By Lora Shimp and Jennifer Haefeli
Immunization is widely acknowledged as one of public health’s greatest achievements. Along with preventing debilitating diseases (and the accompanying physical, financial, and emotional burdens), vaccines have saved more human lives than any other medical invention.
As we celebrate vaccine achievements and 50 years of the Expanded Program on Immunization (EPI), we must also recognize how much has changed over the last half-century. Today’s immunization environment is much more complex. There are more vaccines for older age groups, not just infants. There are advances in technology, such as solar-powered cold chain and mRNA vaccines. There are social media platforms that facilitate rapid communication — and miscommunication. The world is more connected, with many positive implications, but also easing and speeding the spread of both disease and misinformation. We must adapt to this new and ever-changing environment.
We need to strengthen and expand our immunization efforts. Despite the widespread and well-known benefits of vaccination, immunization rates had stagnated prior to the COVID-19 pandemic, and they dropped significantly during the pandemic. The impact of this slide in routine immunization is evident with the re-emergence of outbreaks of vaccine-preventable diseases like measles and diphtheria.
These outbreaks are a stark reminder that science is not enough. Immunization requires much more than an effective vaccine. We must also mobilize human, financial, and operational resources to ensure that immunization programs reach and engage individuals, families, and communities, especially people with limited access to health care services.
Looking to the next 50 years, successful immunization programs will require integration into strong health systems that incorporate holistic and equitable approaches.
Start with an equity lens
Immunization is a public good, and we are all better protected when everyone is included. We need to do all we can to reach traditionally under-vaccinated populations. We must also keep in mind that, when it comes to vaccine uptake, communities are not homogenous. To address disparities in vaccination rates both across and within countries and communities, we need to use tailored approaches that we co-design with the populations we are trying to reach. This includes integrating behavioral science and person-centered care into our outreach and design. Recognizing that greater gender equality is associated with improved immunization coverage, we must also integrate gender considerations into immunization programs to improve equity and coverage. Equitable and sustainable immunization programs require the involvement and commitment of local partners, local resources, and local government. This means partnering with local institutions and engaging local communities.
Ensure a positive service experience
There is growing recognition that the service experience plays an important role in vaccine uptake. Service experience is shaped by health care workers’ job satisfaction, their performance (how they treat and interact with clients), and the quality of vaccine delivery. Clients and caregivers must make repeated visits to a health facility to complete routine immunization. For many, this journey is not simple, and a positive or negative experience during any single visit can influence their willingness to return.
Build capacity and support health care workers
Part of providing a positive service experience is ensuring that health care workers — our frontline for engaging communities and building trust — are adequately trained, compensated, and supported. When health workers have the proper skills and are satisfied in their jobs, clients are more likely to receive accurate information and appropriate care so they can make informed decisions with their health care providers. In today’s complex environment, with increasing numbers of continuously evolving vaccines and immunization programs, we need to give adequate attention to health care workers’ professional development, recruitment, training, and retention. This should include pre-service training and mentorship opportunities to encourage continuous learning, create career paths, and prepare workers for leadership positions.
We also need to consider health workers’ own experiences. Health systems do not always meet workers’ basic needs, including support for their mental health. For health workers to provide a positive service experience for clients, they need to feel satisfied with their own levels of confidence and job performance.
Prioritize locally led programs and human centered design
Ultimately, successful immunization programs are about quality, confidence, and trust — in the vaccine, in health care workers, in the health system, and in the environment where vaccines are delivered. They also require reliable outreach services, which is why local and community participation in design, outreach, and delivery is critical for a successful immunization program.
JSI has been implementing country-led immunization programs for nearly 50 years. We know that local leadership and ownership and a multisectoral approach are essential for program success and sustainability. A community with a voice in program design, implementation, and monitoring is a community more likely to value and participate in vaccination programs. We must continue and strengthen efforts to engage communities in the co-creation of quality, person-centered immunization programs that reflect and address local experiences, challenges, and needs.
Moving immunization systems forward
In today’s complex world, we need to simplify things for clients and providers alike. A focus on prevention is always our best public health investment. As the proverb goes, “an ounce of prevention is worth a pound of cure.” This means reorienting health systems to purposefully and sufficiently resource routine immunization programs and integrate them with primary care services. Public and private health services must also work together to offer professional development opportunities and support health workers so they are able to provide quality services and advance in their careers. As we look to the next 50 years of immunization, let’s commit ourselves to sustained investments, local leadership, and programs that put people at the center of all we do.
