07 IMMUNIZATION

Immunization is key to the prevention and control of epidemic-prone vaccine-preventable diseases (VPDs). A national vaccine delivery system should be in place, with nationwide reach, effective distribution, easy access for marginalized populations, adequate cold chain and ongoing quality control, to respond to existing and new disease threats.

IMPACT:

Effective protection through achievement and maintenance of immunization against measles and other epidemic-prone VPDs. Measles immunization is identified as a proxy indicator for overall immunization against VPDs as measles is a continuing cause of substantial avoidable morbidity and mortality. Identification and implementation of targeted immunization activities to protect populations at risk of other epidemic- prone VPDs of national importance (e.g. cholera, Japanese encephalitis, meningococcal disease, typhoid, yellow fever and COVID-19, etc.). Diseases that are transferable from animals to humans, such as anthrax and rabies, are also included.

MONITORING AND EVALUATION:

90-95% coverage of the country’s 12 month old population with measles-containing-vaccine first-dose (MCV1), as demonstrated by coverage surveys.

Benchmark 7.1

Optimum vaccine coverage (measles) as part of a national programme

Objective To increase vaccine coverage for priority vaccine-preventable diseases (VPDs) in the country

01 NO CAPACITY

  1. Less than 50% of the country's 12 month old population has received measles-containing-vaccine first-dose (MCV1), as demonstrated by coverage surveys or administrative data.

02 LIMITED CAPACITY

  1. Assess and map existing coverage data to identify high risk areas and populations to target control of selected VPDs. *
  2. Conduct stakeholder mapping and form a multistakeholder national advisory committee which will guide country policies and strategies for optimum vaccine coverage based on country risk profile for measles and other VPDs. *
  3. Develop an immunization strategy with a comprehensive multiyear operational plan outlining and describing actions and activities for increasing vaccine coverage at national and subnational levels. *
  4. Develop and disseminate guidance and tools to increase routine immunization services, with a focus on MCV1 coverage and conduct activities to achieve 50–69% MCV1 coverage in the country’s 12 month old population. *
  5. Develop plans to perform catch-up campaigns or supplemental immunization activities, based on epidemiologic and coverage data. *
  6. Evaluate immunization surveillance data, registries, data and reporting systems to identify areas for strengthening of immunization data management.
  7. Develop a standardized system of monitoring and reporting adverse events following immunization (AEFI).

03 DEVELOPED CAPACITY

  1. Finalize, approve and operationalize the national immunization plan with activities to achieve 70–89% MCV1 coverage in the country’s 12 month old population and introduce immunization into targeted populations. *
  2. Develop guidelines, SOPs, training materials and toolkits on pre- and postservice guidance for immunization, safety, waste management and reporting and train health workers. *
  3. Develop specific plans to ensure continuity of routine immunization activity, prevent interruption of services during health emergencies and catch-up vaccination plans when interruptions have occured. *
  4. Use mapping and assessment data to plan targeted routine and supplemental immunization activities in highrisk areas and populations.
  5. Create and disseminate messaging tools to improve knowledge-based capacities (i.e. communication and education) of health workers conducting community mobilization.
  6. Operationalize a national vaccine registry and standardized system of monitoring and reporting AEFI at all health facilities and train health workers on these.
  7. Develop materials and activities to advocate for the importance of vaccination by ministries of education, labour, social security, culture, etc. for relevant populations (children, workers, etc.).

04 DEMONSTRATED CAPACITY

  1. Conduct activities to achieve 90% MCV1 coverage in the country’s 12 month old population, implementing specific strategies focused on reaching vulnerable and marginalized populations at the national and subnational levels to reduce inequities with the target of progressing to 95% national coverage in 2030. *
  2. Develop and implement quality assurance standards and M&E mechanisms for immunization including data quality reviews, and ensure sufficient health workers are appropriately trained. *
  3. Promote immunizations and sensitize communities through routine messaging through traditional and social media and engaging CSOs and religious leaders. *
  4. Evaluate and validate the AEFI reporting system. *
  5. Develop a legal basis and strategy for closer collaboration between public and private institutions involved in implementing the immunization strategy at the national and subnational levels. *
  6. Organize SimEx/AAR/IAR (as relevant) to test the organization of immunization campaigns at national and subnational levels and confirm they are functional as routine systems and during special circumstances such as a health emergency. *
  7. Develop a system to track individual immunization status for priority VPDs while protecting privacy by leveraging immunization registries, electronic databases and national identification number systems. *
  8. Work with relevant ministries to secure sustainable domestic funding (e.g. >12month funded operational plans) for immunization activities. *
  9. Recruit additional voices for immunization advocacy campaigns in the community (e.g. social, religious and traditional leaders) and train them as champions to deliver messages on the importance of immunization for priority VPDs. *

05 SUSTAINABLE CAPACITY

  1. Integrate the national vaccine registry with national health information systems, as appropriate. *
  2. Conduct activities to ensure 95% of the country’s 12 month old population have received at least one dose of MCV. *
  3. Conduct formal surveys of underserved areas to ensure that coverage among vulnerable and marginalized populations is >90%. *
  4. Use results from SimEx/IAR/AAR (as relevant) to update and improve the national immunization strategy. *
  5. Share country experiences in the management of vaccination campaigns for priority VPDs and engagment with marginalized and vulnerable groups, and engage the country in peer-to-peer learning programmes at the subnational, national and international levels. *
  6. Develop programmes or incentives to encourage and support routine vaccination while respecting the autonomy of beneficiaries. *
  7. Develop educational programmes to promote the importance of vaccination and combat misinformation and disinformation about vaccines. *
  8. Develop innovative tools to support information and education campaigns on immunization including development of new platforms, social media tools, and mobile and internet-based technologies based on lessons learned from previous campaigns, communications and social marketing efforts. *

Benchmark 7.2

Provision of national vaccine access and delivery

Objective To strengthen capacity for vaccine access and delivery to target populations 

01 NO CAPACITY

  1. No plan is in place for nationwide vaccine delivery, nor have plans been drafted to provide vaccines throughout the country to target populations or inadequate vaccine procurement and forecasting has led to regular stockouts at the central or district levels.

02 LIMITED CAPACITY

  1. Draft or review existing plans, policies and procedures for vaccine delivery and use results to guide vaccine procurement and delivery of targeted vaccines. *
  2. Review national laws and regulations for procuring vaccines from national and international sources during health emergencies. *
  3. Form a national multisectoral working group to coordinate vaccine procurement and delivery and developd national guidance documents for vaccine stockpile and deployment and obtain approval from health ministry (and agriculture ministry where applicable). *
  4. Establish a cold chain for vaccine delivery to at least 40% of districts or 40% of the target population in the country. *
  5. Complete a review to identify barriers to procuring, receiving, storing and deployinging vaccines and develop a national guideline for vaccine supply chain management, quality assurance and secured delivery to target populations at both national and subnational levels before, during and after health emergencies *
  6. Draft a list of essential vaccines for the country based on international recommendations and country risk profile.

03 DEVELOPED CAPACITY

  1. Conduct a detailed assessment of existing cold chain equipment, including functioning, and identify bottlenecks to maintaining needed cold chain infrastructure at the district, state and provinicial levels and use assessment data to operationalize a plan to service and procure cold chain infrastructure as needed. *
  2. Operationalize national guidelines for vaccine delivery to target populations and develop and disseminate protocols, SOPs, trainings, technical guidelines and toolkits for storage, transportation and deployment of vaccines to health workers and staff. *
  3. Establish a cold chain for vaccine delivery to at least 40–59% of districts or 40–59% of the target population in the country. *
  4. Establish guidance to prevent interruption of routine vaccination during health emergencies (with clear designation of funding sources, minimum staff and cold chain capacity to ensure continuity of immunization services), specifying procedures for procurement, efficient customs clearance, storage and transportation of vaccines. *
  5. Form a strategic national vaccine stockpile based on the list of essential vaccines identified for the country, with security and quality requirements met for sufficient vaccine access and delivery to target populations. *
  6. Regularly invite national vaccine manufacturers to the national working group for coordination of vaccine access and delivery, to facilitate dialogue and negotiation and to ensure affordability of vaccines before, during and after emergencies to avoid speculation. *
  7. Work with relevant partners to secure resources and investments in immunization. *
  8. Develop capacities for international and national transport of vaccines and vaccination material involving public and private transport companies within and outside the country.
  9. Develop specific capacities in relevant sectors to manage vaccine logistics for specific vaccines including cooling warehouses, cooling boxes, specific interim storage conditions, delivery and downstream distribution, etc.

04 DEMONSTRATED CAPACITY

  1. Procure and service cold chain equipment in areas identified by the detailed assessment to ensure vaccine delivery to at least 60–79% of districts or 60–79% of the target population in the country. *
  2. Routinely train health workers and other immunization staff on protocols, SOPs, technical guidelines and toolkits for vaccine storage, transportation and deployment *
  3. Conduct quality assurance of cold chain equipment and delivery systems. *
  4. Develop and implement a strategy for vaccine distribution and identification of vulnerable populations to ensure equitable access to vaccines. *
  5. Monitor, evaluate and amend national and subnational vaccination projects and programmes based on lessons learned from real or simulated implementation and changes needed in the community. *
  6. Involve the government in international initiatives for joint purchase of vaccines and facilitate negotiation with manufacturers on prices as well as desired product profiles to avoid inflation and unfair competition during health emergencies. *
  7. Develop training and exercises for hazard-specific response and management plans with relevant sectors, agencies and other stakeholders. *
  8. Develop tools for staff in relevant sectors at national and subnational levels to work towards global standardization of all steps of vaccines access and delivery. *
  9. Establish an inventory management system that monitors and communicates vaccine supply and requirements at all needed levels.
  10. Implement processes to ensure efficient customs clearance of vaccines by relevant authorities, particularly in emergency contexts.

05 SUSTAINABLE CAPACITY

  1. Secure sustainable funding for vaccine delivery systems, including for procurement and routine repair of cold chain equipment (e.g. costed and financed multiyear operation plans). *
  2. Establish cold chain for vaccine delivery to more than 80% of districts or more than 80% of the target population in the country. *
  3. Assess vaccine delivery in priority areas and/or populations (identified based on existing coverage, registry and/or surveillance data), and use results to improve vaccine delivery. *
  4. Engage research platforms to generate evidence on immunization to improve service delivery and meet the needs of diverse communities, including identifing successful strategies to reduce inequities, improve the quality and delivery of immunization services, improve delivery approaches for life-course immunization. *
  5. Routinely analyse the inventory management system to monitor vaccine supply needs and forecast requirements, with anticipated procurement.
  6. Establish functional national bodies to assess and recommend an evidence-based national vaccine policy and routinely complete a qualitative and quantitative inventory of the strategic national vaccine stockpile.

Benchmark 7.3

An effective mechanism for mass vaccination for epidemics of vaccine preventable diseases (VPD) is in place

Objective To strengthen capacity for mass vaccination in response to VPD epidemics

01 NO CAPACITY

  1. No contingency plans or mechanisms for mass vaccination response to outbreaks of VPD are in place.

02 LIMITED CAPACITY

  1. Include in the ToRs of a national advisory committee on immunization planning for mass vaccination for epidemics of VPDs (including vaccines for novel pathogens) and a decision framework for use of mass vaccination. *
  2. Develop and include contingency plans for mass vaccination deployment for at least one priority VPD outbreak (e.g. Ebola virus disease, measles, yellow fever, cholera, meningococcus, polio, etc.) – including the use of new vaccines – in the national immunization plan. The strategy should include storage, cold chain and distribution capacities, required consumables, potential target populations and engagement of relevant sectors for implementation. *
  3. Conduct a situational analysis on fast-track approval and procurement process for new vaccines/pharmaceuticals – from both new and existing suppliers – and identify regulatory and importation mechanisms for new and experimental vaccines during epidemics of novel pathogens. *
  4. Establish a technical working group endorsed by advisory committee on immunization to work as a knowledge hub to get updates on research, development and global stock details related to vaccines for novel pathogens and report to the advisory committee to support planning for mass vaccination campaigns as needed. *
  5. Include quality assessment and emergency approval for the use of new and experimental vaccines in epidemics of VPD into national fast-track policy for approval of new pharmaceutical products. *
  6. Designate staff to lead planning and implementation of mass vaccination campaigns for VPD outbreaks.

03 DEVELOPED CAPACITY

  1. Assess and streamline the regulatory processes for sourcing and importing vaccines for VPD outbreak response, including new and existing vaccines. *
  2. Develop and implement national and subnational deployment plans, including basic microplanning, for multiple types of VPD outbreaks including the use of new vaccines. Plans should examine potential impacts of various risk-based, equity-based and other approaches. *
  3. Develop and validate SOPs related to the roles and responsibilities of health workers and others for the emergency procurement process of new vaccines in epidemics of novel pathogens to ensure safety, quality, supply chain management, vaccination technique, AEFI reporting, etc. *
  4. Develop or adapt national systems to monitor coverage of new and experimental vaccines, vaccine safety and adequate reporting of serious AEFIs (e.g. WHO target of a least one serious AEFI reported per 1,000,000 population per year) detailing the roles, responsibilities and monitoring and reporting mechanism at all levels. *
  5. Collaborate with existing RCCE efforts to develop proactive strategies to increase acceptance of mass vaccination and address infodemics using real-time social listening with clear linkage to AEFI surveillance programs. *
  6. Establish a mechanism for donor and donation management for access/availability of new vaccines for novel pathogens and quality/safety assurance for in-country use. *
  7. Develop a curricular framework, training plan and materials for mass vaccination campaigns for priority VPD outbreaks.

04 DEMONSTRATED CAPACITY

  1. Conduct SimEx/AAR/IAR (as relevant) for mass vaccination campaigns during epidemics of VPD in collaboration with relevant sectors, to identify functionality, bottlenecks, best practices and assess performance of RCCE activities. Revise SOP and deployment plans accordingly. *
  2. Increase storage capacity and improve logistic management information systems for vaccines and consumable supplies at subnational and local levels, as needed. *
  3. Develop tailored strategies and relevant criteria for mass vaccination campaigns to ensure equity and equality in access to vaccination (including hospitals, community vaccination centres, mobile vaccination sites, home visits to disabled and elderly, etc). *
  4. Implement emergency budget/provisions for reallocation of funds to emergency mass vaccination campaigns, as a national priority *
  5. Validate training materials and tools and for mass vaccination campaigns during VPD outbreaks (including infodemic management) and conduct training at subnational levels.
  6. Enhance integration between disease surveillance and other information systems (e.g. AEFI) to provide data for decision-making in VPD outbreak response.
  7. Implement monitoring and reporting of coverage and safety of vaccines used in mass vaccination campaigns at all levels.

05 SUSTAINABLE CAPACITY

  1. Sustain supply of vaccines for mass vaccination campaigns and test vaccine surge capacities, storage capacities and distribution systems at all levels and resolve challenges identified. *
  2. Secure contingency funding for mass vaccination of epidemics of VPD in the national health budget, including ability to reallocate funding during health emergencies. *
  3. Sustain microplans for reaching all individuals within target populations during mass vaccination campaigns for VPD outbreaks. *
  4. Develop vaccination contingency plans for responding to novel disease scenarios. *
  5. Share best practices and lessons learned in mass vaccination campaigns, with a focus on ensuring access/availability of vaccines, at national and international forums to engage the country in peer-to-peer learning. *
  6. Develop innovative tools to support information and education campaigns on mass vaccination including development of new platforms, social media tools, and mobile and internet-based technologies based on lessons learned from previous campaigns, communications and social marketing efforts *
  7. Effective contribution by relevant sectors for the sustainable supply of vaccines.

* Participation and contribution of other sectors to action.

Tools