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Considerations to tackle barriers to childhood immunization and leaving no one behind from vaccination protection

Understanding, Addressing Challenges to Ensuring Everyone Fully Benefits from Vaccines

When we are bombarded with statistics, charts, and graphs that sound alarms about our vaccination progress, it might be difficult for some to grasp on the relevance of these numbers. In order to build a healthier world through immunization, we must first understand the barriers that stand in our way. Let’s get to know the reasons behind these barriers by taking a closer look at the figures.

UNICEF released the Flagship State of the World’s Children report this April, revealing the continued devastating effects of the COVID-19 pandemic on childhood immunization coverage. The world lost nearly a decade of progress, with one in five children being under-vaccinated or zero-dose. The report also illustrated that outbreaks of previously controlled diseases like polio, cholera, and measles, are on the rise.

More recently, released WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) data showed that while vaccine coverage for immunizations critical to preventing childhood deaths demonstrated some recovery in 2022, inequities within and across regions are significant. Of 73 countries that reported substantial declines in coverage during the pandemic, 39 of them are now recovering or recovered, but a whopping 34 are still stagnant or declining. Progress from high-income countries with large infant populations overshadows the struggling numbers of low-income countries. So, what stands in their way?

Countries’ Unique Stories on Immunization

Each country tells a unique story of immunization barriers. Adetola Bademosi, a journalist and fellow of the IWMF & Sabin Global Health Reporting Initiative, cites cold-chain infrastructural issues as a factor contributing to Nigeria’s low vaccination coverage. She notes that gaps in electricity access and delivery distance have made vaccine transportation to remote communities difficult, with COVID-19 only emphasizing these barriers.

On Sabin’s “Community Conversations on Vaccines” podcast, Dr. Aamer Ikram, chief executive officer for the National Institutes of Health Pakistan, explains how devastating flooding in Pakistan following the pandemic further decreased immunization coverage. With 30 million people displaced, cholera outbreaks became an emerging concern in addition to the disruptions in immunization delivery.

Another piece of the immunization puzzle has been vaccine acceptance challenges. The State of the World’s Children Report detailed research indicating a decline in vaccine confidence in 52 out of the 55 countries studied following the COVID-19 pandemic. UNICEF attributes this decrease to “uncertainty about the response to the pandemic, growing access to misleading information, declining trust in expertise, and political” polarization.

These findings are reflected in the local experience of immunization. Bademosi’s cold-chain article reports that even when barriers to access are overcome in Nigeria, health workers are then faced with “patients’ biases” against immunisation.” In his podcast episode, Dr. Ikram discusses the context-driven nature of vaccine hesitancy in local communities.

In another episode of Sabin’s podcast, University of Guatemala researcher Daniela Da’Costa Franco points out that much of the vaccine mistrust around the COVID-19 vaccination in Indigenous Guatemalan communities had a legitimate basis. The biomedical healthcare system has its roots in a historically harmful colonial system, and she adds that “it is important to not forget that there were a lot of unethical practices by several doctors and research institutions not so long ago.” She says the fight has now shifted from a promotion of the COVID-19 vaccine to a push for childhood immunization, but the vaccine acceptance issues still linger in these communities.

Listen to Communities to Boost Immunization

Fortunately, there are a number of tools to combat barriers to bolster vaccination coverage. Da’Costa Franco describes a four-phase project to develop a deeper understanding of the cultural, contextual, and historical perspectives of communities. On the podcast with Franco, UNICEF’s Senior Adviser for Social and Behaviour Change/Team lead for immunization demand Deepa Risal Pokharel emphasizes the importance of understanding community perceptions of vaccines, and in translating this social data into tailored and human-centered solutions. Experts highlight that one of the most effective ways of doing so is through community-conscious communication.

Risal Pokharel emphasizes the potential of digital media to rapidly reach millions of people and to monitor community perceptions, which has  allowed for targeted and informative vaccine messages to be distributed. Dr. Ikram issued a similar sentiment for the importance of reaching both community members and community health workers to circulate evidence-based information at a local level.

On the podcast with Dr. Ikram, Rukaya Mumuni, Ghana Health Service Public Health Officer and registered general nurse, reveals how Ghana’s 99% vaccination coverage for d diphtheria, tetanus and pertussis was a result of successful communication after understanding  concerns and fears of Ghanaian communities. “Ghana’s Expanded Program for Immunization has ensured that we educate all community members on vaccinations [and] the importance of vaccination schedules,” she says. She emphasizes the value of Ghanaian public health authorities circulating clear and consistent information on vaccines and addressing community concerns and misinformation.

The WHO recently announced a plan to address the COVID-19-exacerbated gaps in childhood immunization, coined “The Big Catch Up”. They state that “partners are working with countries to strengthen health care workforces, improve health service delivery, build trust and demand for vaccines within communities, and address gaps and obstacles to restoring immunization.”

Breaking the barriers to childhood immunization in communities that have been left behind is vital to building a healthier future for all people regardless of where they live.