Unicef ​​adds that being in the most impoverished territories is just one of the characteristics that mark these children exposed to such a level of exclusion. “In all the biases that talk about impoverishment and vulnerability, not only within Brazil, but around the world, you will find zero doses of children. Has a clear race, ethnicity and poverty bias”.

If it were a municipality, the city of zero-dose children would be among the 60 most populous in the country. Even so, the current number of 430 thousand represents an improvement compared to 2021, when there were 710 thousand children in this situation. Luciana Phebo states that this advance is already a reflection of the recovery of vaccination coverage, which still has a long way to go.

Save lifes

The problem of low immunization is not exclusive to Brazil, and data from the 2030 Immunization Agenda indicate that the speed with which the goals are being pursued has not been sufficient for the world to achieve the decade’s objectives.

Cristiana Toscano exemplifies that the number of lives saved by vaccines is increasing at a slower rate than necessary to reach the total of 50 million desired for 2030. Among these millions, many need to be children with zero doses.

“The news is not good. Outbreaks of vaccine-preventable diseases are increasing. Large measles outbreaks doubled in 12 months, from 16 to 33 between May 2022 and May 2023. Measles vaccination gaps are having a major impact on the emergence of new outbreaks in all regions,”

regrets the researcher, who advocates more international cooperation.

“We can’t just take care of our home, we need to look at our neighbors and everyone else to move forward”he states.

Read more:

National and international experts discuss patient safety protocols in Manaus

How healthy is it to forgive betrayal? Relationship expert explains

Plastic surgery in AM: know the precautions when choosing a good professional