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Strengthening Global Immunization Strategies through Trust, Data, and Local Leadership

Bruce Gellin, MD, MPH — Former Senior Vice President/Chief of Global Public Health Strategy, Health, The Rockefeller Foundation
Perspective
Published DateApril 24, 2023
Read Time 6 Minutes

Vaccines are nothing short of miraculous. With a tiny amount of information, vaccines trigger our immune systems to develop defenses that neutralize deadly diseases – enabling us to prevent and even eradicate some of the worst illnesses in human history and protect the health and well-being of generations to come.

But vaccines don’t deliver themselves, so it is important that we pause, every year during World Immunization Week, to recognize the importance of the programs – and people – around the world that deliver these lifesaving tools.

While this is an opportunity to celebrate remarkable progress, this year we’re marking a different, but equally major milestone – though I’m sad to say it’s not a positive one: challenged by the pandemic and the many ways it interfered with routine immunization, countries around the world are experiencing the biggest sustained backslide in vaccine coverage in 30 years. To respond to this challenge, the World Health Organization and other immunization partners have launched The Big Catch-up, a campaign to rebuild hard-won progress on vaccination.

In no small way, my career has been driven by what I have witnessed, the transformative power of vaccines. But as the response to Covid-19 and the disruption of routine immunizations made clear, vaccines only save lives when they become vaccinations, and there are many obstacles that can hinder that process.

In 2022, The Rockefeller Foundation launched the Global Vaccination Initiative (GVI), a two-year investment to address immediate Covid-19 vaccination inequities facing low- and middle-income countries. Since then, the GVI has driven progress on vaccination by supporting leaders to build deep regional knowledge-sharing networks, derive insights from timely data, and communicate accurate information to vulnerable communities. While these lessons came in response to the Covid-19 pandemic, they are applicable to routine immunizations and the promise of health and well-being that they deliver.

As we head into the GVI’s second and final year, we’re applying many of lessons learned – among them, the importance of listening to communities, partnership, and most importantly trust – and the need to apply these principles to the health challenges we’re facing due to climate change.

Trust & Community Listening

The pandemic proved that accurate information is vital for vaccination uptake. As mis- and disinformation about vaccines have proliferated, communicating timely, accurate information became all the more urgent. Through GVI, we have seen the benefits of partnering with trusted messengers to communicate critical facts and counter the misinformation that influences vaccine acceptance.

Community Dialogue in Salima, Malawi, after cinema screening on cholera prevention, transmission and treatment. (Photo courtesy of UNICEF)

Trusted messengers played a key role in increasing vaccination rates in Zanzibar, where religious leaders have helped rebuild vaccine confidence. Workshops supported by GVI brought together leaders of many different faiths to identify misinformation and misconceptions about the Covid-19 vaccine. The leaders then worked to bridge the gap by co-creating toolkits with clear messaging to address community concerns, framing their communications within the context of their religious traditions. The impact was clear: from the initial implementation of this program in March 2022, vaccine demand in Zanzibar skyrocketed, and the rate of people fully vaccinated against Covid-19 .

In Malawi, the Covid-19 pandemic sowed seeds of distrust in the medical system and led many people not to seek care or get vaccinated during a recent climate change-fueled cholera outbreak. Through a grant to Risk Communication and Community Engagement (RCCE) Collective Service, GVI supported the scale of quality, community-led approaches to vaccination and to the public health emergency response—showing how community trust and effective communication extends far beyond vaccination and will be critical as communities grapple with climate-driven disease outbreaks.

 

 

Ministry of Health staff conduct a digital health assessment with Clinton Health Access Initiative partners at Steung Keo Commune, Kampot Province, Cambodia. (Photo courtesy of CHAI Cambodia)

Data & Digital Tools

Accurate, timely data are also vital for public health. To coordinate resources, track outbreaks, and monitor population health, we need a strong digital infrastructure. But, in too many places, paper-based record systems and disjointed databases slow the collection and sharing of invaluable health information.

In Ghana, efforts were underway before the pandemic to transform its health system with digital tools, but the Covid-19 pandemic rapidly increased Ghana’s need for tools to plan, implement, and monitor vaccination campaigns.

In Tanzania, our grantee partner PATH Digital Square hosted a workshop in Arusha with the Ministry of Health to design a digital repository for storing and archiving social and behavior change communication materials, including those aimed at increasing demand for childhood and routine immunization. The communications platform will serve as a central repository to store, search, and filter communications content and materials, and it will include functionality to allow new materials and content to be uploaded, reviewed, and approved in one centralized place.

In Cambodia, people living with hypertension and diabetes are at higher risk of serious complications from Covid-19. Cambodia has a large screening gap among adults for noncommunicable diseases (NCD), which accounts for 23 percent of all premature deaths in the country.

The Rockefeller Foundation, through the Clinton Health Access Initiative (CHAI), supports the Ministry of Health, Cambodia to deliver an integrated package of primary healthcare services that includes NCD screening and Covid-19 vaccinations.

The project enables community health workers and health centers to use digital registers to systematically identify and link to care under-vaccinated and at-risk populations living with NCDs. The model aims to simultaneously increase Covid-19 vaccine boosters through NCD service touch points and increase NCD screening/diagnosis through Covid-19 vaccine touch points.

Knowledge-Sharing Networks

Early in the pandemic we learned that even when communities face multidimensional challenges, collaboration is the key to finding innovative solutions.

That was the impetus behind the Vaccination Action Network (VAN), an inter- and intra-country knowledge sharing platform in Uganda, Tanzania, Kenya, and Malawi for health leaders to discuss vaccination uptake strategies.

Vaccination Action Network members discuss immunization challenges during a meeting in Nairobi, Kenya in October 2022.

Through VAN, ministry of health officials, implementing partners, and other key actors have come together to share successful approaches to increase vaccine rates in their communities. From training local vaccine champions to building databases with accessible vaccine resources – VAN projects have demonstrated how peer-to-peer networks can foster innovation and impact at scale, nurturing regional relationships along the way.

We saw the tremendous impact of VAN in Tanzania, where hyper-local outreach enhanced Covid-19 immunization campaigns: in the Njombe region, the percentage of the eligible population that was fully immunized increased from 17% to 79% after two campaigns, exceeding all targets set.

Looking Ahead

Vaccines are remarkable vessels of progress, hope, and health, and vaccination programs are the foundation of strong, resilient health systems. The challenges the global community has faced in vaccinating people throughout the Covid-19 pandemic foreshadow the challenges in global health that lie ahead: as our climate warms, we’ll face an increasing number of unprecedented crises that will make it more difficult to deliver care where it is needed most.

The GVI model– one that supports the sharing of accurate information, nurtures local leadership, and leverages data and digital tools for better health – can serve as a guide as we strive to protect people and health systems against the impacts of climate change.

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