This November, Marketlinks Explores the Potential of the Private Sector in Expanding the Reach of and Access to National Immunization Programs

This post is authored by Susan Rae Ross, Sr. Private Sector Engagement Advisor, Office of Maternal/Child Health and Nutrition, USAID Global Health Bureau; Dr. Gaurav Sharma, Sr. Maternal, Newborn, Child Health Technical Advisor and Dr. Christopher Morgan, Sr Immunization Technical Advisor for the MOMENTUM Private Healthcare Delivery Project.

As one of the most cost-effective public health interventions, immunization is critical to stopping the spread of preventable infectious diseases and keeping communities and countries healthy. Significant progress had been made in the development and accessibility of immunizations, with 2 to 3 million deaths averted each year due to vaccines for diseases such as measles and pertussis. Despite this progress, in 2020 17 million infants globally did not receive the first dose of their recommended childhood vaccinations — known as “zero dose” children.

The COVID-19 pandemic has stretched many routine health programs and has starkly highlighted the challenge of reaching new adult and adolescent populations with vaccines. The pandemic has required immunization programs to increase the pace and scope of services at scales never seen before, driving these traditionally public sector programs to find innovative solutions and collaborate with new partners — including the private sector — to expand reach and access.

Immunization has been a key priority for the U.S. Agency for International Development (USAID) for more than 50 years and underpins the Agency’s efforts to prevent child and maternal deaths worldwide. USAID supports countries to develop sound immunization policies, strategies, and guidelines to ensure greater country ownership of routine immunization programs. This support not only contributes to global health objectives, but also contributes to the full range of USAID’s development goals, from promoting economic growth and trade to strengthening partner country resilience. Since 2001, USAID has contributed almost $2.8 billion to Gavi, helping 73 lower-income countries immunize more than 888 million children and save more than 15 million lives. USAID’s partnership with Gavi has helped introduce and scale-up new vaccines as well as build sustainable immunization systems needed to support their distribution and delivery.

As a strong advocate for private sector engagement, USAID sees immunization as an area to expand and more deeply engage with healthcare firms, non-governmental/faith-based organizations (NGOs/FBOs), for-profit health providers, and other non-health private sector entities (e.g., transporters, technology, and mobile phone companies). The COVID-19 pandemic has heightened the urgency of working with the private sector to expand immunization access. Throughout the pandemic, private sector engagements to address COVID-19 have focused on improving testing, pandemic surveillance, risk communication, provision of personnel protective equipment, treatment of disease, and the production and distribution of the COVID-19 vaccines globally. Yet, more could be accomplished.

Private sector engagement for the delivery of immunization services is critical for two reasons:

• To achieve a scale where effective vaccine rollout can reach the objectives needed for population level immunity.
• To further leverage the skills, assets, and platforms of diverse groups to sustain the reach and scale of immunization systems in strengthening both routine services and increasing resilience to future shocks.

Gaining a better understanding of the private sector’s role in immunization has been of interest for some time. Over the past twenty years, there have been four global or regional reviews of published evidence, resulting in a World Health Organization guidance document in 2017. In low- and middle-income settings, private sector facilities (e.g. for-profit, NGOs/FBOs) vary hugely in their capacity (and willingness) to provide immunization. What is missing from this evidence, however, is documentation of how private sector actors can truly expand access to vaccination at scale, and the mechanisms of engagement that can catalyze radical change. A clearer understanding is also needed of the perspectives of private sector health workers, and the motivations and enablers that would allow them to fully participate in the vaccination effort.

USAID’s MOMENTUM suite of awards is actively contributing to advancing equitable access to immunizations. Within MOMENTUM Private Healthcare Delivery project, work is underway to:

• explore engagement with the  private sector to boost the reach of immunization programs, particularly to reach adults which has not been the focus of past immunization programs;
• understand the immediate needs generated by the COVID-19 pandemic; and
• identify ways investments in the global COVID-19 response could strengthen immunization service delivery in the future.

 Through this work, key insights have been elevated that can benefit governments, donors, and practitioners in considering engagement with private sector providers to deliver immunization services in support of successful health outcomes. These insights recognize the unfulfilled potential of the private sector  to expand the reach of immunization programs, and the efforts required to harness the benefits of the private sector while managing associated risks.

A learning agenda is needed that captures lessons from the pandemic, especially where the private sector has provided new vaccination sites, staff, approaches, or other resources. Further efforts and learning are needed to build stronger, more resilient immunization programs for the long-term.

Join us!

Join the conversation throughout November! We will be sharing two more blogs about PSE and immunization that will include highlights on evidence, implementation approaches, country experiences, and recommendations for future learning. Also, look out for more details about our November webinar, during which we will share lessons from the field.

In the meantime, please check out these resources:

1. MOMENTUM Private Healthcare Delivery, World Health Organization, MOMENTUM Routine Immunization Transformation and Equity. Looking to the Private Sector to Accelerate the COVID-19 Vaccine Roll-Out: All Hands on Deck for Equitable Delivery | Health Systems Governance Collaborative [Internet]. [cited 2021 Jun 7]. Available from: https://www.psi.org/2021/05/looking-to-the-private-sector-to-accelerate-the-covid-19-vaccine-roll-out-all-hands-on-deck-for-equitable-delivery/.

2. World Health Organization. WHO Guidance Note: Engagement of Private Providers in Immunization Service Delivery. Considerations for National Immunization Programmes [Internet] WHO. World Health Organization; [cited 2021 Mar 16]. Available from: http://apps.who.int/iris/bitstream/handle/10665/258968/WHO-IVB-17.15-eng.pdf;jsessionid=2561E47372A8D305ACB0A1E9FBB56674?sequence=1.

3. Sood N, Wagner Z. For-profit Sector Immunization Service Provision: Does Low Provision Create a Barrier to Take-Up? Health Policy Plan. 2013 Oct 1;28(7): 730–8.

4. Mitrovich R, Marti M, Watkins M, Duclos P. A Review of the Private Sector’s Contribution to Immunization Service Delivery in Low, Middle, and High-Income Countries [Internet]. World Health Organization; [cited 2021 Mar 16]. Available from: https://www.who.int/immunization/sage/meetings/2017/april/2_Review_private_sector_engagement_Mitrovich_et_al.pdf.

5. “Leveraging the Private Sector to Scale Up Covid-19 Vaccine Roll Out.” Published April 22, 2021. Available at: https://www.psi.org/2021/04/leveraging-the-private-sector-to-scale-up-covid-19-vaccine-roll-out/.

6. Morgan R, Ensor T, Waters H. Performance of Private Sector Health Care: Implications for Universal Health coverage. Lancet. 2016;388(10044): 606-12. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00343-3/fulltext.