Advancing Immunization Coverage and Equity: A Structured Synthesis of Pro-Equity Strategies in 61 Gavi-Supported Countries

Vesela Ivanova, A. S.M. Shahabuddin, Alyssa Sharkey, Mira Johri

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Global immunization inequities persist, reflected in the 25 million underimmunized and 18 million zero-dose children in 2021. To identify country approaches to reach underimmunized and zero-dose children, we undertook a structured synthesis of pro-equity strategies across 61 countries receiving programmatic support from Gavi, the Vaccine Alliance. Methods: We extracted data from 174 Country Joint Appraisals and Multi-Stakeholder Dialogue reports (2016–2020). We identified strategies via a targeted keyword search, informed by a determinants of immunization coverage framework. Strategies were synthesized into themes consolidated from UNICEF’s Journey to Health and Immunization (JTHI) and the Global Routine Immunization Strategies and Practices (GRISP) frameworks. Results: We found 607 unique strategies across 61 countries and 24 themes. Strategies to improve care at the point of service (44%); to improve knowledge, awareness and beliefs (25%); and to address preparation, cost and effort barriers (13%) were common. Fewer strategies targeted experience of care (8%), intent, (7%) and after-service (3%). We also identified strategies addressing gender-related barriers to immunization and targeting specific types of communities. Conclusions: We summarize the range of pro-equity immunization strategies employed in Gavi-supported countries and interpret them thematically. Findings are incorporated into a searchable database which can be used to inform equity-driven immunization programs, policies and decision-making which target underimmunized and zero-dose communities.

Original languageEnglish (US)
Article number191
Issue number1
StatePublished - Jan 2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Drug Discovery
  • Infectious Diseases
  • Pharmacology (medical)
  • Pharmacology
  • Immunology


  • children
  • conflict
  • equity
  • gender
  • immunization
  • poor
  • remote
  • rural
  • urban


Dive into the research topics of 'Advancing Immunization Coverage and Equity: A Structured Synthesis of Pro-Equity Strategies in 61 Gavi-Supported Countries'. Together they form a unique fingerprint.

Cite this