Progress and Promise: Compelling Reasons for Optimism in Immunization for the Year 2024

Last updated December 13, 2023

Written by: Lori Sloate, Senior Director of Global Health, United Nations Foundation


Judging from the headlines, 2023 was a rough year for immunization. Large and disruptive disease outbreaks were seen across the globe, mainly as a result of millions of children missing out on essential vaccines during the pandemic. Data released by WHO and UNICEF showed that routine immunization rates had started to improve since the beginning of the pandemic but not enough, with 21 million children still missing out on essential vaccines in 2022, and progress for certain antigens, countries, and regions has been particularly stunted.

However, 2023 was also the year when countries, partners, and communities rallied around The Big Catch-Up effort, launched during World Immunization Week in April, with the common goal of getting immunization rates back on track. All this hard work culminated in a December 7 decision by the Board of Gavi, the Vaccine Alliance to invest an initial $290 million to fully fund catch-up doses for children missed during the pandemic.

In Thanchi, Bangladesh, health assistant Ubahine Prue Marma and volunteer health worker Mahainue Marma travel to remote rural communities to deliver vaccination sessions. Their journey by boat is then followed by two or three hours of hiking to reach these remote communities. Photo: UNICEF/US CDC/Fabeha Monir

Such a decision does not happen either easily or impulsively. It took months of intense collaboration with ministries, who are ultimately responsible for planning catch-up, restore, and strengthening efforts in their countries. Moreover, donor countries on the Gavi Board conducted extensive legal consultations and negotiated with their capitals to repurpose funds originally intended for but not used by COVAX (the vaccines pillar of the Access to COVID-19 Tools Accelerator).

The World Health Organization (WHO), UNICEF, and Gavi colleagues have worked tirelessly since the beginning of the year to: develop a recovery plan and guidelines; coordinate the additional vaccine supply needed to reach previously missed children who are now two to five years old; and align national, regional, and global plans on a weekly basis through the “Recovery Task Team”. As plans came to the Task Team, it became clear that two significant barriers would impede the ability to reach missed kids: financial and national policies on immunization eligibility. WHO and UNICEF have been working directly with countries to help lessen these barriers. And, in a rare move, the Gavi Board has exceptionally waived its co-financing policy for catch-up vaccines in acknowledgement of the extraordinary financial constraints countries are facing.

Obed, 4, is vaccinated during the second round of the polio immunization campaign in Kisangani, the Democratic Republic of Congo. Photo: UNICEF/Jean-Claude Wenga

However, many countries still have national policies and corresponding vaccination schedules that only accommodate children up to two years of age. This means that kids have essentially been “aged out” of routine immunization schedules. While “surge” vaccines will now be made more readily available, the national policies must change to further allow health care workers to vaccinate older kids. Of the 28 priority countries with large numbers of missed kids, 20 now have polices in place or under development that will vaccinate up to five years of age. That leaves seven countries that still need to change the policy and one other that needs to put the policy into practice. These policies will have significant impact for routine immunization going forward, allowing missed kids to be accommodated in national immunization schedules.

We’ve already seen gains in some countries, particularly in India where over one and a half million previously missed kids have been reached since 2021. Lessons learned in India and the South Asia Region can help other countries and regions. For instance, the advocacy and communication platforms that were developed to address demand generation and help mitigate immunization disinformation and misinformation could help others facing this global challenge. In 2024, we expect to hear more about these initiatives and other stories showing inspirational progress.

Auxiliary Nurse Midwife Surekha Jadhav administered doses of Vitamin A and the Measles-Rubella vaccine to 9-month-old Jivika at the her home in Mesarwadi, India. Regular door-to-door visits by health workers aid in awareness and knowledge of the importance of immunization. Photo: UNICEF/US CDC/Anita Khemka

Turning to 2024, in these times of polycrisis, it is possible to find reasons for optimism when it comes to immunization. I believe we will see a lot of progress on many fronts. Having funding and supportive policies to now implement the catch-up and recovery efforts will provide the opportunity to reach more kids than ever. The anticipated pre-qualification of a second malaria vaccine will ensure adequate supply to meet the global demand for millions of doses, which would translate to millions of kids being protected from a disease that accounts for up to 40% of outpatient care in some countries. Efforts to scale up the HPV vaccine in more countries provides more reason to be hopeful. And finally, in December, Gavi’s Board also approved the establishment of the African Vaccine Manufacturing Accelerator (AVMA), a financing instrument that will make up to $1 billion available to support sustainable vaccine manufacturing in Africa.

All this is promising for the year ahead, and so we must now remain vigilant to make sure we rise to the occasion and reach all those missed kids with the tools we know are proven lifesavers.

About the Author

Lori Sloate is the Senior Director for Global Health at the UN Foundation. Prior to her work at the Foundation, Lori was the Deputy Director of Advocacy and Public Policy at Gavi, the Vaccine Alliance for four years. She also worked with the World Health Organization for nearly 10 years, working with ministries and partners and advocating for global campaigns around various health issues. She has worked with other UN agencies, such as UNESCAP in Bangkok and UNOPS in Vietnam. Lori has a Master’s Degree in intercultural and international management from the School for International Training in the United States and has studied economics and development at the University of Nice, France.

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