Strengthening Immunization Systems: Making a Difference, SustainablyPosted on by
I came to CDC to make a difference.
I am the team lead of the Routine Immunization Team (RIT) which is part of CDC’s Global Immunization Division. GID is well known for the essential role it plays in eradicating polio and eliminating measles/rubella. The goal, and driving memory, is to replicate the historic eradication of smallpox, an achievement that is among the top-tier events in public health history.
The goal for the Routine Immunization Team is no less lofty and in many respects is equally challenging even if it’s less well known. Our mission is to strengthen immunization programs around the world to ensure that the crucial foundation for preventing disease is maintained and even strengthened.
For countries to have a successful routine immunization program, they need a comprehensive and holistic approach. There must be an adequate vaccine supply, logistics, service delivery, and surveillance. Effective communication to explain the benefits to an occasionally wary public is also needed—so are consistent and dedicated financing and nimble management.
There are no quick fixes to establishing a routine immunization system. Our team works tirelessly to address system issues related to immunization programs even though the impact may not be easily visible in the short term.
The birth of most routine immunization programs is a legacy achievement of smallpox eradication. The Expanded Programme on Immunization (EPI) was inspired in 1974 by the success of smallpox eradication and was based on the philosophy that all children should have access to life-saving vaccines.
The success is unmistakable. In 1980, only 5% of infants worldwide were vaccinated compared with 83% in 2012. Routine immunization programs are often the foundation of public health programs in many countries. Our team has worked to build on this success by conducting research on the benefits of combining straightforward immunization services with other public health interventions such as malaria bed net distribution.
There’s also this undeniable fact: the work is neither routine nor is it done on a small scale. The focus is on these 17% of infants worldwide who are deemed to be “under-vaccinated.” That translates to over 22 million infants each year.
Reaching them is the most daunting challenge for routine immunization programs. RIT is exploring new and innovative approaches, such as using biometric (fingerprinting) data, to more accurately document and track vaccinations of children in real time as well as expanding the private sector’s role in delivering immunization services.
There’s another obstacle too.
Many programs have been the victims of their own success. Complacency has led to neglect, budget cuts, deteriorating infrastructure, and a shortage of well-trained staff in national immunization programs as well as throughout overall health systems.
Yet, at the same time, new vaccines with large potential impact are continually being added into these strained routine immunization programs. While many at CDC and elsewhere work tirelessly toward developing potentially high-impact vaccines against HIV, tuberculosis, malaria, and avian flu, our small team works hard to ensure that there’s a functional system to vaccinate people with these vaccines when they become available.
Immunization programs are forced to juggle a lot—routinely.
RIT is increasing our efforts to strengthen immunization systems, such as through capacity building. The effort ranges from institutionalizing regular training each month in places like Rajasthan, India to overseeing a large field mentoring project in East Africa. It means innovations such as a test program in Uganda known as Strengthening Technical Assistance for Routine Immunization Today (START). It provides on-the-job training of district immunization staff. RIT hopes that training and mentoring can be braided into routine immunization systems to make them self-sustaining and effective.
There is reason for optimism about the future of routine immunization.
Large-scale donors, such as the Bill and Melinda Gates Foundation and the GAVI Alliance, are increasingly emphasizing the importance of investing in maintaining and enhancing routine immunization systems. As the Global Polio Eradication Initiative nears its endpoint and as the Measles & Rubella Initiative builds momentum, each is increasingly recognizing the importance of strengthening routine immunization systems though their activities.
It’s a future that is exciting and rich with promise for improving the health of millions of people. And that is the polar opposite of routine.