Reinforcing Immunization Systems for Consequential Geographies(RISE4CGs)in DRC, Ethiopia and Nigeria - DRC Abstract summary: DRC hosts one of the largest cohorts of un- and under-immunized children globally, estimated at 734,287 and 1.3 million respectively predisposing the country to frequent VPD outbreaks. The root causes of low vaccine coverage hinclude multiple supply and demand-side factors. Ten provinces account for about 69% of ZD children and constitute consequential geographies (CGs). The purpose of this proposal is to increase the capacity of the Expanded Program for Immunization (EPI) in DRC to prevent, detect and respond to VPDs in priority sub-national CGs, through innovative and sustainable interventions that will contribute to achieving global VPD goals. We propose a “high burden to high impact” approach, prioritizing the implementation of context-tailored, and data-driven interventions targeting CGs with the highest burden of ZD children, VPD outbreaks as well as low vaccination coverage. The expected impact of the project is: 1). improvements towards sustainable, high, and equitable vaccination coverage; 2) progress towards and achievement of VPD control, elimination, and eradication targets; and 3) reduced mortality and morbidity from VPDs. Ethiopia abstract summary:With over 1,000,000 (one million) unprotected children, Ethiopia accounts for 6% of zero-dose children globally. This is mainly due to the existence of sub-national areas (consequential geographies) with weak immunization infrastructure, and overlapping risks such as insecurity/conflict, cross-border migration, internally displaced persons, drought, mountainous terrain, hard-to-reach areas, and mobile populations. This has led to outbreaks of circulating vaccine-derived poliovirus (CVDPV) and measles in Ethiopia. Efforts by the Government and Ministry of Health (MoH) staff to manage immunization programs are hindered by fragmented coordination, limited staff, competing priorities and activities not suited for consequential geographies. This project aims to strengthen immunization systems across the life course ensuring they become more resilient and adaptive to the diverse challenges faced by Ethiopia's healthcare landscape. This will be realized through multi-faceted tailored interventions to accelerate and achieve sustainable vaccination coverage, toreduce morbidity, disability and mortality from VPDs. Nigeria Abstract summary: Nigeria’s national Routine Immunization (RI) coverage is only 57%, significantly below the international standard of at least 90% coverage across all antigens. This lag, exacerbated by the COVID-19 disruptions has resulted in an estimated over 2.3 million zero-dose (ZD) children, accounting for 26% of the global burden. These ZD children are found majorly in communities that with fragile immunization infrastructure with enormous service delivery gaps, and multiple challenges linked to political, economic, security, and ecological instability, resulting in recurrent VPD outbreaks. These settings also face socio-cultural and religious norms that exacerbate inequalities. The goal of this proposal is to support GoN to bolster immunization program capacity in targeted consequential geographies (CGs). The aims are to identify underserved populations and implement tailored interventions for vaccinating these communities, enhance comprehensive VPD surveillance systems, improve preparedness and response to VPD outbreaks, and strengthen the quality and sustainability of immunization delivery systems. The approach is premised on strengthening the three principal functions of the immunization program i.e., prevent, detect, and respond to VPDs across selected CGs in Nigeria through a comprehensive package of context-tailored, people-centered, gender-responsive, and data-driven strategies. The anticipated outcome of the project is: 1) Improved sustainable high and equitable vaccination coverage, 2) Progress towards and achievement of VPD control, elimination and eradication, 3) Reduced morbidity and mortality from VPDs.
