Global health funding has been cut in half since 2021[1] with dramatic reductions over the past ten months, particularly to immunization financing. The impact is eminent and not evenly shared: low- and middle-income countries (LMICs) face the steepest challenges, battling challenges from financing to tightening vaccine supply constraints to the loss of technical support and trainings provided by UN agencies.
In response, many governments are rethinking how they source, schedule, and deliver immunization services. Two existing strategies in this re-design may prove especially powerful: strengthening their Electronic Immunization Registries (EIRs) and leveraging collaborative learning networks to build the “how-to” knowledge of implementation.
Why EIRs matter
Electronic Immunization Registries provide essential, real-time data to immunization leaders. They capture each child’s vaccination status, flag those overdue, and highlight geographic or demographic gaps. When functioning well, EIRs transform routine data into actionable insight that improves planning, targeting, and resource allocation reducing vaccine stockouts and improving outreach to the un and under vaccinated.
But like all information systems, EIRs must evolve: integrating new tools (such as COVID-19 modules), interfacing with national digital public infrastructure (such as civil registration and ID systems), and increasingly incorporating advanced analytics, including AI. There are few roadmaps for countries to follow as they evolve these systems and fewer technical resources they can rely upon for advice.
Turning to their peers for advice
Linked a peer-to-peer, collaborative learning network funded by Gavi and in partnership with UNICEF and WHO, engaged a group of middle-income countries (i.e., Bhutan, Colombia, Guyana, Bolivia, Indonesia, Moldova, Uzbekistan, and Vietnam) representing nearly half a billion people over the past three years to accelerate progress toward reaching zero-dose children by improving and optimizing their EIRs.
Linked’s collaborative learning approach offers a new model for supporting countries to address their most pressing challenges. More traditional technical assistance may provide direct support through external technical advisors facilitating a multi-country training sessions. While this model provides great value to countries, Linked has found that collaborative learning can be a complementary, cost-effective way to drive continuous change – supporting countries to work together as peers, mentors, and accountability partners, learning from tests others are trying.
Its impact is perhaps best summarized by a Bhutanese leader reflecting on his Indonesian counterpart: “Going forward I will need her advice a lot… digital health is new in my country, and we have a long way to go.” There is so much to learn so much from others.
Insights from Istanbul: where countries are heading next
The final event supported by GAVI to discuss EIRs gathered representatives of six MICs in Istanbul, Türkiye from 23–25 October. There, they reviewed the progress each had made against their prior action plans, shared emerging evidence from experiments they had tried, and identified practical strategies each could incorporate when they returned home to strengthen their data collection, use, and advanced analytics. They conducted site visits to a local health clinic and vaccine storage facility to see in-person how the Ministry of Health of Türkiye utilizes their EIR to support vaccine logistics and service delivery. Key themes included:
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Standardizing their data collection practices and interoperability via Digital Public Infrastructure (DPI)
In order to find every child to vaccinate and follow up with those that have not returned for second or third doses, countries have pursued integration of their EIRs with national ID and civil registration systems (CRVS). While early efforts often increased duplicate records, they recognized that each system could provide valuable intelligence to the others. Working together, peer discussions and presentations from the WHO and the Open Concept Lab helped them consider alternative tools to standardize data fields and develop national health data dictionaries. Open Concept Lab’s(OCL), Jonathan Payne could streamline the development of Health Data Dictionaries and simplify data standardization for those just beginning their EIR journeys. Country leaders also learned more about the WHO’s Smart Guidelines and the Immunization Digital Adaptation Kit (DAK) published earlier in the year from the WHO Technical Officer, Natschja Ratanaprayul. Both sessions focused on countries leading the way in brainstorming together if and how technical guidance and open tools might be integrated into their on-going system designs, and sharing challenges faced along the way. Leaving the sessions, two countries committed to advancing data standardization, while others aim to use DAK guidance in upcoming system revisions.
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Motivating sub-national data use and strengthening rural outreach
While each of these MICS already have working national dashboards which monitor immunization performance and supply chain status, they each recognize that local facilities “using the data” to make decisions must be continuously re-enforced, particularly at the sub-national level. Practitioners shared with one another different coaching strategies they had employed ranging from the creation of “data hero” recognitions in which career awards are given to junior staff to fostering a competitive spirit across national sub-groupings when they improve immunization performance.
The group particularly benefitted from the lessons shared by the Ministry of Health of Türkiye who explained how they increased local empowerment by deploying a decentralized “cell” model, where each region has clear immunization targets and the autonomy to implement changes. When regions experienced backsliding, the national team worked with them quietly to understand barriers and provide coaching to get them back on track when indicators slipped. Similarly, Indonesia described their sub-national approach and the weekly joint problem-solving sessions with sub-national teams which they had implemented over the past year to reinforce local ownership and foster a one team mindset. Indonesia also showcased its parent-facing WhatsApp chatbot—a low-cost, tool that enabled them to communicate more effectively with parents to answer questions and check on adverse events, enabling them to reach remote areas more effectively; this was a strategy that several countries incorporated into their action plans.
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Doing more with existing data: advanced analytics and AI
The group turned on day three to discuss new innovations they were considering to do more with the data their health system already collects. While countries do quite a bit in terms of direct data management and basic analytics to predict outbreaks and enhance planning, all are considering if and how they should use AI more effectively. All recognized that there were no existing “roadmaps” to follow from other countries as the use of machine learning and AI remains nascent with only one of the six and Turkey having active pilot tests underway. To kickstart the discussion, CooperSmith’s CTO, Tyler Smith shared how countries were using AI in several distinct use cases in HIV/TB. The countries brainstormed five common use cases they are considering, working with their peers to define these so they could discuss them at home. These ranged from direct engagement with patients and families via chatbot messaging to more internally facing use cases that could bolster decision such as data analysis of supply chain and epidemiological models.
Throughout these discussions, the countries were very conscious of their ethical obligations to rigorous science and protecting patient privacy. They extensively discussed prerequisites for responsible adoption and explored where AI might add value, aligning as a first test use case on approaches that could compare current data techniques with those utilizing AI as an “A/B” test case which could check for bias and accuracy. They also discussed boundary conditions which needed to be considered, most crucially aligning with national data privacy and protection regulations in place as a first step in their future planning. While none committed to immediate deployment of AI, all agreed to initiate structured national conversations using insights from the workshop and build an AI pilot plan and agreed to share lessons learned with one another.
As this workshop demonstrates, in a world of quickly contracting resources, collaborative learning is no longer a “nice to have” strategy but rather an essential method for countries to sustain and strengthen their digital immunization systems. The experience of Linked’s EIR countries shows that when nations learn directly from one another, they advance further, faster, and with solutions better suited to their contexts. Reaching zero-dose children will require every available lever, but one lesson is already clear: the path to stronger digital tools runs through stronger collaboration.
[1] Financing Global Health, 2025; Institute for Health Metrics.