Immunization programs to support primary health care and achieve universal health coverage

Primary Health Care structure and vaccination coverage in Brazilian municipalities

OBJECTIVES

To investigate the relationship between vaccination coverage indicators and the structure of primary care for immunization in Brazilian municipalities.

METHODS

This was a time series ecological study using data from the National Immunization Program Information System (SI-PNI) and the National Program for Improving Primary Care Access and Quality (PMAQ) over three evaluation cycles. A total of 13 variables were assessed, five of which related to the structure of basic health units (BHU) and eight to the availability of immunobiologicals. Analyses of comparisons, associations, and longitudinal models were carried out to assess the influence of these indicators on vaccination coverage levels.

RESULTS

The variables and indicators related to the structure of BHUs, the availability of immunobiologicals in Brazilian municipalities and vaccination coverage showed significant variations over the cycles. BHU structures ranged from fair to good, with lower percentages in Cycle 1 and increases in Cycles 2 and 3 for most of the variables analyzed. The availability of immunobiologicals also improved over the cycles, despite a few exceptions. Indicators of adequate vaccination coverage increased from Cycle 1 to Cycle 2 but decreased in Cycle 3. Improvements in the structure of the BHU and the availability of immunobiologicals were associated with higher adequate vaccination coverage. Keeping the availability of immunobiologicals fixed at good, the chance of having adequate coverage is 86.28% higher for a good structure compared to a poor one.

CONCLUSIONS

Changes in the structure of municipal BHUs and in the availability of immunobiologicals over the cycles evaluated were identified and were associated with higher vaccination coverage when they occurred simultaneously (good availability of immunobiologicals and regular or good structure in BHUs). This highlights the importance of the quality of primary care in achieving vaccination coverage targets in Brazilian municipalities.

Building an integrated healthcare system of China: an assessment of coupling coordination between disease prevention, medical services, and healthcare financing from 2012 to 2021

BACKGROUND

Universal Health Coverage (UHC) is a central component of the Sustainable Development Goals, and integrated healthcare is recognized as a key pathway to achieving UHC. China's healthcare reform, aimed at realizing the "Healthy China 2035" goal, faces challenges in ensuring the coordinated development of disease prevention, medical services, and healthcare financing. However, empirical research assessing the integration of these three systems in China is scarce.

PURPOSE

This study aims to assess the coupling and coordination between disease prevention, medical services, and healthcare financing in China from 2012 to 2021, with the goal of providing a comprehensive evaluation of the progress made in building an integrated healthcare system.

METHODS

The study employs the Entropy Weight Method (EWM) to determine the weight of each system index, followed by the Coupling Coordination Degree Model (CCDM) to measure the coordination among the three components. The Grey Correlation Analysis (GCA) is used to identify key driving factors, and the Grey Prediction Model (GM (1.1)) is applied to forecast future trends of integrated healthcare development across Chinese provinces.

RESULTS

The coupling coordination degree of the three systems ranged from 0.12 to 0.73 from 2012 to 2021, reflecting a shift from moderate imbalance to mild imbalance over time. Regional disparities were observed, with eastern provinces showing higher levels of integration than western provinces. The disease prevention subsystem emerged as the primary constraint to the overall integration process. Most regions exhibited a consistent upward trend in the coupling coordination index, though development speeds varied significantly across provinces.

CONCLUSION

While China's integrated healthcare system has shown progress, there is still considerable room for improvement. Strengthening disease prevention efforts is critical to enhancing the overall coordination of the healthcare system. This study provides valuable insights for other developing countries facing similar challenges in healthcare integration.

Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance

There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.

Advancing Immunization in Africa: Overcoming Challenges to Achieve the 2030 Global Immunization Targets

African immunization programs are crucial in reducing the prevalence of infectious diseases and improving public health outcomes. This review provides an overview of the current status of immunization efforts in Africa, highlights key challenges, and offers recommendations to help the continent achieve the 2030 Global Immunization Goals. While progress has been made, significant challenges remain. For instance, the WHO African Region reports full immunization coverage at 56.5%, partial coverage at 35.1%, and zero immunization coverage at 8.4%. Between 2019 and 2021, approximately 67 million children in Africa did not receive routine vaccinations, with West and Central Africa particularly affected. DTP1 coverage remained stable at 80%, but DTP3 coverage saw a slight drop to 72% between 2021 and 2022. As of 2022, MCV1 coverage reached 69%, reflecting ongoing efforts against measles. Key barriers to vaccination include limited parental education, religious beliefs, inadequate healthcare systems, and vaccine hesitancy. Addressing these barriers requires community-driven approaches like door-to-door campaigns and mobile clinics. To reach the 2030 immunization targets, health systems must be strengthened, vaccine supply chains optimized, and financial resources-both domestic and international-expanded. The Immunization Agenda 2030 (IA2030) emphasizes data-driven decision-making, nation-ownership, and tailored strategies to overcome obstacles and raise immunization coverage among several demographic groups. Achieving these 2030 goals in Africa requires collaborative efforts to ensure equitable access to vaccines, address sociocultural challenges, and strengthen health system infrastructure.

National Immunization Program Decision Making Using the CAPACITI Decision-Support Tool: User Feedback from Indonesia and Ethiopia

To ensure that limited domestic resources are invested in the most effective interventions, immunization programs in low- and middle-income countries (LMICs) must prioritize a growing number of new vaccines while considering opportunities to optimize the vaccine portfolio, as well as other components of the health system. There is a strong impetus for immunization decision-making to engage and coordinate various stakeholders across the health system in prioritization. To address this, national immunization program decision-makers in LMICs collaborated with WHO to structure deliberation among stakeholders and document an evidence-based, context-specific, and transparent process for prioritization or selection among multiple vaccination products, services, or strategies. The output of this effort is the Country-led Assessment for Prioritization on Immunization (CAPACITI) decision-support tool, which supports using multiple criteria and stakeholder perspectives to evaluate trade-offs affecting health interventions, taking into account variable data quality. Here, we describe the user feedback from Indonesia and Ethiopia, two initial countries that piloted the CAPACITI decision-support tool, highlighting enabling and constraining factors. Potential immunization program benefits and lessons learned are also summarized for consideration in other settings.

How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework

BACKGROUND

Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual.

METHODS

We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience.

RESULTS

Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities.

CONCLUSIONS

Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.

Trends in public health emergencies in the WHO African Region: an analysis of the past two decades public health events from 2001 to 2022

The African Region reports the heaviest burden of public health emergencies globally. This paper presents an exploratory analysis of public health events data collected the past 22 years in the WHO Africa region, to explore patterns and trends that can inform public health strategies, policy changes and develop appropriate tools to improve disease surveillance, preparedness and response to public health emergencies. A suite of exploratory data analysis methods combining time series analysis, summary statistics, temporal visualisations, geographic information system (GIS) mapping, trend analysis and statistical tests were used to derive patterns and trends from the data. An in-depth analysis of zoonotic disease outbreaks by geography and time was explored. The analysis also focused on whether these outbreaks were viral haemorrhagic related or had other characteristics. Results reveal that between 2001 and 2022, a total of 2234 public health events have been recorded in the WHO African Region of which 1886 events (84.4%) were substantiated. The paper confirms an average of 102 public health events reported yearly during the last 22 years time frame. The large majority (92%) of the substantiated events were infectious diseases (n=1730), 30% (n=566) are zoonoses and 5% (n=95) are humanitarian crises such as disaster events and conflicts. The number of zoonotic disease outbreaks has significantly increased (by 87%) between the past two decades, from 2003 to 2012 period (M=18.6, SD=4.8) and 2013-2022 period (M=34.7, SD=14); t(18) = 3.4, p=0.0032. This analysis shows growing challenges faced in the Africa region every year. One-health approach and its coordination across multiple sectors, disciplines and communities is critical to achieve the objectives.

Achieving Universal Health Coverage in Low- and Middle-Income Countries: Challenges for Policy Post-Pandemic and Beyond

Background

Achieving universal health coverage (UHC) is critical for ensuring equity, improving health, and protecting households from financial catastrophe. The COVID-19 pandemic derailed the progress made across primary health targets. This article aims to review the policy challenges to achieve UHC in a post-pandemic world.

Methods

A narrative review of 118 peer reviewed and grey literature was conducted. A total of 77 published articles were identified using an electronic search in PubMed and Scopus and a bibliographic search of relevant literature. Another 41 Reports, websites, blogs, news articles, and data were manually sourced from international agencies (WHO, World Bank, IMF, FAO, etc.), government agencies, and non-government organizations.

Findings

The challenges were identified and discussed under five broad findings: i) weak public health care systems ii) challenges to building resilient health systems, iii) health care financing and financial risk protection, iv) epidemiological and demographic challenges, and v) governance and leadership.

Conclusion

LMICs in Africa and South Asia face significant challenges to achieving UHC by 2030. As countries recover from the pandemic's aftermath, significant investments and innovations are needed to ensure progress toward UHC. Efficient resource mobilization through internal accruals, international cooperation, and resource sharing is needed.