Authors: Dilorom Tursunova, Head of the Expanded Immunisation Programme (EPI), Uzbekistan Ministry of Health, Mr. Umidjon Khudaykulov, Immunisation Officer, Uzbekistan Country Office, UNICEF, Vadim Vasilev, IT Specialist, Uzinfocom, Kate Wilson, Technical Advisor, Linked Immunisation Action Network, Colleen Keating, Program Officer, Linked Immunisation Action Network
Estimated reading time: 5 minutes
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On May 14, 2025, the Linked Immunisation Action Network (Linked) convened member countries and implementing partners for a collaborative learning session to discuss Uzbekistan’s progress and challenges in developing its Electronic Immunisation Registry (EIR). This virtual peer-to-peer exchange featured Dr. Dilorom Tursunova, Head of the Expanded Immunisation Programme (EPI) in Uzbekistan; Mr. Umidjon Khudaykulov, UNICEF Immunisation Officer; and Vadim Vasilev from their local technical partner, Uzinfocom. The speakers provided a rich overview of the challenges the country faces in sustaining and expanding its immunisation efforts—and the critical role that EIRs play in helping them reach every child.
The full recording of this learning exchange can be found here on Linked’s website.
Country Context
Uzbekistan is a lower-middle-income country in Central Asia, covering about 447,000 km with a population of roughly 38 million. With population growth slowing—around 23% of citizens are under age 16 and the median age is 28—these demographic shifts are influencing how the Ministry of Health plans and allocates resources.
The country provides universal access to a basic, publicly financed benefits package—primarily focused on primary and emergency care. Health spending relies heavily on modest public budgets (~US $673 PPP per capita in 2021) and high out-of-pocket costs, which often exceed half of total health expenditure. Childhood immunisation coverage remains strong (DTP3 at 96.8% and measles at 98.9%), but challenges persist, including urban-rural inequities in access, rising vaccine hesitancy, limitations in cold-chain capacity, and the need for sustained resource investments to maintain high coverage.
Laying the Foundation: Logistics and Cold Chain
With support from UNICEF, Uzbekistan began investing in digital systems to strengthen immunisation services. The government and UNICEF started by improving vaccine logistics—consulting experienced delivery drivers and warehouse staff to identify key system upgrades. Since 2019, the country has progressively built a robust, multi-tiered vaccine logistics and cold chain infrastructure, beginning with modern walk-in cold rooms and regional Sanepid warehouses. In 2021, they launched the Republican Cold Chain Warehouse—a national facility capable of ultra-cold storage, supported by refrigerated trucks and temperature-monitoring systems to ensure consistent vaccine quality.
At the same time, Uzbekistan digitized its supply management through the deployment of Vaccine Logistics Management Information System (VLMIS 1.0), which included real-time Remote Temperature Monitoring across over 220 warehouses and integrated tablet-based reporting—laying the groundwork for a comprehensive EIR. These systems supported timely resupply for regularly scheduled “immunisation days.”
From Logistics to Registry: New Decisions, New Systems
Despite these gains, the VLMIS had key limitations: it lacked interoperability with other systems, did not adequately manage temperature fluctuations that could compromise vaccines, and could not accurately reflect real-time usage by site. These challenges led to two major decisions. First, the government adopted the Remote Temperature Monitoring System (RTMS) and Beyond Cold Chain technology to better manage temperature integrity in remote areas. While this globally recognised solution has performed well, data storage in the cloud has created compliance issues with Uzbekistan’s national data laws. This served as an important lesson to include local data requirements in early procurement discussions.
Second, the Ministry of Health launched the development of a new, integrated EIR system—starting in September 2022 and completing initial development in April 2023. The EIR was built around four core goals:
- Ensure individual and timely immunisation schedule tracking
The system provides visibility for citizens and providers into vaccination history and upcoming doses. - Register all immunisation events
Health workers record each child’s doses at the point of service and use digital reminders for missed appointments, supported by tablets and computer automation. - Support decision-making
The system provides statistical reports to help the national and subnational government allocate vaccine supplies effectively and monitor program performance. - Identify zero-dose children
The EIR helps locate and reach unvaccinated or under-vaccinated children, especially in remote areas.
After the system’s launch in April 2023, the government rolled it out over six months to 3,197 health facilities, trained over 9,500 vaccinators, and provided tablets and PCs to support data entry. The implementation also included cybersecurity upgrades and improvements in vaccine delivery tracking to ensure full transparency across the supply chain.
System Expansion and Integration
Since the initial rollout, the EIR has been enhanced with new modules, including a mobile app that improves usability for families and enables them to register children and track vaccinations. A business intelligence (BI) module has also been added to help Ministry of Health managers interpret data and increase operational efficiency. Planning for future enhancements is already underway.
The diagram below (Figure 1) shows the multi-stage development plan for the different systems which support Uzbekistan’s immunisation program.
Figure 1:
Audience Q&A Highlights
The presentation prompted several audience questions. One key topic was whether the EIR integrates with national digital public infrastructure, such as the civil registration and vital statistics (CRVS) systems. Umidjon Khudaykulov, UNICEF, confirmed that integration is a strategic priority—critical for reaching nearly 100% BCG coverage at birth and enabling life-course tracking of immunisation. Citizens can also access their personal vaccination records through the government’s digital citizen portal using their national identification credentials.
Another question focused on how Business Intelligence (BI) tools are supporting vaccine forecasting and population denominator estimates. While the team leverages data from multiple systems to inform forecasting and supply management, Dr. Tursunova noted that this remains a largely manual process. Expertise is still required to interpret data correctly, and challenges persist in achieving an accurate population denominator due to cross-border migration and incomplete coverage in rural areas.
Looking Ahead
The event concluded with a discussion on Uzbekistan’s future plans, particularly around Artificial Intelligence (AI) and advanced analytics. The MOH is exploring how to automate cold-chain monitoring across more than 3,000 vaccine sites to identify failing equipment and anticipate replacement needs. They are also looking to integrate the EIR with UNICEF’s Traceability and Verification System (TRVST) to enable real-time vaccine verification at point of delivery.
To learn more, please watch the full video here.