Five Essential Readings Ahead of the Ministerial Conference on Immunization in Africa

February 10th, 2016 | Viewpoint


The upcoming Ministerial Conference on Immunization in Africa is an important opportunity to bring together African leaders, including health and finance ministers, in Addis Ababa to demonstrate their commitment to ensuring high and equitable vaccination coverage. As a long-time leader in the immunization field, JSI has authored and contributed to numerous journal articles focused on routine immunization systems strengthening, a topic which sometimes gets lost amid the excitement surrounding new vaccine introduction and mass vaccination campaigns.

In preparation for the upcoming meeting, I encourage participants to review the following five journal articles.

Angela K Shen, Rebecca Fields, Mike McQuestion.  “The future of routine immunization in the developing world: challenges and opportunities”.  Global Health Science and Practice.  December 1, 2014; 2(4):381-394.

Vaccine costs in the developing world have grown from less than a dollar per child in 2001 to up to thirty-five dollars per child in 2014, as more and costlier vaccines are being introduced into national immunization programs. Researchers, including JSI’s Rebecca Fields of USAID’s Maternal and Child Survival Program (MCSP), explore this and other challenges to routine immunization and call for the strengthening of eight critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.

Anne LaFond, Natasha Kanagat, Robert Steinglass, Rebecca Fields, Jenny Sequeira and Sangeeta Mookherji.  “Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies.”  Health Policy and Planning. (2015) 30 (3):298-308.

The Africa Routine Immunization System Essentials (ARISE) project, managed by JSI and funded by the Bill & Melinda Gates Foundation, conducted in-depth case studies to gain a deeper understanding as to why routine immunization coverage improves in some settings in Africa and not in others. In-depth case studies were used to determine pathways to routine immunization coverage improvement by comparing immunization program experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance.

Robert Steinglass.  “Routine immunization: an essential but wobbly platform.”  Global Health: Science and Practice.  2013. Volume 1, issue 3.

Despite their vital role, routine immunization programs are taken for granted. Coverage levels are poor in some countries and have stagnated in others, while inclusion of new vaccines is an additional stressor. I’ve outlined several factors that we need to strengthen: (1) policy processes, (2) monitoring and evaluation, (3) human resources, (4) regular delivery and supply systems, (5) local political commitment and ownership, (6) involvement of civil society and communities, and (7) sustainable financing. Rebalancing immunization direction and investment is needed.

Michael Favin, Robert Steinglass, Rebecca Fields, Kaushik Banerjee, Monika Sawhney.  “Why Children Are Not Vaccinated: A Review of the Grey Literature”.  International Health. December 2012: 229-238.

>In collaboration with WHO, JSI’s IMMUNIZATIONbasics project analyzed 126 documents from the global grey literature to identify reasons why eligible children had incomplete or no vaccinations. The main reasons for under-vaccination were related to immunization services and to parental knowledge and attitudes. The most frequently cited factors were: access to services, health staff attitudes and practices, reliability of services, false contraindications, parents’ practical knowledge of vaccination, fear of side effects, conflicting priorities and parental beliefs. Some family demographic characteristics were strong, but underlying, risk factors for under-vaccination.

Clements CJ, Watkins M, de Quadros C, Biellik R, Hadler J, McFarland D, Steinglass R, Luman E, Hennessey K, Dietz V.  “Researching routine immunization – do we know what we don’t know?”  VACCINE.  2011 Nov 3; 29(47): 8477-82.

A 2009 U.S. Centers for Disease Control and Prevention (CDC) expert panel reviewed and identified areas of research required to strengthen vaccination service delivery in developing countries. Launched in 1974, the Expanded Program on Immunization (EPI) includes strategies and practices to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. The CDC panel identified an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research, will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies.

Written by Robert Steinglass


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