Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization

Abstract

The 2021 WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) reported approximately 25 million under-vaccinated children in 2021, out of which 18 million were zero-dose children who did not receive even the first dose of a diphtheria-tetanus-pertussis-(DPT) containing vaccine. The number of zero-dose children increased by six million between 2019, the pre-pandemic year, and 2021. A total of 20 countries with the highest number of zero-dose children and home to over 75% of these children in 2021 were prioritized for this review. Several of these countries have substantial urbanization with accompanying challenges. This review paper summarizes routine immunization backsliding following the COVID-19 pandemic and predictors of coverage and identifies pro-equity strategies in urban and peri-urban settings through a systematic search of the published literature. Two databases, PubMed and Web of Science, were exhaustively searched using search terms and synonyms, resulting in 608 identified peer-reviewed papers. Based on the inclusion criteria, 15 papers were included in the final review. The inclusion criteria included papers published between March 2020 and January 2023 and references to urban settings and COVID-19 in the papers. Several studies clearly documented a backsliding of coverage in urban and peri-urban settings, with some predictors or challenges to optimum coverage as well as some pro-equity strategies deployed or recommended in these studies. This emphasizes the need to focus on context-specific routine immunization catch-up and recovery strategies to suit the peculiarities of urban areas to get countries back on track toward achieving the targets of the IA2030. While more evidence is needed around the impact of the pandemic in urban areas, utilizing tools and platforms created to support advancing the equity agenda is pivotal. We posit that a renewed focus on urban immunization is critical if we are to achieve the IA2030 targets.

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review

“…Additional gender research is needed to include complex issues such as working parents, the link between health services and daycare, building on recent analysis in this space [ 32 , 33 ]. The interventions mapped in the analysis are only proposed interventions, and the efficacy and impact of the interventions remains a key research gap [ 34 ]. The issue of cost barriers was present across contexts and represents a significant future area of research.…”

Measuring National Immunization System Performance: A Systematic Assessment of Available Resources

“…Achievement of the IA2030 goals of reducing zero-dose children and improving equity of coverage across the life span will require identifying predictors of low coverage and selecting pro-equity strategies to address disparities, particularly in the context of COVID-19-related disruptions to immunization that have disproportionately affected poorer and more vulnerable populations. 71 The behavioral and social drivers of vaccination tools 66 help to fill this gap, as they collect data on gender and other demographic data to help explain what drives vaccine uptake. Further work to address this gap is needed, as is the need to understand the role of gender, diversity, and inclusion in strengthening decision-making about immunization.…”

Improving Urban Immunization and Reducing the Zero-dose Children: Results from Implementation Study in Dar es-Salaam, Tanzania

“…Although aggregate coverage levels are usually higher in urban than in rural areas, they tend to mask huge gaps. Disaggregated data often shows that coverage in the slums and peri-urban areas within cities is as bad as that in rural areas [11]. Difficulties in accessing immunization services because of distance to reach the health facilities, costs, and time are some of the main barrier that affects migrants, residents of in-formal settlements, and urban poor populations [12].…”