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A research renaissance has yielded a record number of new vaccines — but a failure of delivery systems means 24 million children are still missing out on life-saving immunisation, says a report.

According to 'The State of the World's Vaccines and Immunisation', an assessment by the WHO, the UN Children's Fund (UNICEF) and the World Bank, a record 106 million children were vaccinated in 2008. But 24 million children, most of them in remote or war-torn regions, are yet to be reached.

"This [call to action] is about saving lives in places you may never have heard of; about remote, hard-to-reach places," said Daisy Mafubelu, WHO assistant director-general of family and community health, at the report's launch yesterday (21 October).

"There is room to do more — one in five kids do not get the rotavirus immunisation scheduled for the first year of life."

There are now a record 120 vaccines available against killer diseases. A push in recent years for more vaccine research has yielded products against meningococcal meningitis, rotavirus diarrhoea, pneumococcal disease and human papillomavirus (HPV), which can cause cervical cancer.

A further 80 vaccines are well-advanced in clinical trials, and over 30 of them are for diseases for which no vaccine exists, according to the report. Vaccines for HIV/AIDS, malaria, tuberculosis and dengue fever are at an earlier stage of research.

The report cites a "renaissance in vaccine discovery and development", driven by rising demand from UN procurement agencies. The vaccine market has tripled over the last eight years to more than US$17 billion in revenue.

"The vaccines are there — systems of delivery are the problem. Delivery mechanisms need to be strengthened," said Rakesh Nangia, director of operations at the World Bank Institute, at the launch.

"In a poorly functioning health system it is difficult to ensure equity in access to immunisation and, as a result, there may be a high degree of variability in immunisation coverage," says the report.

Many of the unvaccinated children live in areas without easy access to health services. Others are in areas with restricted access because of conflict, while others may be part of populations that are constantly on the move. Some countries are marred by infrastructural problems affecting storage and stock management of vaccines.

The report calls for an additional US$1 billion a year to help raise global vaccine coverage from 82 per cent to 90 per cent by 2015 — which could prevent an additional two million deaths a year.