Stories

Tag: COVID-19

  • Widening inequities: Immunization Agenda 2030 remains “off-track”

    Widening inequities: Immunization Agenda 2030 remains “off-track”

    The WHO Director General’s report to the 154th session of the Executive Board on progress towards the Immunization Agenda 2030 (IA2030) goals paints a “sobering picture” of uneven global recovery since COVID-19.

    As of 2022, 3 out of 7 main impact indicators remain “off-track”, including numbers of zero-dose children, future deaths averted through vaccination, and outbreak control targets.

    Current evidence indicates substantial acceleration is essential in order to shift indicators out of the “off-track” categories over the next 7 years.

    While some indicators showed recovery from pandemic backsliding, the report makes clear these improvements are generally insufficient to achieve targets set for 2030.

    While some indicators have improved from 2021, overall performance still “lags 2019 levels” (para 5).

    Specifically, global coverage of three childhood DTP vaccine doses rose from 81% in 2021 to 84% in 2022, but remains below the 86% rate achieved in 2019 before the pandemic (para 5).

    The number of zero-dose children fell from 18.1 million in 2021 to 14.3 million in 2022. However, this number is still 11% higher compared to baseline year 2019, when there were 12.9 million zero-dose children (para 10).

    Furthermore, the report stresses that recovery has been “very uneven” (para 6), with minimal gains observed in low-income countries:

    “As a group, there was no increase in DTP3 coverage across 26 low-income countries between 2021 and 2022.” (para 6)

    Regions are also recovering unevenly, especially Africa.

    “In the African Region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019.” (para 6)

    Inequities within countries also continue expanding, with gaps widening “between the best-performing and worst-performing districts” since 2019 (para 6).

    The top priorities (para 34) include:

    1) “Catch-up and strengthening” immunization activities
    2) “Promoting equity” to reach underserved communities
    3) “Regaining control of measles” with intensified responses
    4) Advocacy for “increased investment in immunization, integrated into primary health care”
    5) “Accelerating new vaccine introduction” in alignment with WHO recommendations
    6) “Advancing vaccination in adolescence” such as HPV vaccine introduction

    The report stresses that “coordinated action” on these priorities can get countries back on track towards IA2030 targets in the wake of COVID-19 disruptions (para 27).

    What is needed, says WHO, is “grounding action in local realities” (para 32) to reach underserved areas thus far left behind.

    Given this context, this document asks: “What actions can global partners take to support countries to accelerate progress in the six priority areas highlighted?” (para 37).

    In response, WHO contends that “the operational model under IA2030 must continue shifting focus to the regional level, to facilitate coordinated and tailored support to countries.”

    It is unclear how devolution to the regional level could truly respond to highly localized barriers and enablers.

    Such a claim may best be understood with respect to the internal equilibrium between WHO’s Headquarters (HQ) and the Regional Offices, with IA2030 being initially driven by HQ.

    What other changes might be needed? And what are the barriers that might hinder global immunization partners from recognizing and supporting such changes?

    Reference: Tedros Adhanom Ghebreyesus, 2023. Progress towards global immunization goals and implementation of the Immunization Agenda 2030. Report by the Director-General, Executive Board 154th session Provisional agenda item 9. World Health Organization, Geneva, Switzerland.

    Illustration: The Geneva Learning Foundation Collection © 2024

  • What works in practice to build vaccine confidence?

    What works in practice to build vaccine confidence?

    This is the content of a poster about vaccine confidence presented today by The Geneva Learning Foundation (LinkedIn | YouTube | Podcast | X/Twitter) at the International Social and Behavior Change Communication Summit 2022 (#SBCCSummit) held 5-9 December 2022 in Marrakech, Morocco. What is the Geneva Learning Foundation? Get the full report… Read the preface by Heidi Larson…

    Vaccine confidence: from responding to the initial shock of the pandemic to preparing COVID-19 vaccine introduction

    Over 6,000 health professionals joined the COVID-19 Peer Hub in July 2022, part of the Geneva Learning Foundation’s (TGLF) global immunization learning-to-action platform.

    • From August to October, they focused on developing and implementing recovery plans.
    • In November 2020, members of the COVID-19 Peer Hub decided to launch a reflective exercise to prepare COVID-19 vaccine introduction, after three months on early recovery implementation.
    • The exercise took place between 9 November and 18 December 2020.

    We asked a simple question in relation to vaccine confidence: Can you think of a time when you helped an individual or group overcome their initial reluctance, hesitancy, or fear about vaccination?

    • Each participant developed a case study to describe and analyze such a situation.
    • They then peer reviewed each other’s case studies, giving and receiving feedback to learn from each other.

    Who participated?

    Local practitioners from 86 countries joined this peer learning exercise about vaccine confidence:

    • 81% (n=591) in West and Central Africa
    • 11% (n=80) in Eastern and Southern Africa
    • 6% (n=43) in South Asia

    Health system levels:

    • 18% (n=131) national
    • 29% (n=213) sub-national
    • 29% (n=214) district
    • 20% (n=144) facility

    So what?

    What was the significance of the experience for participants?

    Transformation: “I can tell you this experience changed my life. It has changed my practice and made me think differently about the way I work, considering things I did not think about before.”

    Defying boundaries: “It was a opportunity like I have never had before… I have studied with peer from my country. Having a lot of people from other countries sharing their experience was something else.”

    What we learned from local practice about vaccine confidence

    1. Vaccine hesitancy is a complex problem that blanket recommendations or prescriptive guidelines are unlikely to solve.
    2. Instead, we should strive to recognize that solutions must be local to be effective, leveraging the ability of local staff to adapt to their context in order to foster confidence and acceptance of vaccines.
    3. Supporting health workers, already recognized as trusted advisors to communities, requires new ways of listening and learning.
    4. It also requires new ways of fostering, recognizing, and supporting the leadership of immunization staff who work at the local level under often difficult conditions.

    4 targeted intervention approaches that worked to strengthen vaccine confidence

    1. targeted individual counselling at the individual or household level;
    2. community outreach for larger groups;
    3. formal meetings (usually for community and religious leaders); and
    4. organized training sessions in which particular subgroups were involved (e.g., training for religious teachers, health workers, youth groups, women’s groups).

    2 key determinants that changed minds and behaviors about vaccine confidence

    1. The tone and delivery of the interventions were as critical to the success of the immunization as the activities themselves.
    2. The positive effect of using multiple approaches: high degree of understanding and compassion; navigating sensitive dynamics, grieving families, and issues related to vulnerable communities affected by displacement or war.

    Anthrologica performed the qualitative analysis of the case studies and developed the report for the Geneva Learning Foundation.

  • Heidi Larson: “So much remains determined by the capacity of people on the frontlines to explain, advocate, and respond in ways that are almost entirely dictated by context”

    This is the preface by Heidi Larson for the report “Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers”. This report is presented today by The Geneva Learning Foundation (LinkedIn | YouTube | Podcast | Twitter) at the International Social and Behavior Change Communication Summit 2022 (#SBCCSummit) held 5-9 December 2022 in Marrakech, Morocco. What is the Geneva Learning Foundation? Get the full report… Read the preface by Heidi Larson…

    My own consciousness of the fragile equilibrium sustaining vaccine confidence came from working with immunization programmes and local health workers to defuse rumors that threatened to derail vaccination initiatives. Twenty years ago, this meant traveling to countries to meet, build relationships with, and work side-by-side with frontliners.

    Since that time, the corpus of research on the topic has grown tremendously. Elaborate behavioral science frameworks, supported by robust monitoring and evaluation, are now available to guide policy makers, donors, and other decision makers, for those who have the time and resources to implement them. 

    Nevertheless, there remains a gap in our understanding of how the complex dynamics of change actually happen, especially at the most local levels. For this we need to listen to the local experiences and voices of those at the front lines who can tell the real-life stories of how these complex dynamics are navigated.

    I found the idea of this report fascinating: 734 health professionals from all levels of the health system took time out from their demanding daily duties to reflect on their practice, describing and then analyzing a situation in which they successfully helped an individual or a group accept or gain confidence that taking vaccines would protect them from disease. Furthermore, they did this during four weeks of remote collaboration at a very crucial historical moment, months before the first doses of COVID-19 vaccine were to arrive in Ghana and Côte d’Ivoire.

    Reading this report, I experienced a sense of discovery. The stories shared reminded me of my early work with colleagues working at the local levels, and gave me renewed appreciation of   these health professionals who faced even greater challenges in the face of a deadly pandemic. I could feel how hard it is to remain that ‘most trusted adviser’ to communities, and how so much remains determined by the capacity of people on the frontlines to explain, advocate, and respond in ways that are almost entirely dictated by context, in this case a highly uncertain and evolving pandemic.

    I could also feel the tensions due to the imperfection of a participatory methodology that did not neatly fit the conventions and norms of expert-led research. Conventional research has seldom been able to access such local narratives, and even less so with such a large and diverse sample. Furthermore, the peer learning methodology used by the Geneva Learning Foundation meant that there was an immediate benefit for participants who learned from each other. Rather than research subjects or native informants, case study authors were citizen scientists supporting each other in the face of a common challenge. The scale, geographic scope, and diversity of contexts, job roles, and experiences are also strengths of this work. 

    Supporting health workers, already recognized as trusted advisors to communities, requires new ways of listening, new ways of supporting, new ways of measuring, documenting and learning.

    It also requires new ways of recognizing the leadership of immunization staff who work at local levels under often difficult conditions. 

    In some cases, it may actually be the lack of prescriptive guidelines that enabled local health staff to draw on their own creativity and problem-solving capabilities to respond to community needs.

    Rather than generalizations, we should therefore strive to recognize that solutions must be local to be effective, recognizing the ability of local staff to adapt to their context in order to foster confidence and acceptance of vaccines, and do all we can to support – letting them be the guide for future efforts.

    Heidi Larson, PhD
    Professor of Anthropology, Risk and Decision Science and
    Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine

  • Two false dichotomies: quality vs. quantity and peer vs. global expertise

    Two false dichotomies: quality vs. quantity and peer vs. global expertise

    The national EPI manager of the Expanded Programme for Immunization (EPI) of the Democratic Republic of the Congo (DRC), just addressed the COVID-19 Peer Hub Teams from DRC and Ivory Coast, saluting both teams for their effort to prepare and strengthen COVID-19 vaccine introduction. I am honored to have been invited and pleased to see how this initiative is not only country-led but truly owned and led by its participants.

    She has joined the Inter-Country Peer Exchange (reserved for COVID-19 Peer Hub Members) organized by the Peer Hub’s DRC Team to share rapid learning from COVID-19 vaccine introduction.

    In the room are immunization professionals, primarily those working for the Ministries of Health, directly involved in vaccine introduction from both countries and from all levels of the health system.

    Other COVID-19 Peer Hub country teams are organizing similar inter-country exchanges, in response to their own needs, building on what they have learned as Scholars about the value of digital networks to strengthen and accelerate their response to the pandemic, from recovery to vaccine introduction.

    Today’s exchange is reserved for COVID-19 Peer Hub Members from the two countries, following a public meeting on 27 March 2021. (Short recaps in French and in English are available below. The full recording of the inaugural 27 March 2021 exchange is available on The Geneva Learning Foundation’s social media channels.)

    The Inter-Country Peer Exchange is only possible because, in response to the pandemic in 2020, we co-designed the Peer Hub and rapidly doubled the size of what was already the largest platform for immunization managers. We combined the best of both worlds: the best available global technical expertise with the field-based expertise of thousands of participants.

    In this way, we do not need to choose between false dichotomies that seek to oppose quality to quantity or peer versus global expertise.

    COVID-19 vaccine introduction: Recaps below in English and French about the first COVID-19 Peer Hub Inter-Country Peer Exchange between the Peer Hub teams from the Democratic Republic of the Congo (DRC) and Ivory Coast