Strengthening Immunization Services through Person-centered Care

April 17th, 2023 | Viewpoint

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Every year, immunization prevents an estimated 3.5–5 million deaths from illnesses such as diphtheria, pertussis, influenza, measles, and tetanus. However, the COVID-19 pandemic, conflict, and additional health systems challenges have resulted in a decline in childhood vaccinations. In 2021, of the 25 million children who missed basic vaccines, 18 million did not receive a single dose of the diphtheria-tetanus-pertussis (DTP)-containing vaccine. These children are considered “zero-dose,” and almost all of them live in low- and middle-income countries. The cost of un- and under-vaccination for children and their loved ones is tremendous. As a global community, we must rapidly advance immunization service equity for all children.

We know that vaccination uptake is influenced by highly nuanced sociocultural, behavioral, and structural drivers. It is critical to understand these factors to identify and reach zero-dose and under-immunized children. Person-centered approaches to immunization facilitate development of community-led, tailored, and sustainable strategies that can reach children everywhere with vaccination services. These services protect them from illness and death; increase their chances for a healthy, productive life; are a platform for primary health care; and can increase trust in the health system.

Who are zero-dose and under-immunized children?

Zero-dose children are those who have not received any routine vaccine. For operational purposes, Gavi defines zero-dose children as those who lack the first dose of DTP.

Under-immunized children are those who have missed vaccinations included in the routine immunization schedule. For operational purposes, under-immunization is indicated by children missing the third dose of DTP.

Missed communities are home to clusters of zero-dose and under-immunized children. These communities often face multiple deprivations and vulnerabilities, including lack of services, socio-economic inequities, and gender-related barriers.

Strengthening immunization services though person-centered care

A person-centered approach systematically considers the perspectives of individuals, families, and communities, and sees them as active participants in trusted health systems. The design, management, and delivery of immunization services should be shaped by and respond to the needs of individuals and communities, and focus on overcoming service access barriers related to age, location, gender, and other social and cultural factors. By centering the experiences, perspectives, and knowledge of children and families, communities, providers, and other partners can leverage behavioral insights to co-design respectful and compassionate services that promote vaccine uptake by meeting the needs and preferences of individuals and communities.

JSI’s person-centered care framework can help implementers and program designers understand vaccination barriers and enablers and develop solutions across domains and socioecological levels that uphold the values of person-centered care. Figure 1 provides examples of person-centered interventions that JSI has had success with and that can be scaled up to strengthen immunization services for some of the world’s most vulnerable children.

No child should miss life-saving immunization. Placing families and children at the center of immunization services will benefit zero-dose communities that, in addition to being at higher risk of vaccine-preventable diseases, may lack access to affordable, high-quality curative care. Resources like the Immunization Service Experience Toolkit can help program managers guide discussion on how immunization services can be more person-centered. We must use caregiver voices, perspectives, preferences, and ideas to design services that not only meet children’s vaccination needs now, but can also strengthen the health system to respond to their family’s needs throughout the life course. Accordingly, we must invest time and resources to:

Understand who zero-dose children are, where they live, and why the health system hasn’t reached them.

Develop people-centered, context-specific strategies to reach these children, with focus on how to overcome barriers and support enablers to vaccination.

Apply behavioral insights from both the supply and demand sides to find equitable solutions to communities with low or no vaccination coverage.

Measure, learn, and adapt as strategies are implemented.


By Nicole Castle & Jessica Posner

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