Immunization Lecture Notes - 11.12.2024

KENYA MEDICAL TRAINING COLLEGE
DEPARTMENT OF COMMUNITY HEALTH
Module 32: IMMUNIZATION

Hours: 24
Lecturer: K’Ombija A. H
MPH/Hons. BALM/HND. Epid./KRCHN
CONTENT
■ Introduction ■ Unit Three:
■ Unit One: ■ Vaccinology & Expanded
▪ Immunization Systems Programme on Immunization
▪ Immunization Operations ■ Unit Four:
▪ Immunization Policies ■ Immunization Service
Delivery & Vaccine
▪ Immunization Norms and Administration
Standards
■ Unit Five:
■ Unit Two:
■ Immunization Programme
■ Service Delivery Strategies & Management
Innovative Approaches
INTRODUCTION: IMMUNIZATION
Important Concepts in Immunization
1. Immunization
√ According to the World Health Organization (WHO), immunization
is the process of making a person resistant to a disease, typically through
the administration of a vaccine. OR,
√ It is the process by which an individual's immune system becomes
fortified against an infectious agent, typically through the administration
of vaccines.
̶ Immunization is a crucial public health tool for preventing infectious
diseases and is essential for controlling outbreaks, protecting vulnerable
populations, and achieving herd immunity.
Cont….. Important Concepts in Immunization
2. Vaccination
̶ Vaccination is a simple, safe, and effective way of protecting you against
harmful diseases, before you come into contact with them. It uses your
body's natural defences to build resistance to specific infections and
makes your immune system stronger.
3. Differences between Immunization and Vaccination
̶ Vaccination is the term used for getting a vaccine — that is, having the
injection or taking an oral vaccine dose, while immunisation refers to the
process of both getting the vaccine and becoming immune to the disease
following vaccination.
4. Vaccine
̶ A vaccine is a medical treatment that helps the body's immune system
recognize and fight disease. OR, It is a biological preparation that
provides active acquired immunity to a particular infectious or malignant
disease.
5. Antigen
̶ An antigen (Ag) is a molecule, foreign particulate matter, or an allergen,
such as pollen, that can bind to a specific antibody or T-Cell receptor.
̶ The presence of antigens/pathogens in the body may trigger an immune
response.
7. Cold chain: The cold chain is defined as a system of ensuring that
vaccines are maintained at the required low temperatures from the point
of production until it reaches the consumer. It refers to all the equipment,
processes and mechanisms used to store and transport vaccines from the
producer to the user (including vaccine carriers, cold-boxes,
refrigerators, freezers and cold rooms) by air, road and over water
bodies.
8. Catch-up vaccination (Missed opportunity): Refers to the action of
vaccinating an individual who, for whatever reason, is missing or has not
received doses of vaccines for which they are eligible, per the national
immunization schedule.
9. Delayed dose: Refers to a vaccine dose given “late”, or past the window
of timeliness set for that vaccine, in the national immunization schedule.
7. Fully immunized child: A fully immunized child by one year is one who
has received all the prescribed antigens and at least one Vitamin A dose
under the national immunization schedule before the first birthday.
8. Minimum interval: is the shortest period permissible between doses of
vaccine(s) requiring multiple doses, for it to provide an adequate immune
response. If the interval between the doses is shorter than the minimum
interval, the vaccine dose may not be effective and is considered invalid.
9. Timely dose – refers to a vaccine dose administered within a certain time
as recommended in the immunization schedule.
10.Under Immunized Children: Are children who have not received a
vaccine dose for which they are eligible (and may have started the
schedule), captured in the program as children who have missed the third
dose of diphtheria-tetanus-pertussis containing vaccine.
11. Zero dose children: Are children who have not received any vaccine in the
EPI schedule, captured in the program as children who are eligible but have
not received the first dose of diphtheria-tetanus-pertussis containing vaccine.
12. Defaulter: Person who starts but fails to complete the immunization schedule
for which they are eligible.
13. Delayed dose: Refers to a vaccine dose given “late”, or past the window of
timeliness set for that vaccine, in the national immunization schedule.
14. Minimum interval: is the shortest period permissible between doses of
vaccine(s) requiring multiple doses, for it to provide an adequate immune
response. If the interval between the doses is shorter than the minimum
interval, the vaccine dose may not be effective and is considered invalid.
15. National Vaccine and Immunization Program (NVIP): This is the Division
within the Ministry of Health responsible for the provision and coordination of
vaccination services in Kenya.
16. Combined vaccine: It is a single vaccine that protects against multiple
diseases or a single disease caused by different strains of the same
organism. Combination vaccines can be administered in a few ways:
a) Mixed in a vial: Vaccines are mixed together in a vial right before
administration.
b) Combined in a syringe: Vaccines are filled into separate chambers of a
dual-chambered syringe and combined at the time of injection.
c) Manufactured together: Vaccines are manufactured separately but
combined into one product during the final packaging stages.
■ Examples: Diphtheria, tetanus, and pertussis (DTP), Measles, Mumps, and
Rubella (MMR), Trivalent inactivated polio (IPV), Diphtheria, tetanus, and
acellular pertussis (DTaP) etc.
17.Immunization coverage (IC): It is the percentage of a population or age
group that has received a vaccine or series of vaccines:
̶ Formula:
IC = Number of people vaccinated
Total number of people in the population or age group
̶ Immunization coverage is a key indicator of how well an immunization
system is performing.
18. Drop-out rate: It is the percentage of children who start an immunization
series but do not complete it.
̶ Formula:
IDR = Number of children who start the immunization schedule
Number of children who complete the immunization schedule
̶ The World Health Organization (WHO) considers a dropout rate of more
than 10% to be unfavorable.
̶ A low dropout rate (less than 10%) indicates good utilization and service
quality.
19. Indicator: An immunization indicator is a metric used to measure the
health of individuals or populations, and to assess the effectiveness of
vaccination programs. There are many different immunization indicators,
including: Immunization coverage, drop out rate etc.
20. Logistics: Immunization logistics is the process of ensuring that vaccines
are available and delivered to the communities that need them.
̶ It involves a number of activities, including: Cold chain management,
Vaccine management and monitoring, Immunization safety, Supply chain
management etc.
21. Immunization norms: Immunization norms are standards that ensure the adequate
performance of immunization products and devices.
̶ The standards are based on published international standards and current WHO
immunization policies and guidelines.
22. Immunization standards: Refers to the guidelines and policies that govern the
immunization process, including:
▪ Immunization schedules: The recommended schedule of vaccines for a person's age
group
▪ Immunization coverage: The level of immunization achieved for a population
▪ Immunization supply: The availability of vaccines and related logistics
▪ Immunization quality: The standards that vaccines must meet to be used in a
country.
▪ Immunization outreach: How immunization services are made available to the
community
21.Disease elimination: It is the deliberate reduction of a disease to zero
cases in a specific geographic area. It's achieved through control measures,
such as vaccines, medications, and contact isolation.
22.Disease eradication: It is the permanent reduction of a disease to zero
worldwide through deliberate efforts. Once a disease is eradicated, there is
no longer a need for intervention measures to prevent or treat it.
21.Internal environment
̶ The term "internal immunization environment" typically refers to the
systems, policies, and practices within an organization or community that
promote and regulate immunization efforts.
̶ Creating and maintaining an effective internal immunization environment
is crucial for enhancing public health and ensuring the well-being of the
population.
̶ It requires collaboration among healthcare providers, policymakers, and
community members.
̶ Here's a breakdown of its components and significance:
■ Components of Internal Immunization Environment
1. Policies and Guidelines:
̶ Established immunization schedules and protocols.
̶ Regulations to ensure compliance with national and international immunization
standards.
2. Community Engagement:
̶ Involvement of community leaders and organizations in promoting
immunization.
̶ Feedback mechanisms to address concerns and questions from the public.
3. Education and Training:
̶ Ongoing training for healthcare providers regarding vaccination practices.
̶ Public awareness campaigns to educate the community about the
importance of immunization.
4. Access to Vaccines:
̶ Availability of vaccines in healthcare facilities.
̶ Programs to ensure equitable access for underserved populations.
5. Monitoring and Evaluation:
̶ Systems for tracking vaccination rates and outcomes.
̶ Regular assessment of immunization programs to identify areas for
improvement.
■ Significance of Internal Immunization Environment
1. Disease Prevention: A robust internal immunization environment helps
reduce the incidence of vaccine-preventable diseases.
2. Public Health: Contributes to herd immunity, protecting those who
cannot be vaccinated.
3. Trust and Compliance: Builds trust within the community, encouraging
higher vaccination rates and adherence to guidelines.
▪ EXTERNAL ENVIRONMENT
̶ The "external environment" in immunization refers to the broader context and
factors that influence immunization programs outside of the immediate
healthcare setting.
̶ This includes social, economic, political, and environmental factors that can
impact vaccination rates and public health outcomes.
̶ The external environment plays a crucial role in shaping immunization
programs and outcomes.
̶ Addressing these external factors is essential for improving vaccine access,
acceptance, and overall public health.
̶ Collaboration among governments, international organizations, and
communities is vital to create a supportive environment for immunization.
Here are some key components to consider:
■ Components of the External Environment in Immunization
1. Regulatory Framework: National and international laws and guidelines
governing vaccine approval, distribution, and administration.
̶ Organizations like the WHO that set global immunization standards.
2. Economic Factors: Funding for immunization programs, including
government budgets and international aid.
̶ Economic disparities that affect access to vaccines and healthcare services.
3. Social Determinants of Health: Factors like education, income, and
employment that influence health behaviours and access to healthcare.
Cultural beliefs and practices that shape attitudes toward vaccination.
4. Public Perception and Misinformation: Media coverage and public discourse

surrounding vaccines, including misinformation and myths. Community trust
in healthcare systems and vaccine efficacy.
5. Global Health Trends: Impact of global pandemics or outbreaks that can shift
focus and resources toward immunization efforts. International collaborations
and partnerships that enhance vaccine distribution and access.
6. Technological Advances: Innovations in vaccine development and delivery
systems, including mobile health technologies. Use of data analytics for
tracking immunization coverage and outcomes.
■ Significance of External Immunization Environment
1.Impact on Coverage Rates: The external environment can significantly
affect vaccination uptake and coverage rates across populations.
2.Policy Development: Understanding external factors helps inform
effective immunization policies and strategies.
3.Crisis Response: In times of public health emergencies, such as outbreaks,
the external environment can dictate the speed and efficiency of response
efforts.
21. Immunization Missed Opportunity: The WHO defines a missed opportunity
for vaccination (MOV) as when someone/child who is eligible for a vaccine
does not receive one or more doses.
▪ MOVs can occur in a variety of settings, including hospitals, health centers, and
outreach services.
The WHO strongly encourages member states to implement the MOV Strategy to
improve immunization coverage by initiating:
a) A Planning Guide to Reduce Missed Opportunities for Vaccination
b) A Methodology for the Assessment of Missed Opportunities for Vaccination
c) An Intervention guidebook for implementing and monitoring activities to
reduce MOV
d) The goal of reducing MOVs is to improve health service delivery, improve
immunization coverage, and promote synergy between programs.
■ Causes of Missed Opportunities for Immunization (Vaccination):
1. Lack of knowledge: Parents or caretakers may not have enough knowledge
about immunization.
2. Residence: Children living in rural areas are more likely to have missed
opportunities for immunization.
3. Maternal education: Mothers who are unable to read or write are more likely to
miss immunization opportunities.
4. Perception: Mothers who have negative perceptions about immunization are
more likely to miss opportunities.
5. Health care personnel: Health care personnel may not assess a child's
immunization status or advise them on age-appropriate immunization.
6. Vaccine stock out: There may be a stock out of vaccines during the scheduled
immunization session.
7. Distance: The immunization center may be too far away from home.
8. Illness: The child may be ill at the scheduled time.
9. Side effects: Parents may be concerned about the perceived side effects of the
vaccination.
10. Myths and misconceptions: Parents may have myths or misconceptions about
vaccination.
11. Attitude of vaccinators: The attitude of the vaccinators may be a factor.
12. Crowded vaccination centers: Crowded vaccination centers may be a factor.
13. Poor immunization services: The immunization services may be poorly
arranged.
22. Micro-plan for Immunization Services: A micro-plan is a set of tools and
components used to deliver health-care interventions, such as immunization
services, to a specific population.
̶ The WHO defines a micro-plan as a dynamic tool that can be adapted to suit
local needs and circumstances in the immunizations service delivery.
̶ The WHO's Essential Programme on Immunization uses micro-planning
activities to implement the Reaching Every District (RED) strategy or Reaching
Every Child Strategy.
̶ Here are some key elements of a micro-plan:
1.Data: Uses population distribution, health facility locations, and resource
estimates to identify priority populations
2.Mapping: Creates maps of districts or health centers to identify unreached
areas
3.Community input: Involves community engagement to guide action
4. Technical details: Includes resource estimates, cold chain plans, and tools for
reporting and monitoring
5. Flexibility: Can be adapted to suit local needs and the real situation of the
people in field operations
■ Activities involved in micro-planning include:

i. Identifying priority communities, Addressing barriers
ii. Developing workplans, Planning vaccine storage
iii. Identifying and managing human resources
iv. Planning service delivery
v. Generating demand and ensuring communications
vi. Monitoring implementation, Re-evaluating the plan
23. Support Supervision: It is a process that helps health staff improve their
performance in a respectful and non-authoritarian way.
̶ It's a way to guide, monitor, and coach staff to ensure they deliver quality health
services and comply with standards of practice.
Importance/Benefits of Support Supervision
▪ Improving immunization uptake
▪ Research shows that supportive supervision can help increase immunization
uptake.
▪ Recognizing frontline workers (FLWs)
▪ Supervisors can help ensure that FLWs use good infection prevention and
control (IPC) practices during immunization activities.
▪ Improving provider-caregiver interaction
▪ Good interaction between providers and caregivers can improve immunization
uptake and completion.
■ Key aspects of supportive supervision include:
̶ Regular visits: Supervisors make regular visits to staff in health facilities.
̶ Working as a team: Supervisors and staff work together to meet goals and
objectives.
̶ Identifying and solving problems: Supervisors help staff identify and solve
problems, and proactively improve the quality of service.
̶ Recognizing good practices: Supervisors recognize good practices and help staff
maintain high performance.
■ Barriers to Supportive Supervision

1. Lack of financial and human capital
2. Systemic constraints
3. Inability to measure quality of supervision, and
4. Challenges with sustainability.
24. Strategy to Improve Immunization Coverage: The World Health
Organization (WHO) has several strategies to improve immunization
coverage, including:
i. Reaching Every District (RED)
̶ This strategy involves re-establishing outreach services, providing supportive
supervision, and linking services with communities.
ii. Global Routine Immunization Strategies and Practices (GRISP)
̶ This strategy involves modernizing vaccine supply chains, investing in an
information system, and expanding routine vaccination schedules.
iii. Quality immunization services
̶ This strategy involves reorienting services to meet the needs of individuals and
communities, using feedback mechanisms, and strengthening partnerships.
25. Target: The WHO defines the target population for immunization as the
number of people who are eligible to receive a specific vaccine.
▪ The target population for globally recommended vaccines is the entire

cohort of surviving infants, regardless of whether the vaccine has been
introduced in their country.
▪ To calculate immunization coverage, you can use the following formula:

a) Denominator: The estimated population of the target group of
children who should receive the vaccine
b) Numerator: The target population who have received the vaccine
▪ Immunization coverage is the proportion of the target population that has

received the vaccine in a given year.
▪ The WHO's Essential Programme on Immunization (EPI) has a strategy
called "Reaching Every District" (RED) to increase immunization
coverage.
▪ RED aims to achieve 80% immunization coverage in all districts and
90% nationally.
Target for Immunization include:
1. Children 0 -11months a year for primary routine vaccines
2. Women and adolescents of childbearing age with emphasis on pregnant
women (routine immunization and TT campaigns)
3. Children 0 - 59 Months National Immunization Days (NIDs and
measles campaign)
4. Children 9 months to 14 years (Measles campaign).
The Kenya Context: Immunization in Kenya
The National Vaccines and Immunization Program (NVIP)
▪ This was started in 1978 and established in 1980, and currently provides
14 vaccines and 5 non-EPI vaccines (Hepatitis B, Anti-snake venom, Anti-
rabies, Yellow Fever and Typhoid vaccines).
▪ These vaccines are provided to more than 1.5 million infants and a similar
number of Pregnant women and 700,000 young girls every year through a
network of 9,500 health facilities – Public, Private, Faith based and
NGOs, FREE OF CHARGE.
▪ The MOH, through the NVIP, supported by experts in immunization, and
in consultation with various stakeholders, has updated the National
Immunization Policy Guidelines, to guide implementation of
immunization at all levels, ensure uniformity and standardization with the
latest knowledge and advancements, and ensure all stakeholders are
aligned on delivery of their mandates.
Cont….. Immunization in Kenya
▪ The Kenya National Immunization Policy Guidelines have been
developed in line with the Constitution of Kenya 2010, the Kenya Vision
2030 and the Kenya Health Policy 2014–2030. It is also aligned with
Immunization Agenda 2030, the WHO Regional Immunization Strategic
Plan for Africa, and the Addis Ababa Declaration on Immunization.
Immunization Agenda 2030
▪ The Immunization Agenda 2030 (IA 2030) sets an ambitious, overarching
global vision and strategy for vaccines and immunization for the decade
2021–2030.
▪ It draws on lessons learnt in the implementation of the immunization
programs, acknowledges the continuing and emerging challenges posed
by infectious diseases, and capitalizes on new opportunities to meet those
challenges.
Cont….. Immunization in Kenya
̶ This strategy involves developing tailored strategies to respond to the
differences among countries in size, resources, and the conditions in
which people live.
The Immunization Agenda 2030 (IA 2030) has three main impact goals:
1. Reduce morbidity and mortality from vaccine-preventable diseases for
everyone throughout the life course.
2. Leave no one behind, by increasing equitable access and use of new and
existing vaccines.
3. Ensure good health and well-being for everyone by strengthening
immunization within primary health care and contributing to universal
health coverage and sustainable development.
■ Other strategies to improve immunization coverage include:
1. Implementing effective reminder and recall systems
2. Providing financial incentives to providers and/or parents
3. Checking for immunization at schools and early childhood centers
4. Educating the public about immunization
5. Implementing a national immunization coverage surveillance system
6. Reducing costs
7. Linking vaccination to Women, Infants, and Children (WIC) services
8. Conducting home visits
IMMUNIZATION SYSTEMS
Definition
■ These are critical components of public health infrastructure designed to
protect populations from vaccine-preventable diseases.
■ Effective immunization systems are vital for preventing outbreaks and
protecting community health.
■ Continuous improvement, education, and engagement are necessary to
enhance their effectiveness and reach.
Cont…… Immunization Systems
■ Key Components (elements) of Immunization Systems
1. Vaccine Delivery:
̶ Storage and transport: Vaccines must be stored at specific temperatures
and transported safely to maintain efficacy.
̶ Administration: Trained healthcare professionals administer vaccines,
often in clinics, hospitals, and community settings.
2. Surveillance:
̶ Disease monitoring: Tracking incidence rates of vaccine-preventable
diseases helps identify outbreaks and vaccination needs.
̶ Vaccine coverage: Monitoring vaccination rates among different
demographics ensures equitable access and identifies gaps.
3. Data Management:
̶ Immunization registries: Digital systems that track individual
vaccination histories facilitate reminders and follow-ups.
̶ Reporting systems: Healthcare providers report vaccination data to public
health authorities for analysis and planning.
4. Public Education and Outreach:
̶ Awareness campaigns: Informing the public about the benefits and safety
of vaccines encourages higher uptake.
̶ Community engagement: Involving community leaders can enhance trust
and acceptance of immunization programs.
5. Policy and Funding:
̶ Government initiatives: National policies and funding support
vaccination programs, ensuring they are accessible and affordable.
̶ International collaboration: Global health organizations work together
to address vaccination disparities in low-resource settings.
■ Key Challenges in Immunization Systems
̶ Immunization systems face several challenges that can hinder their
effectiveness and reach.
̶ Addressing these challenges requires a multifaceted approach, including
public education campaigns, improved logistical planning, equitable
access initiatives, and strengthened healthcare infrastructure.
̶ Collaboration among governments, healthcare providers, and
communities is essential for enhancing immunization systems and
achieving better public health outcomes.
̶ Here are some key challenges associated with immunization systems:
1. Vaccine Hesitancy
̶ Misinformation: Widespread misinformation about vaccine safety and
efficacy can lead to distrust.
̶ Cultural Beliefs: Some communities may have cultural or religious
beliefs that oppose vaccination.
̶ Fear of Side Effects: Concerns about potential side effects can deter
individuals from getting vaccinated.
2. Logistical Issues
̶ Cold chain management: Vaccines often require specific temperature
controls during storage and transport. Failures in the cold chain can
compromise vaccine efficacy.
̶ Supply chain disruptions: Interruptions in the supply chain can lead to
vaccine shortages or delayed access.
3. Accessibility
̶ Geographical barriers: Remote or rural areas may have limited access to
healthcare facilities offering vaccinations.
̶ Healthcare infrastructure: Inadequate healthcare infrastructure can
impede the delivery of vaccination services.
4. Equity and Inclusion
̶ Marginalized populations: Vulnerable and marginalized groups, including
low-income communities and ethnic minorities, may face barriers to
accessing vaccines.
̶ Language and literacy: Communication barriers can prevent effective
outreach and education about vaccination.
5. Policy and Funding Challenges
̶ Inconsistent policies: Variability in vaccination policies across regions can
lead to confusion and inequity.
̶ Funding shortages: Insufficient funding for immunization programs can
limit their reach and effectiveness.
6. Surveillance and Data Management
̶ Inadequate data systems: Poor data collection and management can hinder
the tracking of vaccination rates and disease outbreaks.
̶ Lack of integration: Immunization data may not be integrated with general
health records, complicating follow-up and reporting efforts.
7. Global Health Disparities
̶ Developing countries: Many low-income countries struggle with
immunization due to resource constraints and health system challenges.
̶ Pandemic impact: Global health crises, like the COVID-19 pandemic, can
disrupt routine immunization schedules and outreach efforts.
IMMUNIZATION OPERATIONS
Definition
̶ These refer to the systematic processes and activities involved in
planning, implementing, and managing immunization programs to ensure
the effective delivery of vaccines to populations.
̶ These operations encompass various aspects, including logistical,
administrative, and educational components, aimed at maximizing
vaccination coverage and minimizing vaccine-preventable diseases.
̶ Immunization operations are crucial for the success of vaccination
programs.
■ Effective management of these operations ensures that vaccines are
accessible, safe, and administered efficiently, ultimately leading to
improved public health outcomes and the prevention of vaccine-
preventable diseases.
Cont…. Immunization Operations
■ Key Elements of Immunization Operations
1. Planning and Coordination
̶ Program Development: Establishing goals, strategies, and timelines for
immunization campaigns.
̶ Stakeholder Engagement: Collaborating with health authorities,
community leaders, and organizations to align efforts and resources.
2. Logistics and Supply Chain Management
̶ Vaccine Procurement: Ensuring a reliable supply of vaccines through
effective procurement strategies.
̶ Cold Chain Management: Maintaining the required temperature
conditions for vaccines during storage and transport.
̶ Distribution: Coordinating the delivery of vaccines to healthcare
facilities and outreach locations.
3. Training and Capacity Building
̶ Healthcare Provider Training: Equipping healthcare workers with the
knowledge and skills needed for vaccine administration and patient
education.
̶ Capacity Strengthening: Enhancing the capabilities of local health systems
to support immunization efforts.
4. Data Management and Monitoring
̶ Immunization Registries: Implementing systems to track individual
vaccination histories and coverage rates.
̶ Surveillance and Reporting: Monitoring vaccine-preventable diseases and
vaccination coverage to inform public health decisions.
5. Public Awareness and Education
̶ Community Outreach: Engaging with communities to promote the
importance and safety of vaccines.
̶ Addressing Vaccine Hesitancy: Providing accurate information to counter
misinformation and build trust in vaccination programs.
6. Evaluation and Improvement
̶ Program Assessment: Regularly evaluating the effectiveness and
efficiency of immunization operations to identify areas for improvement.
̶ Feedback Mechanisms: Incorporating feedback from healthcare providers
and the community to enhance program delivery.
■ Challenges of Immunization Operations
̶ Immunization operations face a variety of challenges that can impede the
effectiveness and efficiency of vaccination programs.
̶ Addressing these challenges requires a comprehensive approach,
including improved logistics, enhanced public education, equitable access
initiatives, and stronger data management systems.
̶ Collaboration among stakeholders—such as governments, healthcare
providers, and communities—is essential to strengthen immunization
operations and ensure effective vaccination delivery.
■ The key challenges affecting immunization operations:
1. Logistical Challenges
̶ Cold Chain Logistics: Ensuring vaccines are stored and transported at the
correct temperatures is critical, and failures can lead to vaccine spoilage.
̶ Supply Chain Disruptions: Interruptions in the supply chain can result in
vaccine shortages or delays, affecting immunization schedules.
2. Resource Constraints
̶ Funding Limitations: Insufficient funding can restrict vaccine
procurement, training, and outreach efforts.
̶ Human Resource Shortages: A lack of trained healthcare workers can
hinder the administration of vaccines and the management of
immunization programs.
3. Data Management Issues
̶ Inadequate Information Systems: Poor data collection and management
systems can lead to gaps in tracking vaccination rates and disease
outbreaks.
̶ Integration Challenges: Difficulty in integrating immunization data with
broader health information systems can limit program effectiveness.
4. Vaccine Hesitancy
̶ Misinformation: The spread of inaccurate information about vaccines can
lead to public distrust and lower vaccination rates.
̶ Cultural Barriers: Some communities may have beliefs or practices that
discourage vaccination, necessitating tailored education and outreach
efforts.
5. Inequitable Access
̶ Geographical Barriers: Rural or underserved urban areas may have
limited access to vaccination services, leading to disparities in coverage.
̶ Marginalized Populations: Vulnerable groups may face additional
barriers related to language, education, or socio-economic status.
6. Policy and Regulatory Challenges
̶ Inconsistent Policies: Variability in immunization policies at local,
national, and international levels can create confusion and inequities.
̶ Regulatory Hurdles: Complex regulations can complicate vaccine
approval and distribution processes.
7. Emerging Health Threats
̶ Pandemic Preparedness: Health crises, such as the COVID-19 pandemic,
can disrupt routine immunization services and lead to declines in
coverage.
̶ Evolving Disease Patterns: Changes in disease epidemiology can
necessitate adjustments in vaccination strategies and priorities.
IMMUNIZATION POLICY IN KENYA
Definition
A policy (statement) is a set of rules and guiding principles that help an
organization operate effectively and efficiently to achieve a particular
outcome.
■ Importance / Benefits of Policy Statements:
1. Define expectations: Policy statements outline the expectations for all
members of an organization and hold them accountable to the same
standards on immunization requirements.
2. Promote consistency: Policy statements help ensure that everyone in the
immunization management and service delivery is working towards the
same goals. This consistency can help build a healthy reputation for
immunization services.
Cont… Immunization Policy in Kenya
3. Reduce risk: Policies and procedures can help reduce the risk of
liability for immunization management and service delivery.
4. Provide a framework: Policy statements provide a framework for how
an immunization management and service delivery operates.
5. Define actions: Policy statements define the actions that are
advantageous to the immunization management and service delivery.
Cont… Immunization Policy in Kenya
■ The National Immunization Policy Framework

̶ A National Vaccine Immunization Policy (NVIP) is a set of guidelines that
guide the implementation of immunization programs at the national and
county levels.
̶ The purpose of NVIP is to ensure that immunization services are delivered
equitably to all eligible individuals.
̶ The NVIP is developed by the Ministry of Health in consultation with
immunization experts and other stakeholders.
̶ The NVIP is intended to be adopted by all health care workers, including
those in public, private, and NGO health facilities.
Cont….. Immunization Policy in Kenya
̶ Kenya's immunization policies are designed to enhance public health by
providing comprehensive vaccination coverage to its population.
̶ These policies are guided by national health goals and international
standards, aiming to reduce the burden of vaccine-preventable diseases.
̶ Kenya's immunization policies are focused on achieving high vaccination
coverage, improving public health outcomes, and ensuring equitable
access to vaccines.
̶ Continuous evaluation and adaptation of these policies are essential to
respond to emerging health challenges and population needs.
Cont….. Immunization Policy in Kenya
NVIP Vision
A Kenya free of vaccine preventable diseases
NVIP Mission
To save lives and protect people from vaccine preventable diseases by
promoting and guiding the provision of efficient, equitable, safe, and
effective high-quality immunization services to all Kenyans
NVIP Mandate
Ensure availability of high-quality Government of Kenya provided vaccines
and provide guidance on all immunization schedules for the life course in
line with the Kenya Health Policy 2014–2030 objective of eliminating
communicable diseases. The mandate of the program will be achieved by
implementing the activities while observing the following core values.
Cont…. Immunization Policy in Kenya
Core Values
1. Professionalism and ethics
2. Integrity and accountability
3. Partnership and collaboration
4. Resilience and efficiency
5. Equity, adaptiveness, and innovation

Cont…. Immunization Policy in Kenya
NVIP Goal
̶ The goal of the NVIP strategic plan is to increase and sustain high
coverage and equitable utilization of vaccines, reduce the number of zero-
dose children and ensure uninterrupted availability of high quality, safe
and effective vaccines in a sustainable manner.
̶ While it is premised on the need to accelerate attainment of Universal
Health Coverage (UHC) and Universal Access to Immunization, it will
give special focus to under-immunized population groups in Kenya
including in urban informal settlements, remote rural areas, insecurity-
affected settings, refugees, and marginalized groups that face social,
cultural, economic and gender barriers to vaccination, ensuring that no
child is left unprotected against vaccine preventable disease.
THE NVIP GUIDING PRINCIPLES
Implementation of the strategic plan will be guided by the following four
principles, as outlined in the National Immunization Policy Guidelines.
1.People centred: Equitable delivery of immunization services through a
strengthened and integrated primary health care system.
2.National, county and community ownership: Immunization is key to
achieving universal health coverage (UHC) in Kenya.
3.Partnership based: The engagement of partners at various levels including
the community, non-profit organizations, civil society, other government
departments and ministries as well as development partners to work
collaboratively to attain the goals of the immunization program.
4.Evidence driven: A robust monitoring and evaluation framework that
generates timely data for action is important for tracking and informing
improvement areas in program performance.
National Vaccines and Immunization Policy Objectives
(NVIP)
■ The seven (7) NVIP Policy Objectives are:
1.Policy Development, Implementation and Oversight: To oversee high
quality, uniform and standardized immunization delivery. Priority actions
include:
i. Developing, updating and disseminating immunization service delivery
guidelines, job aids, manuals and other reference materials.
ii. Facilitating and coordinating periodic reviews of the Immunization
Policy.
iii. Advising relevant legislative and regulatory authorities on enactment
and implementation of relevant immunization policies and initiatives.
iv. Provide oversight for immunization services.
Cont… NVIP Objectives
2.Commodity Security and Quality Assurance: Ensure uninterrupted
availability of potent and safe vaccines. Priority actions include:
i. Ensure efficient supply chains for vaccines and related commodities vis-
a-vis effective vaccines management.
ii.Identify and respond to vaccine safety events in a timely manner.
3.Monitoring, Evaluation, Accountability and Learning (MEAL):
Improve data quality, reporting and utilization for strategic decision
making. Priority actions include:
i. Strengthening immunization evidence generation.
ii. Supporting immunization data capture processes, management and use.
iii.Supporting operational research, technology and innovations in data
management.
iv.Supporting mechanisms to monitor and validate administrative
coverage, including data reviews, sero-surveys and surveillance.
4.Advocacy, Communication and Demand generation: Drum up support
for and visibility of immunization services in order to improve access and
uptake of immunization services. Priority actions include:
i. Develop policies on interventions aimed at increased acceptance,
reduced vaccine hesitancy and refusals.
ii. Mobilization of partners, stakeholders and communities towards active
participation and support for immunization.
iii. Improving the capacity of community health workers communication
on immunization.
iv. Designing and Implementing evidence-based communication plans and
messaging to address emerging demands on the immunization Program
such as life-course immunization and vaccine hesitancy.
5.Capacity Strengthening: To improve knowledge, skills and competencies
of immunization teams and stakeholders for effective, efficient, and
people-centred service delivery. The priority actions include:
i. Determine and guide on the skills set required for the efficient and safe
delivery of immunization services.
ii. Support and facilitate transfer of skills and knowledge.
iii. Engagement and fostering linkages with training institutions to update
their training curriculum and core competencies on pre and in-service
training on immunization.
iv. Guide on approaches to equipping immunization service delivery points
to deliver high quality and equitable immunization services.
v. Develop innovative learning methods that includes e-Learning, blended
–learning and on-the job training to cover a wide range of HWs.
6.Partnership and Collaboration: Broadening Immunization services
resources (financial, human and technical) through collaboration. Priority
actions include:
i. Broadening and strengthening Immunization partnerships, planning and
coordination mechanisms.
ii. Create an enabling environment that fosters public private partnership.
iii. Establish new partnerships to increase knowledge and raise awareness
of the value of immunization, building community trust in
immunization services. Policy Objective
7.Resource Mobilization and Immunization Financing: To ensure
adequate, specific budget lines & resources are allocated by national and
county governments to guarantee quality, uninterrupted immunization
services. Priority actions include:
i. Determine multi-year and annual funding needs for the immunization
program and develop comprehensive resource mobilization plans.
ii. Advocacy with state and non-state actors to commit to Universal
Access to Immunization.
iii. Enactment of relevant policies and legislation supporting
immunization financing, including outbreak response and catch-up
vaccinations.
iv. Evaluate promising innovations and scale up innovations, as
appropriate, on the basis of the best available evidence.
IMMUNIZATION NORMS AND STANDARDS
These are essential guidelines that govern the implementation of vaccination
programs.
̶ These standards ensure the safety, efficacy, and accessibility of vaccines,
ultimately aiming to protect public health.
̶ Establishing and adhering to immunization norms and standards is crucial
for the success of vaccination programs.
̶ The guidelines ensure that immunizations are delivered safely, effectively,
and equitably, ultimately contributing to the control and prevention of
vaccine-preventable diseases.
̶ The World Health Organization (WHO) sets norms and standards for
immunization to ensure that vaccines are safe, effective, and reach the
people who need them.
Cont…. Immunization Norms and Standards
The WHO's immunization norms and standards include:
1. Prequalification and Purchase
̶ A process to ensure that vaccines and delivery technologies purchased by
UN agencies are safe and effective.
̶ The prequalification process also provides a way for end-users to give
feedback on product performance.
2. Biological standardization
̶ A program that develops and revises recommendations for the production
and quality control of vaccines.
̶ The program also establishes and distributes biological reference materials
to laboratories around the world.
3. Routine immunization recommendations
̶ The WHO provides summary tables with recommendations for routine
immunizations for all age groups, including children, adolescents, and
adults.
4. Expanded Programme on Immunization (EPI)
̶ The EPI schedule has been broadened to include additional antigens and
doses, and continues to expand as new vaccines are developed.
5.Cold Chain Management
̶ Temperature Control: Vaccines must be stored and transported within
specific temperature ranges to maintain their potency.
̶ Monitoring Systems: Implement temperature monitoring devices and
protocols to ensure compliance with cold chain requirements.
̶ The WHO's immunization norms and standards help ensure that vaccines
stay potent and safe for longer, and that more people have access to life-
saving vaccines.
6.Vaccine Quality and Safety
̶ Regulatory Approval: Vaccines must be evaluated and approved by national
regulatory authorities to ensure they meet safety and efficacy standards.
̶ Adverse Event Monitoring: Systems should be in place to monitor and
report adverse events following immunization (AEFI) to ensure ongoing
safety.
7.Vaccination Schedule
̶ Standardized Immunization Schedule: A national immunization schedule
should be established, outlining the timing and type of vaccines for different
age groups.
̶ Catch-Up Vaccination: Guidelines should be provided for catch-up
immunization for those who miss scheduled vaccines.
8.Training and Competency
̶ Healthcare Provider Training: All personnel involved in immunization
should receive regular training on vaccine administration, safety protocols,
and communication strategies.
̶ Competency Assessments: Routine evaluations of healthcare workers’
skills and knowledge regarding immunization practices.
9. Data Management and Reporting
̶ Immunization Registries: Establish systems for tracking individual
vaccination histories and coverage rates to inform public health decisions.
̶ Regular Reporting: Healthcare facilities should report immunization data
to relevant authorities for monitoring and evaluation.
10.Community Engagement
̶ Public Awareness Campaigns: Implement strategies to educate
communities about the importance of vaccination and to address vaccine
hesitancy.
̶ Involvement of Community Leaders: Engage local leaders and
organizations to promote immunization efforts and ensure community buy-
in.
11.Accessibility and Equity
̶ Equitable Access: Ensure that immunization services are available to all
populations, particularly marginalized and underserved groups.
̶ Service Delivery Models: Utilize various delivery methods, including
outreach and mobile clinics, to reach remote areas.
12.Policy Compliance
̶ Adherence to National Guidelines: All immunization activities should
comply with established national and international guidelines, such as
those set by the WHO.
̶ Quality Assurance Processes: Regular assessments of immunization
programs to ensure compliance with norms and standards.
13.Emergency Preparedness
̶ Pandemic Response Plans: Develop guidelines for maintaining
immunization services during public health emergencies, ensuring
continuity of care.
̶ Flexibility in Delivery: Adaptation of immunization strategies in response
to emerging health threats and changing epidemiological patterns.
COMMUNITY PARTICIPATION IN IMMUNIZATION
Definition
▪ It is the involvement of the community and key stakeholders (partners) in
the provision of immunization services at all levels.
OR,
▪ It is the process of building working relationships between health workers
and communities (and groups) to work together in the provision of
immunization services.
̶ The WHO also emphasizes the importance of partnering with communities

to increase immunization coverage and reduce dropout rates.
Cont…. Community Participation in Immunization
̶ Community participation in immunization can include:
1. Planning: Involving community members in the planning of
immunization services
2. Decision-making: Including the community in decision-making
processes
3. Implementation: Ensuring that the community is involved in the
implementation of immunization activities that impact them
4. Evaluation: Involving the community in the evaluation of immunization
services.
■
▪ Things to consider when partnering with communities for

immunization include:
1. Schedules: Adhering to agreed-upon immunization session schedules
2. Ensuring that sufficient vaccines, supplies, and equipment are available
3. Effective communication: Establishing communication channels to
keep the community informed of potential changes
4. Community engagement: Community engagement can help build trust
in vaccines and overcome hesitancy. You can engage communities
before, during, and after vaccination by organizing activities with
decision-makers, local representatives, and parents.
5. Collaboration: A consistent commitment to vaccination programming
and collaboration between the government, community, and partners can
strengthen networks.
6. Coordination: Immunization stakeholders should work together to align
activities and improve access to vaccination and other primary health care
services.
7. Support: Communities can provide support in many ways, including:
Advocating and providing financial, human, and logistical support
8. Planning immunization sessions
9. Referral: Identifying and referring newborns.
10. Defaulter tracing: Tracking and following up defaulters
11. Creating awareness: Publicizing immunization sessions
12. Advocacy: Developing advocacy and mobilization messages
13. Transportation: Assisting with transport and other resources
14. Volunteers: Encouraging and training volunteers to support
immunization services
15. Monitoring and Evaluation of the immunization program
▪ Importance / Benefits of Community Participation in Immunization

̶ Community participation in immunization services offers numerous
benefits that enhance public health outcomes.
̶ Community participation in immunization services is essential for
increasing coverage, improving access, and fostering a culture of health.
̶ By leveraging local knowledge and building trust, communities can
significantly enhance the effectiveness of vaccination efforts, ultimately
leading to better health outcomes.
̶ Here are some key benefits/ advantages/importance:
1. Increased Vaccine Coverage: Community involvement can help increase
the number of people who receive immunizations.
̶ Awareness and Education: Involving the community helps disseminate
information about the importance of immunization, leading to higher
vaccination rates.
̶ Local Trust: Families are more likely to trust and accept vaccines when
they come from recognized community leaders or organizations.
2. Reduced Dropout Rates: Community involvement can help reduce the
number of people who drop out of immunization programs
3. Greater equity: Community involvement can help ensure that

underserved populations have more equitable access to immunization
services
4. Improved Access: Tailored Solutions: Communities can identify barriers
to access (e.g., transportation, timing) and work together to create
solutions, such as mobile clinics or extended hours.
̶ Cultural Sensitivity: Local insights ensure that immunization campaigns
are culturally appropriate and resonate with the community’s beliefs and
practices.
5. Enhanced Outreach: Peer Education: Community members can act as
peer educators, sharing experiences and encouraging others to vaccinate
their children.
̶ Targeted Campaigns: Community input can help design outreach efforts
that effectively target specific populations or areas with low vaccination
rates.
6. Strengthened Health Systems: Local Engagement: Community
involvement fosters a sense of ownership over health initiatives, leading
to sustained support and participation.
̶ Feedback Mechanisms: Communities can provide valuable feedback on
service delivery, helping to refine and improve immunization programs
7. Empowerment and Advocacy
̶ Building Capacity: Participation empowers community members with
knowledge and skills, enabling them to advocate for their health needs.
̶ Collective Action: A united community can advocate for policy changes or
resources needed to improve immunization services.
8. Better Health Outcomes
̶ Herd Immunity: High vaccination rates contribute to herd immunity,
protecting vulnerable populations who cannot be vaccinated.
̶ Disease Prevention: Community engagement can lead to a decrease in
vaccine-preventable diseases, benefiting overall public health.
9. Trust Building
̶ Transparency: Involving the community in decision-making processes
fosters transparency and builds trust between health authorities and the
public.
̶ Long-term Relationships: Strong community ties can lead to ongoing
collaboration in health initiatives beyond immunization.
INTEGRATED APPROACHES IN IMMUNIZATION
Definition
Refers to immunization programs that are combined with other health
services to improve access to care, strengthen health systems and improve
immunization coverage.
̶ Immunization programmes are integrated in the wider health system

more comprehensively to address population health needs over time,
making efficient use of resources, and improving health outcomes,
especially for those who are underserved.
Cont…. Integrated Approaches in Immunization
■ Immunization integration include:
̶ Providing family planning services with routine child immunization
visits
̶ Combining immunization services into routine mobile and outreach
health services
̶ Co-delivering immunizations with other services e.g., curative services
̶ Integrating immunization into primary care visits, e.g. routine growth
monitoring
̶ Sharing administrative and operational functions and responsibilities
with immunization services management
■ Benefits of integrated immunization services include:
̶ Improved health: Women and young children may have improved
perceptions of their health
̶ Improved equity and coverage: Immunization coverage can increase by
reducing missed opportunities for vaccination
̶ Improved efficiency: Frontline workers may experience reduced
redundancy
̶ Improved community vaccine acceptance: Communities may be more
accepting of vaccines
̶ Time savings: Both groups may save time as they are seen ones together.
̶ Improved referrals: Clients may be better referred between the
services (ANC, CWC, PNC & curative etc.).
■ Strategies for integrating immunization services include:
1. Ensuring adequate training and workload for health workers
2. Ensuring the participation of community-based organizations, leaders,

and volunteers
3. Selecting interventions that can be feasibly integrated
4. Coordinating across program levels
5. Developing robust monitoring and evaluation strategies

Challenges of Integration of Immunization with other services:

1. Overloading health workers: Health workers may be unable to take on
additional responsibilities due to issues with pay, conditions, skills,
knowledge, or training.
2. Reduced demand for services: Clients may not accept integrated
services, especially if stigmatized services are mixed with non-
stigmatized services.
3. Unintended consequences: Even well-designed integrated services can
have unintended consequences.
4. Lack of support: Pharmacists may not receive support from physicians,
and may face other barriers such as a lack of space to store or administer
vaccines.
5. Vaccine skepticism: Vaccine skepticism can arise due to insufficient
data on vaccine safety and efficacy for certain groups, such as pregnant
women.
6. Conflict: Conflict can lead to the destruction of medical facilities and
supplies, and make it difficult for displaced populations to access
healthcare services.
ACCESSIBILITY AND QUALITY IN IMMUNIZATION
A. Accessibility to Immunization Services

■ According to the WHO, access to high-quality, affordable vaccines is a key
factor in the success of immunization programs.
■ The WHO has identified several strategies to improve access and quality
of immunization, including:
1. Investing in research and development: This includes identifying the
best ways to access technology and expertise, and developing
thermostable products/vaccines.
2. Supporting regulatory agencies: Well-functioning national regulatory
agencies and advisory bodies are essential for a positive environment
for vaccine development.
Cont….. Accessibility and Quality of Immunization
3. Immunization Agenda 2030 (IA2030): This global strategy aims to
ensure that everyone has access to vaccines by 2030. It focuses on
increasing vaccine coverage and equity, and integrating immunization with
other health services. Reaching every district and leaving no child or
pregnant woman out.
4. Essential Programme on Immunization: This program aims to
strengthen vaccine programs and ensure universal access to vaccines.
5. The Big Catch-Up: This global communications and advocacy push was
launched in 2023 to help countries catch up on vaccinations missed during
the pandemic through increased financing for immunization and restoring
immunization services to pre-pandemic levels.
6. WHO launching the Expanded Programme on Immunization (EPI):
in 1974 to make life-saving vaccines available globally
7. Immunization Campaigns (through NIDs): Helping to eliminate wild
poliovirus in the African Region through systematic campaigns.
8. Creating awareness and dispelling rumours and misconceptions:
Communities are informed and properly educated on the availability and
importance of childhood and maternal immunizations and are encouraged
to take up the services.
9. Forecasting vaccine requirements: Reliable forecasts of national vaccine
needs and priorities can help ensure healthy market dynamics and improve
supplies.
10. Strengthening service quality: Through training of personnel,
maintaining cold-chain, availability of supplies and vaccines, effective
and efficient procurement processes, integration of services etc.
11. Practical issues: Such as the high cost of transportation or barriers to
accessing health facilities, unfriendly staff can contribute to low
vaccination uptake.
12. Monitoring inequality: This can be done by identifying relevant
immunization indicators and dimensions of inequality.
13. Partnerships: Work with community groups, health care systems,

religious groups, trusted messengers, and local leaders.
14. Community Engagement Programs: Increase access with mobile
clinics, local health fairs, and vaccination drives.
15. Other good practices include: Access-oriented management of

intellectual property rights, Price regulation, Public-private
partnerships, Policies that encourage generic medicine production, and
Innovative procurement and distribution models.
B. Quality of Immunizations
The WHO has several initiatives to ensure the quality of immunizations,
including:
1. Biological standardization: This brings together committee of experts to
develop and revise recommendations for vaccine production and quality
control.
2. Prequalified vaccines: These includes vaccines that meet the WHO's
standards for quality, safety, and efficacy. These vaccines are also suitable
for the target population and meet the operational specifications for
packaging and presentation.
3. Immunization data quality self-assessment (DQS) tool: This tool helps
verify the accuracy of reported coverage data. It compares data from one
level, such as a form or report, to the same information reported at a more
central level.
4. Vaccines Explained series: This series of explainers from the WHO
provides information about vaccines, including how they work, how
they're made, and how to ensure safety and equitable access.
5. Monitor temperature: Regularly check the temperature of the storage
unit and review temperature trends weekly. Use temperature monitoring
devices on each vial.
6. Store and handle vaccines correctly: Ensure that vaccines are stored and
handled properly.
7. Train staff: Ensure that all staff are trained in their role in immunization
delivery and patient education, including offering friendly services.
8. Designate an immunization coordinator: This person should be the
point person for ensuring that vaccines are stored and handled correctly,
and that staff are trained.
9. Use the right diluent: Only use the diluent provided by the
manufacturer.
10. Dispose of unused vaccines: Throw away unused vials of reconstituted
vaccine after a vaccination session.
11. Use auto-disable syringes: Use only auto-disable syringes with a fixed
needle.
12. Dispose of waste properly: Collect, transport, and dispose of waste in an
appropriate manner.
13. Educate staff on risks: Educate personnel on the risks of technical
errors.
14. Adequate allocation of resources: Commit to allocating timely and
adequate human and financial resources.
15. Engage with the community: Engage with community leaders and
representatives of the civil society to inform decisions.
16. Update supply chains: Update supply chains and logistical processes to
improve efficiency, accessibility, and reliability.
IMMUNIZATION SERVICE DELIVERY STRATEGIES
AND
INNOVATIVE APPROACHES
̶ Implementing these strategies can enhance immunization rates and ensure
equitable access to vaccines, ultimately improving community health outcomes.
A. Immunization Service Delivery Strategies
̶ Here are some innovative approaches for improving immunization service
delivery:
1. Integrated health immunization services: Combine immunization with other
health services, such as maternal and child health care, to streamline access
and improve overall health outcomes.
2. Immunization campaigns: Immunization campaigns or supplemental

immunization activities (SIAs)
Cont… Immunization Service Delivery Strategies and
3. Outreach services: Immunization delivery through outreach services
4. Mobile vaccination units: Deploy mobile clinics to reach underserved
areas, ensuring access to vaccines for remote or marginalized populations.
5. Fixed/static strategy: Immunization at static health facilities (Fixed
strategy), for example, Child Welfare Clinic (CWC) in the OPD of a
hospital.
6. Partnerships with Schools: Collaborate with educational institutions to
provide vaccinations on-site, making it convenient for children and their
families.
7. Incentive programs: Offer incentives (like food vouchers or health
check-ups, ITNs etc.) to encourage families to complete vaccination
schedules.
8. Use of social media: Utilize social media platforms for educational
campaigns, addressing myths and misinformation about vaccines.
9. Community health workers: Train local community health workers to
educate and facilitate vaccination campaigns, building trust and
improving uptake.
10. Digital health solutions: Implement mobile apps and SMS reminders to
notify families about vaccination schedules and locations, enhancing
compliance.
11. Flexible hours and locations: Extend service hours and provide
vaccinations in non-traditional settings (like workplaces or community
centers) to accommodate various schedules.
12. Data-driven strategies: Use data analytics to identify areas with low
vaccination rates and tailor outreach efforts accordingly.
13. Engaging influencers: Partner with local leaders and influencers to
advocate for vaccinations, leveraging their credibility to promote public
health messages.
B. Innovative Approaches
i. Decade of vaccines
ii. Global vaccine action plan 2011 – 2020
iii. GAVP for pneumonia and diarrhoea
iv. RED Reach every district/reach every child/every community/

1. The Decade of Vaccines: was a global health initiative that ran from 2010
to 2020, with the goal of creating a world where everyone could live free
from vaccine-preventable diseases.
̶ The Decade of Vaccines (DoV) Collaboration developed the Global

Vaccine Action Plan (GVAP) to achieve this goal.
̶ The DoV's mission is to extend the benefits of immunization to everyone,

regardless of where they are born, who they are, or where they live.
2. GVAP: The Decade of Vaccines Collaboration (DoV) developed the

Global Vaccine Action Plan (GVAP) to achieve this goal.
The GVAP had five goals to realize a world in which all individuals and
communities enjoy lives free of vaccine-preventable diseases, namely:
1. Polio eradication: Achieving a world free of polio
2. Vaccination coverage: Meeting vaccination coverage targets in every

region, country, and community
3. Child mortality: Exceeding the Millennium Development Goal 4 target

for reducing child mortality
4. Elimination targets: Meeting global and regional elimination targets
5. New vaccines: Developing and introducing new and improved vaccines

and technologies
■ Achievements of Global Vaccines Action Plan (GVAP):
1. Improved immunization visibility: GVAP increased the visibility of
immunization and helped build political will.
2. Established a common framework: GVAP provided a common
framework for establishing priorities, aligning activities, and assessing
progress.
3. Introduced new vaccines: GVAP met its goal of introducing new
vaccines.
4. Increased immunization coverage: Many low- and middle-income
countries increased their immunization coverage.
5. Eliminated rubella: Rubella was eliminated in 81 countries.
6. Increased number of NITAGs: The number of countries with National
Immunization Technical Advisory Groups (NITAGs) nearly tripled from
2010 to 2018.
7. Reduced child mortality: Global child mortality declined by a quarter.
8. Polio eradication: There were no new cases of polio after 2014, leading to
the certification of polio eradication.
■ However, GVAP was only partially successful in influencing national

actions and many targets were seen as unrealistic. Lessons learned from
GVAP can inform the Immunization Agenda 2030.
3. The GAPPD: The WHO and UNICEF's Global Action Plan for the
Prevention and Control of Pneumonia and Diarrhoea (GAPPD) is a plan
to reduce the number of deaths from these diseases in children:
a) Reduce incidence: Reduce the number of severe cases of pneumonia
and diarrhea in children under 5 by 75% by 2025.
b) Eliminate deaths: Eliminate deaths from pneumonia and diarrhea in
children under 5 by 2025.
c) Reduce stunting: Reduce the number of children under 5 who are
stunted by 40%.
̶ The GAPPD also aims to improve access to life-saving interventions.
̶ The Global Action Plan for the Prevention and Control of Pneumonia and
Diarrhoea (GAPPD) interventions include:
1. Protect children: Promote exclusive breastfeeding, adequate
complementary feeding, and HIV prevention
2. Prevent pneumonia: Vaccinate children, wash hands with soap,
reduce household air pollution, and provide cotrimoxazole prophylaxis
for HIV-infected and exposed children
3. Treat pneumonia: Ensure that children have access to the right care,
including antibiotics and oxygen.
4. Vaccines: 90% of children should have access to vaccines that protect against
pneumonia and rotavirus
5. Breastfeeding: At least 50% of children should be exclusively breastfed for the
first six months of life
6. Antibiotics: 90% of children should have access to antibiotics for pneumonia
7. Oral rehydration salts: Children with diarrhea should have access to oral
rehydration salts
8. Sanitation and drinking water: All children should have access to safe
drinking water and improved sanitation
9. Indoor air pollution: Reduce indoor air pollution
10. HIV transmission: Virtually eliminate pediatric HIV transmission
New Challenges in Immunization Service Provision
These include:
1. Unimmunized: Despite all effort to immunize all the children, some
still remain unimmunized.
2. Identifying under-immunized children: It can be challenging to
identify under-immunized children, especially those who are transient
or marginalized.
3. Unreached and Hard to reach: Some children and women remain
unreached or hard to reach.
4. Vaccine cost: The cost of vaccines, especially Hib-containing vaccines,
is high in proportion to the budgets of many developing countries.
5. Limited access: In 2023, 14.5 million infants did not receive their first
dose of the DTP vaccine, and 6.5 million were partially vaccinated. This
is due to a lack of access to immunization and other health services.
6. Vaccine supply: There is a limited global supply of preferred products,
especially combination vaccines.
7. Vaccine hesitancy: Vaccine hesitancy is a challenge to immunization
service provision.
8. Assessing population sizes: It can be challenging to accurately assess
population sizes in urban slums.
9. Disrupted healthcare services: Disruptions in healthcare services are a
challenge to immunization service provision.
10. Logistical challenges: Logistical challenges are a challenge to
immunization service provision.
11. Inequities in access: Inequities in access to services are a challenge to
immunization service provision.
12. Capturing data from private providers: It can be challenging to capture
data from private providers.
VACCINOLOGY AND EXPANDED PROGRAMME ON
IMMUNIZATION
A. VACCINOLOGY
Definition The Process of Vaccine Development
■ It is the branch of medical science ̶ The vaccine development process
concerned with vaccines and their includes:
development to prevent infectious
1. Experimental stages
diseases and cancers.
2. Preclinical stages
̶ It involves a variety of medical 3. Clinical stages
specialties, including: immunology,
infectious illnesses, epidemiology, 4. Manufacturing stages
public health, and pediatrics. 5. Quality control stages
6. Regulatory review stages
7. Approval stages
NATURAL HISTORY OF DISEASE
Definition
The natural history of a disease refers to the progression of a disease in an
individual over time, encompassing all stages from initial exposure to
resolution or chronicity.
̶ Understanding this progression is crucial for prevention, diagnosis, and
treatment.
̶ The natural history of a disease provides valuable insights into its
progression, informing healthcare strategies and improving patient
outcomes.
̶ Understanding these stages helps prioritize prevention, enhance early
detection, and guide effective treatment options.
Cont…. Natural History of Disease
Key Stages of The Natural History OF Disease
1. Susceptibility:
̶ Definition: This stage involves the presence of risk factors that make an
individual more vulnerable to developing a disease. Factors can be genetic,
environmental, lifestyle-related, or a combination.
̶ Examples: Age, sex, genetic predisposition, environmental exposures, and
lifestyle choices (e.g., smoking, diet).
2. Exposure:
̶ Definition: The point at which an individual comes into contact with a
disease-causing agent (e.g., bacteria, viruses, toxins).
■ Examples: Infections through vectors (like mosquitoes), exposure to
pollutants, or contact with infectious individuals.
3. Pre-symptomatic Phase (Incubation Period):
̶ Definition: The period after exposure when the disease is developing but
symptoms have not yet appeared. Can be short or lengthy.
̶ Examples: The incubation period for influenza is typically 1-4 days, while
for HIV, it can be several years before symptoms emerge.
4. Clinical Phase:
̶ Definition: Symptoms become apparent, and the individual may seek
medical attention. This phase includes the onset of clinical signs and
symptoms and can be further divided into:
̶ Mild: Symptoms are manageable and may not require hospitalization.
̶ Moderate to Severe: Symptoms necessitate medical intervention, which may
include hospitalization or intensive care. Examples: Fever, pain, fatigue, or
specific signs related to the disease.
5. Recovery or Chronicity:
̶ Recovery: The individual may fully recover, returning to a state of health.
̶ Chronicity: The disease may persist over time, leading to long-term health
issues or disability.
̶ Examples: Chronic diseases like diabetes or heart disease may require
ongoing management and can significantly impact quality of life.
6. Resolution or Death:
̶ Resolution: The disease resolves either through the body’s immune
response or medical treatment.
̶ Death: In severe cases, the disease can lead to mortality.
̶ Examples: Some infections can resolve spontaneously, while others, like
certain cancers, may lead to death if not treated effectively.
■ Importance of Understanding/Studying Natural History

1. Prevention: Identifying high-risk populations and implementing
preventive strategies (e.g., vaccinations, lifestyle modifications).
2. Diagnosis and Treatment: Facilitating timely diagnosis and appropriate
treatment interventions to improve outcomes.
3. Public Health: Informing policies, resource allocation, and health
education campaigns based on disease patterns and progression.
TYPES OF IMMUNITY
Definition
Immunity refers to the ability of an organism to resist and defend against
infections, diseases, and foreign substances.
̶ Immunity is a complex biological response involving various cells, tissues,
and organs of the immune system.
̶ Each type of immunity plays a vital role in protecting the body and
maintaining overall health.
̶ Understanding the different types of immunity is crucial for developing
effective vaccines, treatments, and public health strategies to combat
infectious diseases.
Cont…. Types of Immunity
These are:
1. Innate Immunity
̶ Definition: The first line of defense that is present from birth. It provides a
rapid, non-specific response to pathogens.
Components:
̶ Physical Barriers: Skin, mucous membranes.
̶ Cells: Phagocytes (e.g., macrophages, neutrophils), natural killer cells.
̶ Chemical Mediators: Cytokines, complement proteins.
̶ Characteristics: Immediate response, does not adapt or improve with
repeated exposure.
2. Adaptive Immunity
̶ Definition: A specific immune response that develops over time and
improves with repeated exposure to the same pathogen.
Components:
̶ Lymphocytes: B cells (produce antibodies) and T cells (kill infected cells or
help other immune cells).
̶ Antibodies: Proteins that specifically target and neutralize pathogens.
̶ Characteristics: Slower initial response but provides long-lasting protection
through memory cells that remember past infections.
3. Active Immunity
̶ Definition: Immunity that develops when the immune system is exposed to
a pathogen and produces its own antibodies.
■ Methods of Acquisition:
a) Natural Active Immunity: Acquired through infections (e.g., recovering
from chickenpox).
b) Artificial Active Immunity: Acquired through vaccinations (e.g., receiving
a flu vaccine).
4. Passive Immunity
̶ Definition: Immunity gained by receiving antibodies from another source
(mother to foetus) rather than producing them.
■ Methods of Acquisition:
a) Natural Passive Immunity: Occurs when antibodies are transferred from

mother to child (e.g., through the placenta or breast milk).
b) Artificial Passive Immunity: Involves the transfer of antibodies through
medical interventions (e.g., antibody infusions for certain infections).
Examples typical of artificial passive immunity include:
a) Human immune globulin (IG): A concentrated solution of antibodies
derived from plasma from healthy donors. These include: IgG, IgA, IgM,
and other serum proteins. IG is given intramuscularly (IM) and provides
temporary protection.
b) Antitoxins: Solutions of antibodies against a toxin, which can be derived
from human or animal sources. For example, tetanus immune globulin is
derived from humans, while diphtheria and botulism antitoxin are derived
from animals.
c) Monoclonal antibodies: Antibodies that protect against disease without
activating the immune system. Monoclonal antibodies are used to treat
and prevent infections.
5.Herd Immunity (population immunity)

̶ Definition: When a large percentage of a population becomes immune to a
disease, making its spread unlikely, thus protecting those who are not
immune.
̶ This immunity can be achieved through vaccination or by developing
immunity from a previous infection.
̶ Importance: Essential for preventing outbreaks and protecting vulnerable
populations who cannot be vaccinated.
̶ The percentage of people who need to be immune to achieve herd
immunity varies by disease, for example:
1. Measles, 95% of the population vaccinated.
2. Diphtheria, 75–90% of the population vaccinated
3. Pertussis, 92 – 94% of the population vaccinated
4. Poliomyelitis, 50 – 93% of the population vaccinated
5. Rubella, 83 – 85% of the population vaccinated

VACCINES
Definition
▪ A vaccine is a medical treatment that helps the body's immune system
recognize and fight disease. OR,
▪ It is a biological preparation that provides active acquired immunity to a
particular infectious or malignant disease.
How the Vaccines Work
1. Vaccines work by imitating an infection to engage the body’s natural
defenses.
2. Vaccines help the body learn how to defend itself from disease without the
dangers of a full-blown infection.
3. Every child or pregnant woman should get all recommended vaccines at
the recommended times.
Cont…. Vaccines
■ The examples of EPI vaccines are:
1. Bacillus Calmette-Guérin (BCG)
6. Hepatitis B (Hep B)
2. Polio (OPV and IPV)
7. Measles and rubella
3. Pentavalent (Diphtheria, Tetanus,
Pertussis (whooping cough), 8. Pneumococcal vaccine (PCV 10)
Hepatitis B and Haemophilus 9. Rotavirus (Rota)
influenzae type B)
10. Human papillomavirus (HPV)
4. Tetanus toxoid
11. COVID-19 (for adults)
5. Hepatitis B (HepB)
12. Malaria
Types of Vaccines
̶ The main types of vaccines that act in different ways are:
1. Live-attenuated vaccines use a weakened form of the germ.
2. Inactivated vaccines use a killed version of the germ.
3. Sub-unit, recombinant, polysaccharide, and conjugate vaccines use only
specific pieces of the germ, such as its protein, sugar, or casing.
4. Toxoid vaccines use a toxin (harmful product) made by the germ.
5. mRNA vaccine is a preventive treatment that trains the body to fight infectious
agents. Only COVID-19 vaccines currently use mRNA technology.
6. Viral vector-based vaccines use a harmless virus to smuggle the instructions
for making antigens from the disease-causing virus into cells, triggering
protective immunity against it.
For example, Janssen Jcovden (Johnson & Johnson) COVID-19 vaccine and
Astrazeneca Vaxzevria COVID-19 vaccines.
Other Types of Vaccines
1. Monovalent
2. Combined vaccines
3. Live and killed vaccines
4. Bacteria and viral vaccines
5. Liquid and lymphosized vaccines
Characteristics of an ideal vaccine
Vaccines used in the National Immunization Programme (Schedule of

Vaccination)
The Common Components of Vaccines
Vaccine Constituents/Components/Elements
̶ Vaccines majorly contain antigens, that is, weakened (or killed forms of
germs) or inactive parts of a particular organism (antigen) that triggers an
immune response within the body against the infectious organisms.
̶ The antigens mimic the actual pathogens, prompting the immune system
to produce a response without causing the disease.
̶ This helps the body to develop immunity, enabling it to recognize and
fight off the actual pathogens in the future.
The Common Components of Vaccines
̶ A vaccine consists of many parts, one of which is the antigen, by which it
is often described, also referred to as the immunogen.
1. Antigen: Is the principal part of any vaccine and has evolved over several
years from killed or denatured (Attenuated) whole bacterium or virus, to
parts of the disease-causing agent such as the capsule or genetically
engineered components that mimic the disease-causing agent.
2. Adjuvants: Substances that are added to some vaccines to enhance the
body’s immune response to the antigen. Examples are aluminium
hydroxide gel, emulsigen, aluminium phosphate, calcium phosphate,
quillaja saponin and ginsenoids.
3. Antibiotics: Prevent bacterial contamination e.g., neomycin.
Cont…. Common Components of Vaccines
3.Diluents: Include water, aqueous buffer (such as buffered saline), alcohols
and polyols (e.g. glycerol). Some vaccines require reconstitution where the
diluent is provided separately from the lyophilized (freeze dried) vaccine
for reconstitution at the time of use.
4.Preservatives: Chemical additives to vaccines to ensure that they remain
microbiologically stable. That is, they prevent the growth of
microorganism and fungi during the long time of storage as well as during
its use (especially with multi-dose vials) e.g., formaldehyde, phenol,
Thimerosal, beta-propiolactone etc. Not all vaccines contain preservatives.
5.Stabilizers: Chemical substances added to vaccines in micro-quantities to
maintain vaccine integrity under varying external conditions of
temperature and light, and to sustain physical properties such as solubility.
e.g., lactose, gelatin.
Cont…. Common Components of Vaccines
6. Trace components: These are left over from the process of manufacture
of the vaccine e.g., formaldehyde.
Properties of Vaccines
Vaccines used in EPI in Kenya has the following properties:
1.Efficacy: A vaccine’s efficacy refers to the rate of protection from
infection and/or disease under optimal Phase III clinical trial conditions.
̶ No vaccine is 100% protective. Some vaccines, like the hepatitis B
vaccine, have an efficacy of over 95% if all three doses are received, and
this protection can last for up to 10 years.
̶ Some vaccines do not protect as many people against disease but may still
be able to stop epidemics.
̶ People who are vaccinated may be less likely to pass on the infectious
organism to others, so protection can be greater for the group.
Cont…. Properties of Vaccines
■ A vaccine’s efficacy can be compromised by:
i. Exposure to inappropriate temperatures (freezing or high temperatures),
ii. Wrong reconstitution methods (use of wrong diluent or use of warm
diluent)
iii.Wrong route of administration (e.g subcutaneous injection instead of
intra dermal injection).
2.Effectiveness: Effectiveness describes how well the vaccine reduces

disease in the overall population.
̶ This depends on the efficacy as defined in clinical trials and characteristics
of the general population, including how many people actually get
vaccinated, as well as whether they complete the full series of
vaccinations.
3. Herd Immunity: When a large proportion of people in a community are
vaccinated against a disease (85%-90%), even those who are not
vaccinated in that community get some protection because of a
phenomenon called herd immunity.
̶ If enough people in the community are vaccinated, there is less chance of
the infection spreading from person to person, and unvaccinated
individuals may be less likely to get infected because there is a lower risk
of exposure.
̶ For example, the measles vaccine protects vaccinated people and reduces
spread of the disease to people who are not vaccinated. However, if too
many people are unvaccinated, ‘herd immunity’ cannot occur.
4. Safety – Vaccines are generally safe when used as intended in that they do
not cause serious side effects.
̶ Common side effects include transient fevers and pain at the injection site.
However, there is always a risk of unusual or unexpected reaction to a
vaccine, so health workers have to be alert in case of any adverse event
following immunization (AEFI).
̶ For example, Anti-snake venom is inherently risky to administer and
therefore must only be administered by a clinician with an anaphylaxis
management kit ready.
5.Stability - This refers to the ability of the vaccine to retain its efficacy
under various conditions and environments.
̶ Stability can be compromised by:
i. Contamination with bacteria during administration or reconstitution
ii. Changes in temperature
iii. Exposure to light (a few vaccines)
̶ Most vaccines are inherently thermo-labile and rapidly lose their

potency when exposed to inappropriate extremes of temperature.
̶ Some vaccines are very stable when frozen whereas others are
denatured after even the briefest storage below freezing point
̶ All reconstituted vaccines should be discarded at the end of every
vaccinating session or after six hours – whichever comes first.
̶ Incineration is the best method of destruction for vaccines as they are
biological products.
̶ Any suspicious vaccine vial/s should be documented in the stock ledger:
a) Stating the problem noted,
b) Number of affected vials/doses,
c) The batch number/s
̶ All vaccines for human use in Kenya MUST, therefore:
1. Meet the quality requirements as defined in the current WHO policy
statement on vaccine quality: https://iris.who.int/handle/10665/63578
Or: https://www.who.int/publications/i/item/WHO-VSQ-GEN-96.02REV.1
1. Not interfere significantly with the immune response to other vaccines
given simultaneously.
2. Must have a remaining shelf life of not less than 18 months at the time of
arrival in the country – for routine vaccination services.
3. Must have a remaining shelf life of not less than 6 months at the time of
arrival in the country – for emergency response (outbreak) vaccination
services.
4. Must have Vaccine Vial Monitors (commonly known as VVMs), except
for vaccines under Emergency Use Listing.
The Body's Natural Response
̶ When a pathogen enters the body, it causes the formation of antibodies.
̶ The antibodies produced in response to the pathogen’s antigen are an
important part of the immune system.
̶ Antibodies are considered as the soldiers of the body’s defence system.
̶ Each antibody, or soldier, in our system is trained to recognize one specific
antigen. The body has thousands of different antibodies to protect it
against various diseases.
̶ When the human body is exposed to an antigen for the first time, it takes
time for the immune system to respond and produce antibodies specific to
that antigen.
̶ In the meantime, the person is susceptible to becoming ill and once the
antigen-specific antibodies are produced, they work with the rest of the
immune system to destroy the pathogen and stop the disease.
Cont….. The Body's Natural Response
̶ Antibodies to one pathogen generally don’t protect against another
pathogen except when two pathogens are very similar to each other, like
cousins. Once the body produces antibodies in its primary response to an
antigen, it also creates antibody-producing memory cells, which remain
alive even after the pathogen is defeated by the antibodies.
̶ So, if the body is exposed to the same pathogen more than once, the
antibody response is much faster and more effective than the first time
around because the memory cells are at the ready to pump out antibodies
against that antigen.
̶ This means that if the person is exposed to the same dangerous pathogen
in the future, their immune system will be able to respond immediately,
protecting against the disease.
Cont….. Illustration: The Body's Natural Response
Importance of Childhood Immunization
̶ Childhood vaccines save an estimated 2–3 million lives worldwide every
year, which has contributed substantially to the reduction in global infant
mortality rate from 65 per 1,000 live births in 1990 to 29 in 2018.
̶ Childhood immunizations are a cornerstone of public health, benefiting
not just the individual child but the entire community by preventing
outbreaks and promoting overall well-being.
̶ Specifically, here are some key points highlighting their importance and
benefits of childhood immunizations:
1. Disease prevention: Immunizations protect children from serious and
potentially life-threatening diseases, such as measles, mumps, rubella,
whooping cough, tuberculosis, and poliomyelitis etc.
Cont…. Importance of Childhood Immunization
2. Herd immunity: High vaccination rates in a population can lead to herd
immunity, which protects those who cannot be vaccinated, such as infants
and individuals with certain medical conditions.
3. Reduction of disease spread: Vaccines help reduce the transmission of
infectious diseases, contributing to overall public health and reducing
outbreaks.
4. Long-term health benefits: Vaccinated children are less likely to develop
complications associated with vaccine-preventable diseases, which can
include long-term health issues or disabilities.
Cont…. Importance of Childhood Immunization
5. Cost-effectiveness: Immunization programs can save healthcare costs by
preventing diseases that would require expensive treatments or
hospitalizations.
6. Global health impact: Vaccination campaigns have led to the eradication
or significant reduction of diseases worldwide, improving global health
outcomes.
7. Encourages health literacy: Immunization initiatives can foster a better
understanding of health and disease prevention among families and
communities.
8. Access to education: Many schools require vaccination for enrolment,
ensuring that children are protected from diseases while they are in a
communal setting.

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KENYA MEDICAL TRAINING COLLEGE

DEPARTMENT OF COMMUNITY HEALTH

Module 32: IMMUNIZATION

4. Public Perception and Misinformation: Media coverage and public discourse

■ Activities involved in micro-planning include:

■ Barriers to Supportive Supervision

▪ The target population for globally recommended vaccines is the entire

▪ To calculate immunization coverage, you can use the following formula:

▪ Immunization coverage is the proportion of the target population that has

■ The National Immunization Policy Framework

1. Professionalism and ethics

2. Integrity and accountability

3. Partnership and collaboration

4. Resilience and efficiency

5. Equity, adaptiveness, and innovation

̶ The WHO also emphasizes the importance of partnering with communities

▪ Things to consider when partnering with communities for

▪ Importance / Benefits of Community Participation in Immunization

3. Greater equity: Community involvement can help ensure that

̶ Immunization programmes are integrated in the wider health system

■ Strategies for integrating immunization services include:

1. Ensuring adequate training and workload for health workers

2. Ensuring the participation of community-based organizations, leaders,

3. Selecting interventions that can be feasibly integrated

4. Coordinating across program levels

5. Developing robust monitoring and evaluation strategies

Challenges of Integration of Immunization with other services:

A. Accessibility to Immunization Services

13. Partnerships: Work with community groups, health care systems,

15. Other good practices include: Access-oriented management of

2. Immunization campaigns: Immunization campaigns or supplemental

ii. Global vaccine action plan 2011 – 2020

iii. GAVP for pneumonia and diarrhoea

iv. RED Reach every district/reach every child/every community/

̶ The Decade of Vaccines (DoV) Collaboration developed the Global

̶ The DoV's mission is to extend the benefits of immunization to everyone,

2. GVAP: The Decade of Vaccines Collaboration (DoV) developed the

2. Vaccination coverage: Meeting vaccination coverage targets in every

3. Child mortality: Exceeding the Millennium Development Goal 4 target

4. Elimination targets: Meeting global and regional elimination targets

5. New vaccines: Developing and introducing new and improved vaccines

■ However, GVAP was only partially successful in influencing national

■ Importance of Understanding/Studying Natural History

a) Natural Passive Immunity: Occurs when antibodies are transferred from

5.Herd Immunity (population immunity)

1. Measles, 95% of the population vaccinated.

2. Diphtheria, 75–90% of the population vaccinated

3. Pertussis, 92 – 94% of the population vaccinated

4. Poliomyelitis, 50 – 93% of the population vaccinated

5. Rubella, 83 – 85% of the population vaccinated

Characteristics of an ideal vaccine

Vaccines used in the National Immunization Programme (Schedule of

2.Effectiveness: Effectiveness describes how well the vaccine reduces

̶ Most vaccines are inherently thermo-labile and rapidly lose their

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