Recovering from the Unprecedented Backsliding in Immunisation Coverage: Learnings from Country Programming in Five Countries


Learning how 5 countries recovered from declines in immunisation coverage during the Covid-19 pandemic.


The lessons outlined in this article can be helpful for countries seeking to maintain, restore, and strengthen their immunisation services and catch up missed children in the context of pandemic recovery.


This article, authored by Clinton Health Access Initiative (CHAI), Global Vaccines Delivery Team and Country Offices, spotlights examples of strategies used by five countries—Cambodia, Cameroon, Kenya, Nigeria, and Uganda—who have exhibited exemplar performance in strengthening routine immunisation programmes and restored lost coverage levels in the last two years of the COVID-19 pandemic.

Key Messages

  • Closing immunity gaps and reaching missed communities require intensified efforts that are well planned and informed by evidence. In Cambodia, Kenya, Nigeria, Cameroon, and Uganda, multiple rounds of catch-up activities were conducted to service high-risk communities throughout the pandemic to address coverage gaps and inequities.
  • Despite challenges brought on by the pandemic, these countries continued to strengthen health information system capacities to capture and use routine immunisation data for planning and implementation. By promoting a systemic approach that leverages existing data, underserved communities can be identified and necessary resources allocated for rapid course correction.
  • Across the spectrum of activities undertaken to plan, implement, and monitor the COVID-19 vaccine roll-out, many of the countries who demonstrated resilience in the last two years capitalized on these activities for the mutual benefit of routine immunizations.
  • Early intervention by governments to provide clear directives to health facilities was instrumental in minimizing service delivery disruptions.
  • Learning from the largest disruption to immunisation service delivery in three decades and the largest vaccination roll-out in history, a few countries are prioritizing investments in systems that enable multisectoral collaboration with strong community participation for agile decision making. This strategy aims to emphasize stronger community engagement and new models of service delivery that could strengthen the resilience of health systems.
  • The importance of integrating routine immunisation into primary healthcare systems has never been clearer. As countries continue to recover and adopt lessons from the last few years, to not only mitigate the effects of backsliding but to reach those who were previously unreached, integrated and holistic PHC systems offer the best way forward for supporting resilient and sustainable routine immunisation programmes.

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