Opinion: An unacceptable inequality in women and children’s health

A mother brings her child to be vaccinated at an immunization clinic in Pokhara, Nepal. Photo by Jim Holmes / AusAID / CC BY

For such a mild virus, it inspired immense fear. As the disease spread, infecting 12.5 million people in the United States alone, so too did evidence of the birth defects it caused. Without a vaccine or cure, pregnant women were left vulnerable. This outbreak was not Zika in 2016, but rubella in the 1960s.

The first vaccine arrived soon after, in 1969, and the Americas were declared rubella free in 2015. The combined measles-rubella vaccine is now both relatively inexpensive and widely recommended, yet this disease continues to threaten mothers and disable 100,000 babies every year, mostly in developing countries. Why is this still happening?

Rubella demands a level of global prioritization that it simply has not received. The rubella vaccine is one of the best we have, requiring only one dose for individual protection. However, for effective disease prevention in the community, at least 80 percent of children must be vaccinated over a sustained period. That’s no small feat in any country, let alone the world’s poorer nations.

For policymakers and parents, the rubella shot’s advantages may also seem less immediate. The immunization is delivered in childhood to provide future benefits to women of reproductive age, both directly — protecting them against exposure in later years — and indirectly — through herd immunity. This protection is incredibly important, shielding pregnant women from the traumas of miscarriage, stillbirth, or delivering a child disabled by the deafness, heart disease, and poor vision of Congenital Rubella Syndrome.

In our gender unequal world, it does not help that the burden of this difficult disease — both in terms of maternal health and the caregiving such a disabled child requires — falls particularly upon women. In the countries where rubella is now most prevalent, limited health care, discrimination, and poor disability support services only serve to make things worse for women whose lives are blighted by contracting rubella in early pregnancy.

These challenges to prioritizing rubella prevention have had a shocking outcome: The number of children with CRS worldwide in 2010 was still roughly the same as it was in 2000.

Complexities are no excuse. Recent advances in the number of children receiving basic vaccines around the world, supported by my organization Gavi, the Vaccine Alliance, have shown that immunization progress in developing nations is possible. I know firsthand, from my work on polio in my former role at India’s Ministry of Health and Family Welfare, that ambitious, long-term immunization goals can be achieved in these contexts. But it requires political will and solid health systems to get there. In this case, that means strengthening delivery of immunization services so rubella can be one of the shots that generations of children worldwide receive reliably, year on year.

Fortunately, there are signs of global improvement. In 2011, Gavi opened its window of support for the measles-rubella vaccine. To date, with Gavi’s support, 24 countries have introduced the vaccine into routine immunization schedules. India and Indonesia are both making strides towards widespread rubella vaccination, receiving partial Gavi support to vaccinate more than 450 million children between 2017-2019. But it will only be by consistently going beyond campaigns to include rubella vaccines in strong routine immunization programs that we will see sustained benefits.

Too long have we let rubella harm women and children around the world, even when we have the tools to prevent it. The panic around the recent Zika epidemic is a reminder of the fear every mother at risk of rubella faces and should compel us to act.

The theme of International Women’s Day this year was press for progress. Rubella’s challenges show that this is not just about looking to the future of women’s rights and breaking new ground, but also ensuring that every mother around the world has the protection that more privileged women have enjoyed for years. It is within our power to ensure that this legacy of suffering is not passed down to future generations, and it is a responsibility the world cannot ignore.

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About the author

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    Anuradha Gupta

    Anuradha Gupta is the deputy chief executive officer of Gavi, the Vaccine Alliance. Since joining Gavi in 2015, Anuradha has been leading efforts to better integrate support to countries within Gavi’s strategy. In particular she has played a pivotal role in setting up a new model of country-level Alliance support through the establishment of a Partners’ Engagement Framework. At the same time, she has helped improve country ownership and leadership of Gavi-supported programs through the development of new country-focused approaches.