Closing the global immunization gap, one child at a time

Fasala is a 27-year-old woman who works as a farmer in Ethiopia. “I am illiterate,” she said. “But I want my child to become an educated person. Now he will be able to become a wise boy and maybe, one day, a health professional.”

Fasala’s child is lucky. He had just caught up with his vaccinations in a village in the Benishangul-Gumuz Region of Ethiopia, where only 57% of children under two years have received the basic vaccines against life-threatening childhood diseases and 13% have not received any at all.

The region has been one of the places grappling with the types of challenges that have stymied immunization coverage globally. While coverage increased quickly around the world over the last two decades, it has recently stagnated. Twenty percent of children are still caught behind a myriad of barriers affecting them and their families, including limited awareness of the immunization schedule, low confidence in the health system, low capacity among health workers, lack of access to services as well as stock-outs of vaccines and supplies.

Luckily, the immunization of Fasala’s child is not an isolated success story. At the International Rescue Committee, we’ve recognized that monitoring the immunization status of every child and individually tracing them in case they are overdue for a specific vaccine is critical, particularly in fragile states and hard-to-reach areas.

Proactively tracking immunization status at the individual level and conducting adequate follow-up helps prompt better, data-driven, decision-making and allows health workers to have a more accurate sense of which villages are most in need of immunization services and when. While the benefits of this approach are clear, it is often dismissed as too difficult.

But the IRC’s experience continues to confirm that this strategy is not only necessary — but has real impact. In Uganda, the IRC has developed and is currently testing a mobile phone-based data platform, called mReach. mReach tracks all vaccine-eligible children and automatically flags defaulting children for health workers to get them back on schedule. It shares individual child immunization status data across health centers, in case parents choose to visit different locations and allows health workers to map immunization coverage by village in order to more accurate identify, and plan for, where services are needed most.

In Ethiopia, limited network connectivity prompted the IRC Ethiopia health team to develop complementary tools to mReach: a color-coded health calendar for parents to track appointments at home and a paper-based defaulter tracing tool, enabling health workers to collaborate with the community to trace and subsequently immunize children missing any vaccines. In 2016, of the 2,830 defaulting children identified, 84% were successfully immunized with the vaccines they had missed. A formative evaluation of this strategy concluded that it contributed to a 15–21% increase in the immunization coverage in project areas of Benishangul-Gumuz, in less than 3 years.

Using innovative tools to help community-based health workers trace children who have defaulted on immunization visits has proven possible in a variety of contexts, and is most successful when communities are highly engaged in the process. This has enabled the IRC to increase local immunization coverage while also sensitizing both community and facility-based health workers to use all interactions with children under 1 year to ensure they are up to date with their immunization schedule.

The global strides in immunization are to be celebrated, as should the immunization of Fasala’s child. But only when such assurances of a healthier future are within reach for every child, regardless of where they live, can the global health community consider its work done. Challenges are certainly before us, but so are indications of real opportunities to close the global immunization gap. We must continue to exhibit the creativity, commitment and courage to close the gap, one child at a time.

This post was authored by IRC Technical Advisors Justine Landegger and Comfort Olorunsaiye.

Learn more about World Immunization Week.

Read about immunization in Uganda.


The International Rescue Committee responds to the world’s worst humanitarian crises, helping to restore health, safety, education, economic wellbeing, and power to people devastated by conflict and disaster. Founded in 1933 at the call of Albert Einstein, the IRC is at work in over 40 countries and 26 U.S. cities helping people to survive, reclaim control of their future and strengthen their communities.

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