Beyond vertical and horizontal programs: a diagonal approach to building national immunization programs through measles elimination

Measles outbreak prevention and control among adults: Lessons from an importation outbreak in Yunnan province, China, 2015

“…This outbreak demonstrated that a rapid response, even with relatively high preresponse coverage, may be able to avert more cases. 20 Our investigation supports the concept of a "diagonal" approach to measles elimination 21 in which the visibility and high transmissibility of measles can help epidemiologists identify program areas to strengthen. Two program areas to strengthen are hospital infection prevention and control and adult susceptibility to measles.…”

Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya

“…In an era marked by increasing HIV burden among MSM/MSW (Baral et al, 2007;Beyrer et al, 2012;Lane et al, 2016;Singh et al, 2018;van Griensven et al, 2009), a population that exhibits high levels of (unmet) needs, our findings lend support to the importance for vertical programmes. The on-going debate in current literature on the investment in and effectiveness of vertical versus horizontal programmes often forges compromises, those that focus on integrated or diagonal approaches often aimed to strengthen fragile health systems (Behague & Storeng, 2008;Orenstein & Seib, 2016). Diagonal and horizontal approaches; however, can potentially risk further neglect of highly vulnerable and underserved populations by diverting specifically allocated HIV funds, especially at a time when future funding streams for these populations are uncertain (Grépin, 2011).…”

“…This article aims to contribute to extant literature by addressing gaps in our current understanding around general health and psychosocial characteristics of Kenyan MSM and MSW. Moreover, we expand on our initial focus on HIV prevention in the analysis of the findings by considering the following: (1) the potential importance of key populations organisations in a socio-political milieu such as Kenya, (2) the related implications on capacitating these on-the-ground advocacy centres, and (3) the significance and contributions of our findings to the on-going debate in current literature on the investment in and effectiveness of vertical versus horizontal programmes (Atun et al, 2008;Behague & Storeng, 2008;Orenstein & Seib, 2016).…”

Improving the Science of Measles Prevention—Will It Make for a Better Immunization Program?

“…These measles resurgences served as indicators for shortcomings in the overall immunization program and acted as an impetus for change, leading to measles elimination in the US in the year 2000 [ 11 ]. Additionally, the cyclical nature of measles periodically “resets” the social norms for acceptable levels of disease and triggers new and innovative interventions [ 12 ]. For example, the 2015 measles outbreak had fewer than 1,000 cases, minor compared to previous resurgences.…”

“…Moving away from independent, “vertical” operation and focusing on integration with national programs speaks to country ownership, shared responsibility, partnership, and sustainability, guiding principles of the plan. Measles programs provide an opportunity to institute a “diagonal” approach [ 12 ], in which it is possible to leverage resources available to vertical programs such as measles to deliver other health services and strengthen overall health systems. While implementing additional SIAs based on trigger indicators may provide a scientific advantage, focusing on strengthening overall routine immunization programs will have lasting benefits beyond measles alone.…”