Immunization

Programs
Dr Siene Oluwatosin Orogun
 Introduction
• Immunization programs are systematic efforts by public health authorities to vaccinate individuals within a
population to protect them from vaccine-preventable diseases.
• Key immunization programs play a vital role in public health by providing protection against various infectious
diseases.
• These programs typically include the administration of vaccines that can prevent illnesses ranging from seasonal
influenza to life-threatening diseases such as polio, measles, and diphtheria.
• Immunization is the process by which an individual's immune system is fortified against an agent (known as the
immunogen).
• When the immune system is exposed to molecules from disease-causing organisms (antigens) through vaccination, it
learns to recognize and fight them. This process either prevents the development of a disease or reduces its severity.
 Importance of Immunization
• Prevents Disease Outbreaks : Immunization is crucial in controlling and eliminating life-
threatening infectious diseases. Diseases like smallpox have been eradicated, and polio is on the
verge of eradication, thanks to extensive vaccination efforts.
• Protects Vulnerable Populations: Not everyone can be vaccinated, including very young infants,
those with certain allergies, or individuals with compromised immune systems. High vaccination
rates within a community provide herd immunity, indirectly protecting these vulnerable groups.
• Saves Lives and Reduces Disease Burden: Vaccination has significantly reduced the burden of
infectious diseases worldwide. It is one of the most cost-effective health interventions, preventing
millions of deaths each year.
 Components of Immunization
Programs
• These programs have several key components:
• Vaccine Development and Approval : Public health agencies collaborate with vaccine manufacturers to develop safe and effective vaccines.
Regulatory bodies like National Agency for Food and Drug Administration and Control ( NAFDAC) assess and approve vaccines for use.
• Vaccine Recommendations: The National Immunization Program in Nigeria is designed to ensure that all children and at-risk adults are
protected from vaccine-preventable diseases. This program is overseen by the National Primary Health Care Development Agency
(NPHCDA), which is responsible for the development and implementation of immunization policies in Nigeria.
• The vaccine schedules are recommended by experts in Pediatric Association of Nigeria( PAN) , in collaboration with others in UNICEF and
the WHO
• Vaccine Distribution : Vaccines are distributed to healthcare providers, clinics, and public health centers. Cold chain logistics are essential to
maintain the vaccines' integrity during transport and storage.
• Vaccination Infrastructure: Public health agencies establish vaccination clinics, often in healthcare facilities, schools, and community
centers, where trained healthcare professionals administer vaccines.
 Components of Immunization
• Education and Outreach: Public Programs
health campaigns inform the public and healthcare providers
about the importance of vaccination, vaccine safety, and the benefits of herd immunity.
• Vaccination Records: Vaccination records are maintained to track individuals' immunization
status and ensure they receive all recommended doses.
• Monitoring and Surveillance: Continuous monitoring and surveillance systems track vaccine
coverage rates, adverse events, and disease outbreaks to assess the effectiveness and safety of
immunization programs.
• Vaccine Access: Efforts are made to ensure equitable access to vaccines, including reaching
underserved populations and providing vaccines at no or reduced cost for those in need.
 Components of Immunization
Programs
• School Immunization Requirements: Many countries have policies requiring certain vaccines for
school entry to protect both individual students and the wider community.
• Catch-Up Vaccination: Programs may be in place to provide catch-up vaccinations for individuals
who missed doses or were not vaccinated according to the recommended schedule.
• International Collaboration: Global organizations like the World Health Organization (WHO)
coordinate efforts to ensure vaccination access worldwide, particularly in regions with limited
resources.
• Immunization programs have been highly successful in reducing the incidence of many serious
diseases, such as measles, polio, and influenza. They play a crucial role in public health by
preventing the spread of infectious diseases and protecting vulnerable populations, including
children, from severe illnesses and complications.
 Outreach and Education
Campaigns
• Outreach and Education campaigns are critical components of immunization programs, aiming to increase vaccination coverage
and acceptance among populations.
• These campaigns are designed to inform, educate, and motivate individuals to get vaccinated, thereby reducing the prevalence of
vaccine-preventable diseases

Objectives
• Increase Awareness: Educate the public about the importance of vaccines in preventing diseases.
• Build Confidence: Address vaccine hesitancy by providing clear, accurate, and science-based information about vaccine safety
and effectiveness.
• Promote Equity: Ensure equitable access to vaccines for all population segments, especially underserved and vulnerable groups.
• Facilitate Accessibility: Make information about where and how to get vaccinated easily accessible
 Strategies

• Tailored Messaging: Develop messages that resonate with specific target audiences, considering
cultural, linguistic, and socio-economic factors.
• Multi-Channel Communication: Utilize a variety of communication channels (social media, TV,
radio, print media, digital platforms) to reach a broader audience.
• Community Engagement: Involve community leaders, healthcare providers, and influencers in
spreading vaccine-related information to build trust and acceptance.
• Education Materials: Create and distribute educational materials (flyers, brochures, posters) that
address common concerns and questions about vaccines.
• Digital Platforms: Use websites, mobile apps, and social media to provide up-to-date information
on vaccination schedules, locations, and eligibility.
• Training for Healthcare Providers: Equip healthcare workers with the knowledge and skills to
communicate effectively about vaccines and address patient concerns.
 Importance of Immunization
• Prevents Antibiotic Resistance: By reducing the number of bacterial infections, vaccination helps slow
down the development of antibiotic resistance, a significant global health threat.
• Economic Benefits : Immunization programs save billions in healthcare costs and economic losses. By
preventing disease, vaccinations reduce healthcare spending and prevent loss of productivity due to illness
and disability.
• Supports Healthy Development: Diseases prevented by vaccines can lead to long-term health problems
affecting the brain, hearing, and overall development in children. Vaccination supports healthy growth and
development.
• Global Health Security : In a globalized world, infectious diseases can spread rapidly across borders.
Immunization is a key component of global health security, helping prevent the international spread of
contagious diseases.
 Benefits of Immunization
• Immunization offers numerous benefits, both directly to individuals who receive vaccines and indirectly to communities and societies
at large.
• These benefits contribute significantly to public health, economic savings, and the overall well-being of populations. Here are some
key benefits of immunization:
• Prevention of Disease and Disability
• Eradication of Diseases
• Economic Benefits
• Herd Immunity
• Improved Quality of Life
• Global Health Security
• Innovation and Research
 Goals for Immunization
• Global and national goals for immunization are designed to protect populations against vaccine-preventable diseases, aiming to achieve high
coverage levels and eradicate or control these diseases. Here's a detailed look at these goals:
Global Goals for Immunization
 World Health Organization (WHO) and Global Vaccine Action Plan (GVAP)**
• The WHO, along with partners, has established goals through the Global Vaccine Action Plan aiming to prevent millions of deaths through
more equitable access to vaccines by 2020, and now extending towards 2030 with the Immunization Agenda 2030 (IA2030).
• Key targets include achieving 90% national vaccination coverage and at least 80% vaccination coverage in every district or equivalent
administrative unit for all vaccines in national programs.
 Eradication and Elimination Goals
• Polio: The goal is the global eradication of poliovirus, building on the significant progress made since the Global Polio Eradication Initiative
(GPEI) began in 1988.
• Measles and Rubella: Reduce measles deaths and aim for regional elimination of measles and rubella in at least five WHO regions by 2030.
 Goals for Immunization
• Neonatal Tetanus: Eliminate maternal and neonatal tetanus globally, a goal nearly achieved but still requiring efforts in a few countries.
 Introduction of New Vaccines
• Support the introduction of new and under-utilized vaccines, such as those against rotavirus, human papillomavirus (HPV), and
pneumococcal disease, particularly in low- and middle-income countries.
National Goals for Immunization

• National immunization goals are tailored to the specific needs and circumstances of each country but generally align with global objectives.
They often include:
 Achieving and Maintaining High Coverage
• Aim to reach high vaccination coverage (usually >90%) for all routine childhood and adult vaccinations as per the national schedule.
 Goals for Immunization
 Strengthening Health Systems
• Enhance the capacity of health systems to deliver vaccines efficiently through improved cold chain logistics,
healthcare worker training, and public health infrastructure.
 Incorporating New Vaccines into National Programs
• Assess the disease burden, cost-effectiveness, and health system readiness to introduce new vaccines into the
national immunization schedule.
 Enhancing Surveillance and Response
• Strengthen disease surveillance systems for better detection and response to vaccine-preventable disease
outbreaks.
 Increasing Equity in Vaccine Access
• Address disparities in vaccine access and coverage across different regions, socio-economic groups, and
communities within the country.
 Public Engagement and Vaccine Confidence
• Implement strategies to increase public trust in vaccines, combat misinformation, and engage communities in
immunization efforts.
 Immunization Programs
Here are some of the key immunization programs recognized worldwide:
• Childhood Immunization Schedule
• Human Papillomavirus (HPV) Vaccination Program
• Pneumococcal Vaccination Program
• Hepatitis B Vaccination Program
• Tetanus, Diphtheria, Pertussis (Tdap) Vaccination Program
 Global initiatives on
immunization
• Global initiatives on immunization aim to increase vaccine coverage, improve health outcomes, and achieve equity in vaccine
access worldwide. These initiatives are spearheaded by various organizations, including the World Health Organization (WHO),
UNICEF, Gavi (the Vaccine Alliance), and the Global Polio Eradication Initiative (GPEI), among others. Key global
immunization initiatives include:
• Expanded Programme on Immunization (EPI): Launched by the WHO in 1974, the EPI aims to make vaccines that protect
against major infectious diseases accessible to all children worldwide. It focuses on vaccines against tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis, and measles.
• Gavi, the Vaccine Alliance : Founded in 2000, Gavi is a global health partnership representing public and private sectors,
dedicated to increasing access to immunization in poor countries. Gavi supports vaccines for hepatitis B, rotavirus, human
papillomavirus (HPV), and others, in addition to the EPI vaccines.
• Global Polio Eradication Initiative (GPEI) : This public-private partnership launched in 1988 aims to eradicate polio worldwide.
It has made significant progress, reducing polio cases by over 99% since its inception.
 Global initiatives on
immunization
• Measles & Rubella Initiative (M&RI): Launched in 2001, this initiative aims to reduce measles and rubella deaths
and prevent congenital rubella syndrome globally. It focuses on widespread vaccination campaigns and
strengthening health systems.
• Global Vaccine Action Plan (GVAP): Endorsed by the World Health Assembly in 2012, the GVAP aims to prevent
millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities
• Immunization Agenda 2030 (IA2030): As a successor to the GVAP, the IA2030 was launched in 2020. It sets an
ambitious global vision and strategy for vaccines and immunization for the decade 2021–2030, focusing on
achieving universal access to vaccines, integrating immunization into broader health systems, and managing
health emergencies
• COVID-19 Vaccine Global Access (COVAX): COVAX is part of the Access to COVID-19 Tools (ACT)
Accelerator, launched in 2020. It aims to accelerate the development, production, and equitable access to COVID-
19 tests, treatments, and vaccines.
 Immunization Schedule
•At b
At birth
•Hepatitis B ( 1st dose)
•Oral Polio Vaccine (OPV 0),
•BCG

6 weeks
•Pentavalent Vaccine (1st dose)
• Oral Polio Vaccine
•Pneumococcal Conjugate Vaccine (1st dose),
• inactivated polio vaccine
•Rotavirus Vaccine (1st dose)

10 weeks
•Pentavalent Vaccine (2nd dose),
•Oral Polio Vaccine (2nd dose),
•Pneumococcal Conjugate Vaccine (2nd dose)
•Rotavirus Vaccine (2nd dose)
 Immunization Schedule

14 weeks
•,Pentavalent Vaccine (3rd dose),
•Oral Polio Vaccine (3rd dose),
•Pneumococcal Conjugate Vaccine (3rd dose)
•Inactivated polio vaccine 2
•Rota virus vaccine 3

9 months,
•Yellow Fever Vaccine,
•Measles vaccine 1st dose
•Meningitis A vaccine

15 months
•Measles vaccine 2nd dose
 Cold chain management
• Cold chain management for vaccine storage and transportation is a critical aspect of ensuring the efficacy and safety of vaccines from the point of
manufacture to the point of administration. The cold chain involves maintaining a consistent and appropriately low temperature for vaccines
throughout their journey.
Components of the Cold Chain

• Storage Equipment: Refrigerators, freezers, and cold boxes used for storing vaccines at health facilities or distribution centers. These devices must be
capable of maintaining specific temperature ranges, often between 2°C and 8°C for refrigerated vaccines and -15°C to -25°C for frozen vaccines.
• Transportation: Vehicles equipped with refrigeration units or insulated containers are used to transport vaccines. The choice of transport method
depends on the volume of vaccines, distance, and the available infrastructure.

• Temperature Monitoring Devices: Devices such as digital data loggers (DDLs), vaccine vial monitors (VVMs), and temperature indicators are
essential for monitoring the vaccine temperature throughout the cold chain. These tools help in identifying any exposure to temperatures outside the
recommended range.
 Cold Chain management
Key Considerations
• Temperature Management: It's crucial to maintain the correct temperature range for each vaccine. Exposure to temperatures
outside the recommended range can reduce vaccine potency, leading to reduced effectiveness.
• Logistics and Distribution Planning: Efficient logistics and distribution planning ensure that vaccines reach their destinations
promptly while minimizing the time they spend in transit, where they might be more vulnerable to temperature excursions.
• Training and Capacity Building: Personnel involved in the cold chain, from healthcare workers to logistics staff, need to be
trained on best practices for handling, storing, and transporting vaccines.
• Power Supply and Backup Systems: Reliable power sources and backup systems (such as generators or solar panels) are
essential to maintain storage equipment, especially in areas prone to power outages.
• Emergency Preparedness: Contingency plans for equipment failures, natural disasters, and other emergencies that could
compromise the cold chain are critical.
 Cold Chain management
Challenges

• Infrastructure Limitations: In many parts of the world, particularly in low-income countries, the lack of
infrastructure can pose significant challenges to maintaining the cold chain.
• Resource Constraints: Financial, technological, and human resource constraints can impact the ability to
establish and maintain an effective cold chain.
• Global Distribution: The global distribution of vaccines, especially during pandemics, requires international
coordination and significant logistical efforts to ensure that cold chain standards are met across different
regions and countries.
• Effective cold chain management is vital for the success of Immunization programs worldwide, ensuring that
all individuals have access to safe and effective vaccines.
Examples of Successful Campaigns

• Polio Eradication Initiatives: Global efforts involving mass immunization campaigns and
extensive community education to eradicate polio.
• Influenza Vaccination Campaigns: Annual campaigns to encourage uptake of the flu
vaccine, targeting high-risk groups such as the elderly, pregnant women, and healthcare
workers.
• COVID-19 Vaccination Campaigns: Worldwide efforts to educate the public about
COVID-19 vaccines, addressing vaccine hesitancy, and promoting vaccination through
innovative strategies like partnering with social media influencers and celebrities.
 Challenges
• Equity and Access: Ensuring that vulnerable and underserved populations have access to vaccines and accurate
information.
• Misinformation: Combating misinformation and disinformation on social media and other platforms.
• Logistical and Supply Chain Issues: Ensuring the consistent availability of vaccines in remote and resource-poor
areas is a significant challenge. This includes maintaining the cold chain (a temperature-controlled supply chain) to
keep vaccines effective, managing stock levels to prevent shortages or wastage, and distributing vaccines to hard-to-
reach populations.
• Vaccine Hesitancy : Skepticism or refusal of vaccines by individuals or communities can significantly impact
immunization efforts. Vaccine hesitancy is driven by a variety of factors, including misinformation, religious or
philosophical beliefs, concerns about vaccine safety or effectiveness, and distrust in healthcare systems or
government.
 Challenges
• Financial Constraints: Many low- and middle-income countries face financial barriers to
implementing widespread immunization programs. This includes the cost of vaccines, delivery,
healthcare worker training, and infrastructure development. International aid and subsidies play a
crucial role, but funding gaps can still hinder access to vaccines.
• Health System Challenges: Weak healthcare infrastructures can impede immunization programs.
This includes insufficient healthcare workers, inadequate facilities, and poor healthcare
management practices. Strengthening healthcare systems is essential for improving vaccine
delivery and coverage.
• Political and Economic Instability: Political unrest, conflicts, and economic crises can disrupt
immunization programs. These situations can lead to the displacement of populations, making it
difficult to carry out vaccination campaigns and maintain routine immunization services.
 Challenges
• Disease Surveillance and Data Management: Effective immunization programs rely on robust disease surveillance
systems to track vaccine-preventable diseases and monitor immunization coverage and effectiveness. Challenges in
data collection, management, and analysis can impede the ability to respond to outbreaks and adjust immunization
strategies accordingly.

• Equity Issues: There is often a gap in immunization coverage between different socioeconomic groups, with children
in the poorest communities being the least likely to receive vaccines. Addressing these disparities requires targeted
efforts to reach under-served populations.

• Emerging Pathogens and Changing Epidemiology: The emergence of new pathogens and changes in the epidemiology
of diseases can necessitate adjustments to immunization programs. Developing new vaccines, updating immunization
schedules, and conducting catch-up campaigns are essential but challenging aspects of responding to these changes.