Immunization resources

Improving service delivery

Publications focusing on service delivery issues, such as improving coverage and maintaining quality services under health care reform, among others. Our featured resources give you quick access to essential and up-to-date resources for service delivery improvement.

Featured resources

Assessing new vaccines for national immunization programs (2000)
World Health Organization (WHO)
This 32-page paper helps to frame the questions program managers should ask themselves when considering new vaccine introduction.

Freezing temperatures in the vaccine cold chain: A systematic literature review (2007)
Matthias Dipika M., et al. Vaccine. 25(20):3980-3986.
This analysis highlights the pervasiveness of accidental freezing across the cold chain and makes recommendations for adressing the problem.

Preventing freeze damage to vaccines (2007)
WHO
This aide-memoire details best practices in how to prevent freeze damage to vaccines.

Preventing vaccine freezing in the cold chain (2003)
PATH
Vaccine freezing in the cold chain is increasingly recognized as a serious threat to immunization programs. This zipped set of materials includes background information on the freezing problem (two literature reviews and a PowerPoint presentation); posters and stickers ready for use in the vaccine store and the clinic; and a sample protocol for a vaccine freeze study along with the results of a study in Indonesia.

Procedure for expedited review of imported prequalified vaccines for use in national immunization programs (2007)
WHO
These guidelines are directed at countries that may lack resources to carry out a regulatory approval procedure for sourcing WHO prequalified vaccines either through UN agencies or directly from manufacturers.

Strengthening cold chain and logistics systems (2007)
UNICEF
This report details the first UNICEF-hosted meeting of partners involved in immunization to enhance and coordinate the collective support provided to national governments for strengthening cold chain and logistics sytems.

Sustaining immunisation efforts under health reform: Challenges for Africa (1999)
Msambichaka K.
In this paper Dr. Khadija Ali Msambichaka looks at the current state of EPI programs in Africa and the effects that health care reform is having on them. She cautions that health care reforms must be implemented carefully to ensure that immunization benefits are achieved and sustained, and she offers practical suggestions for implementing health care reform in a manner that will strengthen national immunization programs. Dr. Msambichaka's paper was originally presented at the November 1998 CVI Consultative Group meeting held in Geneva.

Temperature sensitivity of vaccines (2006)
WHO
This document addresses issues regarding potential exposure of temperature-sensitive vaccines to freezing temperatures and provides updated information on vaccine vial monitors, as well as a discussion of future advances in cold chain technology.

Vaccine introduction guidelines - Adding a vaccine to a national immunization programme: Decision and implementation (2005)
WHO
This tool from the WHO was developed to offer guidance in decision-making and introduction of new vaccines.

Vaccine-preventable diseases: Improving vaccination coverage in children, adolescents, and adults (1999)
US Centers for Disease Control and Prevention (CDC)
This 23-page "Recommendations and Reports" insert is from the June 18, 1999, issue of Morbidity and Mortality Weekly Report.

Vaccines: Handled with care (2004)
UNICEF
This attractive, 25-page booklet describes how vaccines are stored and handled to ensure safety.

Vaccine stock management: Guidelines on stock records for immunization programme and vaccines store managers (2007)
WHO
This document was developed to assist countries in improving vaccine stock management practices in accordance with the WHO-UNICEF Effective Vaccine Store Management initiative. It reviews approaches and tools for recording necessary information. Related Excel forms, including stock cards and reports, may be downloaded from TechNet.

General service delivery resources

Access to vaccine technologies in developing countries: Brazil and India (2007)
 Milstien J, Gaulé G, Kaddar M. Vaccine. 25:7610-7619.
The authors of this study analyzed advantages and disadvantages of different ways vaccine manufacturers access new technologies. Among the methods considered were collaborations with academia and research institutions; technology transfer agreements with multinational corporations, public sector, or developing country organizations; and importation and finishing of bulk products.

Attitudes toward immunization in Cambodia: A qualitative study of health worker and community knowledge, attitudes, and practices in Kampong Chhnang (2002)
 Forder J. PATH
Nearly 200 consumers and medical care providers were interviewed for this well-documented, qualitative research study. The data offer insight into many aspects of public and professional attitudes toward immunization and health care in general.

Guidelines on the international packaging and shipping of vaccines (2005)
WHO
This widely used reference from WHO has been updated according to new developments in vaccine stability, temperature monitoring, and recently pre-qualified vaccines.

Imaginative ways of raising immunization coverage (1997)
WHO
This issue of EPI Update offers country examples and practical ideas for improving coverage.

Immunization safety (2000)
Bulletin of the World Health Organization. 78(2)
This entire issue of the WHO Bulletin is devoted to the topic of immunization safety, including vaccine quality, adverse events reporting, and safety of immunization injections.

Increasing immunization coverage at the health facility level (2002)
WHO, UNICEF
This 41-page handbook offers practical guidance for understanding and addressing reasons for low coverage.

The manager’s electronic resource center
Management Sciences for Health (MSH)
This web resource center provides management tools and information across an international network of health professionals. The site is run by MSH, a nonprofit organization geared toward strengthening health programs worldwide.

Outbreak communication guidelines (2005)
WHO
A 13-page paper describing best communication practices for rapid disease outbreak control.

TechNet Forum
BASICS, WHO
This online discussion forum addresses issues in logistics for health, with a primary focus on management and operational logistics of national immunization programmes.

Technologies for vaccine delivery in the 21st Century
Lloyd J. WHO, US Agency for International Development (USAID), and PATH
This 25-page paper looks at new vaccine delivery concepts that could benefit the developing world within the next ten years.

The cold chain: Keeping it cool is critical (2001)
Paulson T. Seattle Post-Intelligencer
Part of Seattle Post-Intelligencer's 2001 special report on the immunization and health-related initiatives supported by the Bill & Melinda Gates Foundation.

Understanding and addressing childhood immunization coverage in urban slums (2005)
Agarwal S, Bhanot A, Goindi G. Indian Pediatrics. 42(7):653–663.
Supported by the US Agency for International Development, the authors identified challenges and potential solutions for improving immunization coverage in urban slums.

Using Uniject™ to increase the safety and effectiveness of hepatitis B immunization (2002)
Nelson C, Widjaya A, Wittet S. PATH
This seven page paper describes use of an innovative injection device to immunize Indonesian newborns as soon after birth as possible. Results were positive: more infants were protected against hepatitis B earlier in life, health workers and parents liked the device, and use of Uniject is cost-effective.

Vaccine management
WHO
This section of the WHO website focuses on vaccine management issues including the cold chain, transport, stock management, and reconstitution of vaccines.

Working to ensure quality, safety and standards in global immunization (2007)
WHO
This document outlines the changing regulatory environment required to keep pace with demand for the introduction of new vaccines. It includes sections on setting norms and standards; assuring the quality of vaccines and immunization equipment; and monitoring, assessing and responding to vaccine safety issues of global concern.