Strengthening Routine Immunization and Health Systems to Reach Unvaccinated Children

Globally each year, 13 million children are unvaccinated and 7 million children remain undervaccinated and at risk for contracting vaccine-preventable diseases. Coupled with stagnating and decreasing immunization coverage in many contexts, how can we strengthen immunization and health systems to address these inequities?

The Challenge

Despite many years of progress, immunization coverage has stagnated or declined in many countries, many children are unvaccinated (“zero-dose”) or undervaccinated, thereby unprotected from vaccine-preventable diseases. These inequities have been further exacerbated by the COVID-19 pandemic, which the WHO has estimated will potentially put more than 80 million children at risk for missing routine immunizations. To address these persistent challenges in increasing immunization coverage and reducing inequities, new solutions co-created with country and global actors are needed to strengthen the broader health and immunization system.

The Opportunity

There is a renewed focus on reaching undervaccinated and unvaccinated children in the WHO’s Immunization Agenda 2030 and Gavi, the Vaccine Alliance’s strategy for 2021-2025, Gavi 5.0. With the disruption caused by the COVID-19 pandemic, there are also opportunities to rethink immunization service design to begin to address inequities while providing safe access to services throughout the pandemic. There are also opportunities to think more broadly and innovatively in supporting countries to address challenges in integrated management, health systems strengthening, financing, data and learning, social and behavior change, gender and human-centered design that could help improve immunization coverage.

Our Work

As a partner on the USAID MOMENTUM Routine Immunization Transformation and Equity program (M-RITE), R4D is supporting global, regional, and country-level actors to analyze and co-create health systems and financing solutions that help to strengthen immunization systems to reach under- and unvaccinated children. R4D will contribute to M-RITE’s approach that puts people at the center, introduces new innovations, fosters creative problem-solving, and builds on collective experience and resources to build the capacity of country institutions and local organizations to close equity gaps, improve service experience and actively partner with communities and others to improve immunization outcomes.

In Jigawa state, Nigeria, R4D co-created a capacity building plan for health managers in Dutse and Kiyawa Local Government Areas (LGAs) with the state Ministry of Health, the Primary Health Care Development Agency (PHCDA) and the Ministry of Budget. The capacity building plan focused on strengthening competencies in data analysis and reporting, advocacy, planning and fostering familiarity with budget preparation/disbursement processes. Through technical assistance, training, mentorship and coaching synchronized with the state budget cycle, R4D is strengthening the capacity of local health managers so they can prepare and negotiate budgets in 2024. R4D also preparing to implement the activity in Kenya.

Photo credit: Alex Robinson for CHMI/Kusuma Buana Foundation

Project Name:

MOMENTUM Routine Immunization Transformation and Equity (M-RITE)






JSI Research & Training Institute, Inc. (JSI), PATH, Gobee Group, Accenture Development Partners, Manoff Group



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