Opinion: Global immunization efforts need a new BRAVE and BOLD approach

This opinion piece was originally published by Devex on January 18, 2023. 

Early last year, journalist Yukfu Sylvie Bantar summed up the sluggish COVID-19 vaccine rollout in cosmopolitan Kumbo, a conflict-ridden town in northwest Cameroon, with one sentence: “Global problem, global solutions, but local resistance.” Other media reports in low- and middle-income countries have echoed that view, highlighting astounding variations in the acceptance of and demand for vaccines — not only between countries but also within countries.

The message is loud and clear: A globally prescribed, one-size-fits-all approach to vaccination is obsolete. Global institutions must listen to local voices, respect their expertise and wisdom, and co-craft solutions if we are to deliver on the transformational power of vaccines for society.

Global health institutions have rightly sounded the alarm over the largest sustained decline in routine immunization in 30 years. However, it would be overly simplistic and dangerous for public health leaders to conclude that the problem is temporary and that immunization coverage declines will automatically be reversed with status quo programming as COVID-19 pandemic restrictions are lowered.

Even before the pandemic, vaccination rates were plateauing after decades of steady increases. Expanded programs on immunization have largely served the families and households that are easiest to reach. Meanwhile, families living in extreme poverty, under the shadow of active conflict, or those who had been displaced are frequently deprived of immunization and other essential services such as nutrition, education, and sanitation. As a result, millions of children remain “zero-dose,” having not received any lifesaving vaccinations.

The truth is that progress on global targets set under Immunization Agenda 2030, the Sustainable Development Goals, and the Gavi 5.0 Strategy is moving in the wrong direction. Maintaining the status quo on immunization is not an option — it is time for a BRAVE and BOLD approach that puts the people with the most impact on vaccination decisions at the center of efforts to reach and vaccinate those who are perennially left behind.