WHO’s 154th Executive Board meeting provided a sobering picture of how the COVID-19 pandemic reversed decades of progress in expanding global immunization coverage and controlling vaccine-preventable diseases.
- Over 3 million more zero-dose children in 2022 compared to 2019 and widening inequities between and within countries.
- Africa in particular suffered a 25% increase in children missing out on basic vaccines.
- Coverage disparities grew between the best- and worst-performing districts in the same countries that previously made gains.
In response, the World Health Organization is calling for action “grounded in local realities”.
Growing evidence supports fresh approaches that do exactly that.
Tom Newton-Lewis is part of the community of researchers and practitioners who have observed that “health systems are complex and adaptive” and, they say, that explains why top-down control rarely succeeds.
- The claim is that directive performance management—relying on targets, monitoring, incentives and hierarchical control—is largely ineffective at driving outcomes in low- and middle-income country health systems.
- By contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams for improvement.
However, top-down control and directive management appear to have been key to how immunization programmes achieved impressive results in previous decades.
Hence, it may be challenging for the current generation of global immunization leaders to consider that enabling approaches that leverage intrinsic motivation, foster collective responsibility, and empower teams – especially for local staff – are the ones needed now.
One example of an enabling approach is the Movement for Immunization Agenda 2030 (IA2030).
This is a locally-led network, platform, and community of action that emerged in March 2022 in response to the Director-General’s call for a “groundswell of support” for immunization.
In Year 1 (report), this Movement demonstrated the feasibility of establishing a large-scale peer learning platform for immunization professionals, aligned with global IA2030 goals. Specifically:
- Over 6,000 practitioners from 99 countries joined initial activities, with 1,021 implementing peer-reviewed local action plans by June 2022.
- These participants generated over half a million quantitative and qualitative data points shedding light on local realities.
- Regular peer learning events known as Teach to Reach rallied tens of thousands of national and sub-national immunization staff, defying boundaries of geography, hierarchy, gender, and job roles in collaborative sessions with each other, but also with IA2030 Working Groups.
By September 2022, over 10,000 professionals had joined the Movement, turning their commitment to achieving IA2030 into context-specific actions, sharing progress and results to encourage and support each other.
In Year 2, further evidence emerged on participant demand and public health impacts:
- By June 2023, the network expanded to 16,835 members across over 100 countries.
- Some participants directly attributed coverage increases to the Movement (see Wasnam Faye’s story and other examples), with many sharing a strong sense of IA2030 ownership.
Overall, the Movement has already demonstrated a scalable model facilitating peer exchange between thousands of motivated immunization professionals during its first two years.
- Locally-developed solutions are proving indispensable to practitioners, to make sense of generalized guidance from the global level.
- Movement research confirmed that “progress more likely comes from the systematic application and adaptation of existing good practice, tailored to local contexts and communities.”
- Connecting local innovation to global knowledge could be “instrumental for resuscitating progress” towards more equitable immunization, especially when integrated into coordinated action across health system levels.
- It could be part of a teachable moment in which global partners learn from local action, rather than prescribe it.
The Movement has already been making sparks. It will take the fuel of global partners to propel it to accelerate progress in new ways that could meet or exceed IA2030 goals.