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The Child Survival Revolution 2.0

NEW YORK (May 15, 2012) — Thirty years ago, former UNICEF Executive Director James P. Grant launched what would become known as the “Child Survival and Development Revolution.” The bold and unprecedented effort, involving a diverse coalition of supporters and partners from all over the world, saved 25 million young lives and spared millions more the misery of severe disability. Elevating the cause of children’s well-being to historic heights, the ambitious campaign also forever changed the face of global health and demonstrated the amazing potential of international development.

Now, a second child survival revolution is taking shape, claims UNICEF’s Chief of Health Dr. Mickey Chopra. “We are on the cusp of achieving something equivalent to putting a man on the moon,” he says.

The fight against child mortality has seen marked progress, thanks to the work of UNICEF and its partners. Since 1970, global under-five deaths have fallen by more than 54%. During the 15 years of the Jim Grant era, between 1980 and 1995, this number dropped from 13.2 million to 10.7 million—even though the population of all children under five in the developing world surged by 19 percent over the same period of time. Since then, worldwide under-five deaths have plummeted to 7.6 million, and in recent years, the rate of decline in under-five mortality has accelerated. Still, 21,000 children die every day from preventable causes.

Now, says Chopra, by combining lessons learned from the first child survival revolution with powerful new interven­tions and a concerted push to reach the poorest of the poor, UNICEF and its partners can capitalize on recent gains and perhaps save millions more lives within the next generation.

Learning from the First Child Survival Revolution

In 1980, when Grant took over as the head of UNICEF, more than 36,000 chil­dren under the age of five were dying every day. He dubbed this appalling mass loss of life to mostly preventable, poverty-related causes a “global silent emergency.” A longtime champion of the poor with the zeal of a preacher, Grant noted that these deaths did not land in the headlines or on the evening news. “If more than 100 jumbo jets filled with children crashed every day, there would be an outrage,” he once said. “But that is the number of children who are dying every day of starvation and disease.”

To attack the “silent emergency,” Grant worked with a team of UNICEF veterans and other experts, including American pediatrician Dr. Jon Rohde, to devise a strategy that would save the maximum number of lives. What they came up with in the fall of 1982 was a mix of four simple and inexpensive interventions: growth monitoring to halt malnutrition, oral rehydration therapy to combat deadly diarrheal dehydration, breastfeeding promotion, and immunization. Known as GOBI, this small package packed a huge punch. Additional programs like food supplementation and the promotion of female education were added later.

These interventions existed long be­fore Grant came to UNICEF, but they had not yet been put to widespread use. Grant changed that, in part, by unleashing a barrage of diplomacy and social mobilization. As a result, UNICEF was able to build an influential movement—a “grand alliance for children” as Grant put it—of presidents and prime minis­ters, religious leaders and military gen­erals, donors and volunteers, students and teachers, private companies and non-governmental organizations, civil servants and community leaders, and not least, mothers and children. 

Immunization against killer childhood diseases like measles and polio became the vanguard. Huge vaccination drives carried out by national governments and supported by UNICEF, the World Health Organization, and many other partners began sweeping across the develop­ing world, from Colombia to Turkey to Senegal to dozens of other countries. UNICEF helped broker historic ceasefires in war-torn countries, so that even children in conflict zones could be immunized. In the mere span of ten years, between 1980 and 1990, the worldwide immunization rate nearly quadrupled, jumping from 20 percent to around 80 percent. Jim Grant died in 1995, but many of the lessons from his child survival revolution still resonate today and are evident in UNICEF’s present work. Among them: set measurable, specific goals; commu­nicate using simple, powerful messages; and make sure to generate and sustain political will and commitment. “Jim Grant showed political leaders and lead­ers of civil society and the private sector how this package of interventions could be used to transform the lives of women and children, and how this was really important for the future growth and devel­opment of their countries,” says Chopra. “Today, the challenge remains one of get­ting the attention and the priority given to the welfare of women and children.”

Current UNICEF Executive Director Anthony Lake is determined to do just that, says Chopra. “It is a very exciting time to be at UNICEF,” he adds.

The Way Forward

UNICEF now has more weapons at its disposal in the fight against child mortality.  New vaccines against pneumonia and diarrhea, new antiretroviral drugs to stem the toll of HIV/AIDS, and new delivery approaches have enhanced and broadened UNICEF’s ability to counter the gravest threats to children, says Chopra.

As in the first child survival revolution, immunization is key. In 2010, UNICEF procured 2.5 billion doses of vaccine—enough to immunize 58 percent of the world’s children. Yet despite major progress over the last few decades, 20 percent of the world’s children remain unvaccinated. UNICEF aims to help bridge the immunization gap by significantly expanding its vaccination program and tripling its capacity over the next five years. “Immunization has always enabled us to meet the needs of the poorest and neediest first and has also allowed us to be on the verge of eradicating polio,” says Chopra.

In addition to the recently developed vac­cines for pneumonia and diarrhea, a new vac­cine for malaria is expected shortly. UNICEF is examining ways to improve and update immunization systems to make the most of new vaccines, as well as old ones. “Building and strengthening the infrastructure to deliver vaccines is more critical than it’s ever been before, because of the potential payback we can get in terms of lives saved and better development for children,” Chopra says.

Immunization is also a pivotal part of UNICEF’s “equity” strategy—a global drive to reach the poorest and most disadvantaged children. By explicitly targeting the lowest-income, highest-mortality communities and countries first, UNICEF and its partners can reach the unreached and get lifesaving aid to children who need it most. Much of the equity push will occur in sub-Saharan Africa and South Asia, which are home to the highest child mortality rates in the world.

Equity is at the heart of the second child survival revolution and, coupled with new vaccines and technologies, has created a monumental opportunity. “We can make a big jump forward,” says Chopra.

And as with the first child survival revolution three decades ago, it will not just be UNICEF alone. It will be another “grand alliance”—a potent movement of donors, corporations, foundations, and volunteers; of students and teachers; of health workers, civil servants, and community leaders; of children and their families; of people all over the world who commit to fight for the survival and health and future of every child on this Earth.

Author: Adam Fifield