The path to strengthening immunization systems requires innovative technical assistance approaches to learning and capacity building. A recent correspondence in The Lancet proposes peer learning in immunization programmes as a crucial mechanism for achieving the goals of the Immunization Agenda 2030 (IA2030), arguing for “an intentional, well coordinated, fit-for-purpose, data-driven, and government-led immunisation peer-learning plan of action.” This proposal merits careful examination, particularly as immunization programmes face complex challenges in reaching 2030 goals.
Learn more: 50 years of the Expanded Programme on Immunization (EPI)
Beyond traditional knowledge exchange
The Lancet commentary identifies several key rationales for peer learning in immunization.
- First, “immunisation policy makers operate in dynamic sociopolitical and economic contexts that often compel quick decision making.” In such environments, peer knowledge becomes crucial “when research evidence is scarce.”
- Second, the authors recognize that “contextual factors in immunisation systems are constantly interacting to exhibit emergent behaviour and self-organisation,” necessitating constant adaptation of technical approaches.
These insights point toward an important truth: traditional approaches to knowledge sharing – whether through technical guidelines, formal training, or policy exchange – remain necessary but increasingly insufficient for today’s challenges.
The question becomes not just how to share what we know, but how to systematically generate new knowledge about what works in different contexts.
Complementary approaches to peer learning in immunization programmes
While government counterparts learning from each other offers valuable benefits for policy coordination and strategic alignment, implementation challenges are situated – and solved – at the local levels. This call for complementary peer learning approaches. Three stand out as particularly critical:
- First, the persistent gap between national planning and local implementation suggests the need for systematic learning about how policies and strategies are turned into effective, community-led and -owned action on the ground.
- Second, as programmes work to sustain coverage gains beyond campaign-based interventions, they need reliable mechanisms for identifying and spreading effective practices for routine immunization.
- Third, the continuous influx of new staff into EPI teams creates an ongoing need for rapid capacity building that goes beyond technical training to include development of professional networks and practical implementation skills.
From reporting challenges to creating implementation knowledge
A crucial distinction emerges between simply documenting implementation challenges and systematically creating new knowledge about effective implementation. This difference parallels the distinction in epidemiology between case reporting and analytical epidemiology.
When health workers report challenges, they might note that coverage is low in remote areas due to transport limitations, staff shortages, and cold chain issues. This provides valuable surveillance data but does not necessarily generate actionable knowledge. In contrast, systematic analysis of successful remote area coverage can reveal specific transport solutions that work, staff deployment patterns that succeed, and cold chain adaptations that enable reach.
This shift from reporting to knowledge creation requires careful structure and support. Just as analytical epidemiology employs specific methods to move from observation to insight, systematic peer learning needs frameworks and processes that enable pattern recognition, cross-context learning, and theory building about what works.
Enabling systematic learning at scale
Recent experience demonstrates the feasibility of systematic peer learning at scale. For example, Gavi-supported country-led initiatives facilitated by The Geneva Learning Foundation (TGLF) in Côte d’Ivoire and Nigeria, health workers from districts and facilities shared specific strategies through structured processes, they collectively generate new knowledge about effective implementation. Launched in 2022 with support from Wellcome, the Movement for Immunization Agenda 2030 (IA2030) has demonstrated that such ground-level learning, when properly captured and analyzed, provides crucial insights for national planning.
Consider the introduction of new vaccines. When thousands of practitioners share specific experiences about what enables successful introduction, patterns emerge that might be missed in smaller exchanges or formal evaluations. These patterns help reveal not just what works, but how solutions adapt and evolve across contexts.
Supporting new EPI staff through networked learning
The challenge of rapidly building capacity when new staff join EPI teams highlights the potential value of structured peer learning. Training approaches like Mid-Level Management (MLM) Training provide essential technical foundations, and have been able to reach more professionals by moving online. However, new staff also need to rapidly build professional networks and learn from peers facing similar challenges.
A cohort-based approach combining technical training with structured peer learning can accelerate both capability development and network formation. This helps new staff analyze local challenges, identify priorities, and access peer support for implementation. Cross-country learning opportunities are particularly valuable for young professionals, enabling them to build relationships beyond hierarchical constraints.
From vaccination campaigns to sustainable primary health care systems that integrate routine immunization
For immunization programmes work to sustain coverage gains beyond campaign-based interventions, peer learning networks are needed to support the transition to stronger routine immunization systems. By connecting practitioners across health system levels, these networks help identify and spread effective practices for reaching families through regular services.
This network-based approach complements formal exchange mechanisms by creating multiple pathways for knowledge flow:
- Ground-level innovations inform national strategy through systematic capture and analysis
- Peer feedback helps practitioners adapt solutions to local contexts
- Implementation experiences create evidence about what works and why
- Cross-level dialogue strengthens connections between policy and practice
Peer learning embedded into government-owned health systems
This peer learning approach does not replace traditional technical assistance, capacity building, or policy exchange. Rather, it transforms them by creating new connections between levels and actors in health systems. While formal exchanges remain crucial for policy coordination, structured peer learning adds vital capabilities:
- Granular understanding of implementation challenges while maintaining systematic rigor in knowledge capture;
- Documentation of practical innovations while creating frameworks for adaptation across contexts; and
- Evidence-based feedback loops between policy and practice.
Success requires careful attention to structure. Through carefully designed processes, practitioners engage in cycles of sharing, feedback, connection, and action. This structure is not bureaucratic control but scaffolding that supports genuine knowledge creation and application.
Looking forward
The World Health Organization’s Executive Board has highlighted widening inequities between and within countries as a critical challenge for immunization programmes. In the African region particularly, where many countries are introducing new vaccines while working to strengthen basic immunization services, innovative approaches are needed.
New evidence from recent large-scale peer learning initiatives suggests that structured approaches can help bridge the gap between strategy and implementation while strengthening both. Success requires investment in learning processes and support structures – but the potential rewards, in terms of accelerated progress and improved outcomes, make this investment worthwhile.
This offers a concrete path toward what WHO calls for: “grounding action in local realities.” By systematically connecting learning across health system levels while maintaining rigorous standards for evidence and implementation support, we can create learning systems that effectively link regional strategy with local innovation and action.
The future of immunization capacity building lies not in choosing between formal exchanges and practitioner networks, but in thoughtfully combining them to create comprehensive learning systems. These systems can drive rapid improvement while strengthening health systems as a whole – an essential goal as we work toward ambitious immunization targets for 2030 and beyond.
Reference
Adamu AA, Ndwandwe D, Jalo RI, Ndoutabe M, Wiysonge CS. Peer learning in immunisation programmes. The Lancet [Internet]. 2024 Jul; 404(10450):334–5. Available from: https://doi.org/10.1016/S0140-6736(24)01340-0
Jones, I., Sadki, R., Brooks, A., Gasse, F., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Movement Year 1 report. Consultative engagement through a digitally enabled peer learning platform (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7119648
Image: The Geneva Learning Foundation Collection © 2024