Future

Mass vaccination campaigns worked during the acute phase of the pandemic. But campaigns take up a lot of resources.

While they were needed and critical, they are an expensive way to deliver vaccines. They are also disruptive to essential national immunization programs. As COVID-19 settles further into the ebb and flow of life, we must find ways to counter it that can be maintained. Ways to provide vaccines that are integrated and part of everyday services. Health care that is truly accessible. Gavi, UNICEF and WHO are providing technical and financial support to countries for strategic integration to strengthen their primary health systems. They are also working to bring integrated COVID-19 vaccine delivery and basic health services to displaced people in countries such as the Democratic Republic of the Congo. The pandemic starkly showed the need for new approaches and new mindsets. One change will be shifting perspectives on vaccine delivery: from childhood to vaccines for all ages. Being able to successfully deliver vaccines to adults will help them now, and help countries better prepare for future health threats – and for future vaccines.

Health and care workers around the world are the indispensable motor of vaccine delivery – bringing vaccines where they need to go, with great effort.

They are often overworked and underpaid - sometimes they aren‘t paid at all. They are sometimes subject to violence and harassment. The majority are women, and many come from disadvantaged backgrounds. Yet, they are seen as essential workers. They deserve decent working conditions - protection, good management, formal recognition within the health system and fair pay. UNICEF and partners are supporting countries to strengthen and integrate community health systems into formal health systems, which will build their capacities for future pandemic preparedness and response.

The cold chain remains central to storing and transporting vaccines and prevents them from getting damaged and losing potency because of temperature excursions or deviations.

Advanced cold chain equipment found its way to many places during the pandemic where it had not been previously. It was the first, largest and fastest ultra-cold chain scale-up in history – financing, coordinating, assessing country needs, procuring and delivering a total of 1320 UCC freezers to 81 countries by 2022. This made the delivery of mRNA vaccines to low-and middle-income countries possible in a short period of time, with reinforcement of vaccine and waste-management capacity within the countries. 47 countries were also globally engaged in strategic planning for the solar electrification of approximately 30 000 health facilities to strength primary health services. Going forward, countries will need to assess the continued need for ultra-cold chain freezers, depending on COVID-19 vaccination activities in the respective countries, and take into consideration repurposing options as well as future pandemic preparedness.

That’s why we see initiatives like Africa CDC’s Pathogen Genomics Initiative. It made use of the COVID-19 emergency to boost training in genetic sequencing and data analytics, and to deliver equipment for hundreds of technicians and scientists around the continent. This should improve public health surveillance and scrutiny of disease outbreaks. Improved access to information is also seen at the country level, where partners are supporting countries in moving from paper-based systems to electronic immunization registries. These registries capture individual-level information on vaccines delivered; they display immunization performance information at health centre, sub-national, andnational levels. This means vaccination centres can easily verify vaccine uptake across groups, enabling them to reach those targeted. In Kenya and Uganda, the Africa Population and Health Research Center is working to develop a mobile-phone-based digital vaccine card. The pandemic spurred major leapfrogging in digital technologies for vaccination records and tracking analytics. Other advances include the use of geolocation within apps to track routine immunization coverage in rural and remote places. In the future, we’ll need more effective linking of data sources between and among organizations working to deliver vaccines. It’s necessary in order to act more quickly on information about country targets, demand and available stock. As we recover from the last pandemic and work to prevent a future one, continued investment in information systems for vaccination and disease surveillance is critical, including through strengthening community and primary health systems.

The Country Readiness and Delivery team (CRD) and COVID-19 Vaccine Delivery Partnership (CoVDP) made strides in developing systems and mechanisms to listen and respond to communities with agility, and generate evidence in order to understand barriers to uptake among specific groups.

These mechanisms have provided a foundation for future emergency preparedness. Investments in scaling people-centred approaches created an opportunity to co-create and co-design solutions with communities and has become an entry point for strengthening public health systems as a key community engagement strategy. More investments are needed to make vaccination easy and convenient. Additionally, communication around acceptance of vaccination by communities needs clearer messaging. Evidence must be presented in a compelling, people-centred way that encourages priority groups to value and seek recommended vaccines.