The second half of the 20th century marked a period of great advancement in immunization. As donors and national governments stepped up investments to develop vaccines and strengthen routine immunization programs, infectious diseases that once ravaged much of the world were either wiped out or largely stripped of their devastating impact. The achievements of the past century now read like a laundry list—smallpox eradicated, wild poliovirus is more than 99% eliminated and cases of measles and Hib among children under-five now reduced to record low numbers.
Despite these tremendous leaps forward, however, the quarter-century has seen a slowing of progress. In many of the world’s poorest regions, already-fragile health systems now face increasing strain from the introduction of new vaccines. Immunization systems continue to lack reliable, high-quality data, and as a result, health officials are left hamstrung—unable to assess program performance and prevented from extending life-saving vaccines to the very last child.
Over the past few years, the global health community has placed the need for better immunization data at the top of the agenda. So in 2013, the Vaccine Delivery team responded to the proverbial call-to-action with its largest investment to-date: the BID Initiative.
Led by a partnership between PATH and select Ministries of Health—with support from WHO and Gavi, the Vaccine Alliance—BID is rooted in the premise that better data plus better decisions equals better health outcomes. With plans to run through 2018, BID shines a light on the challenges associated with data collection, quality and use and aims to identify innovative, sustainable and country-owned immunization solutions.
Now for how it all works: First, a country decides it wants to improve its health information systems, with immunization data as a starting point. In-depth interviews with key leadership and personnel are conducted, and the country’s willingness and ability to implement a package of interventions is assessed—from electronic immunization registries and policies for information-sharing to cultural shifts around data use. Second, prospective solutions are co-designed by BID staff, in consultation with workers across the entire country health system. Third, solutions are tested regionally and then brought to scale at the national level. Finally, insights and improvements realized through BID are shared with peer governments and other key stakeholders looking to implement a similar package.
Now three years in, BID has made strides in its two demonstration countries. Tanzania has begun testing solutions in the northern Arusha region, with 101 facilities in the program, 37,964 children in a new electronic immunization registry and 148 health workers trained on BID solutions. In Zambia, solutions such as an electronic immunization registry have been developed and testing is currently underway in the southern province. Once testing is complete, both countries will explore additional funding options to support scale-up at the national level.
For immunization progress in the 21st century to pick up where it left off in 1990, access to high-quality and actionable data is key. So too is local input and country ownership. BID is currently just one program in a sea of efforts to improve global immunization beyond 90 percent coverage targets. But in the coming years, its outcomes could surely prove instructive to the cause.