WHO and UNICEF Lay Out Considerations for COVID Vaccine Integration

While the world developed and distributed COVID-19 vaccines with unprecedented speed, the required emergency focus, coupled with response inequities and disruptions caused by the pandemic itself, took an enormous toll on health services. Health workers burned out, access to care fell, and childhood vaccinations suffered the largest sustained decline in 30 years. While the pandemic’s trajectory remains unknown, the latest wave appears to have peaked, creating space to consider how to incorporate COVID management into routine services, help health systems recover, and use lessons and resources to increase preparedness.

To move toward those goals, the World Health Organization (WHO) and UNICEF are developing a document outlining considerations for incorporating COVID-19 vaccination into national immunization programs and primary care. Among priorities is helping countries shift from the mass vaccination campaigns required during the pandemic’s initial emergency response to more sustainable, integrated approaches that continue to make COVID vaccines available while better balancing attention and resources to other health services. While some focus is on integration of vaccine delivery, the organizations also suggests taking a broader view of repurposing that includes cold chain improvements, information systems, and methods for reducing disinformation and misinformation to bolster immunization and health systems overall. As a “living document,” these considerations will be updated as circumstances warrant.

As a first step, the document suggests countries establish temporary working groups to assess their current COVID vaccination levels, integration readiness, and available resources. Countries will need to develop national policies for continuing efforts toward primary immunization and boosters with COVID vaccines. With many countries still struggling to meet overall COVID vaccination goals, WHO’s latest strategy prioritizes urgently vaccinating high risk groups including health workers, older adults, and the immunocompromised. Based on a WHO interim statement, additional COVID vaccine doses are likely to be needed at least for those groups into the future and the document suggests countries ensure continued vaccine accessibility.

While listing possible risks associated with integration, including stretching health staff and other resources too thinly and the uncertainty of future COVID-19 vaccine needs, the organizations also cite the potential to capitalize on pandemic investments and innovations to reinvigorate and enhance services. For example, development of additional delivery platforms creates opportunities to expand immunization, screening, and other services to older adults and establishes necessary infrastructure for future pandemics. The document also suggests repurposing other COVID innovations including digital health care and technological upgrades.

Many countries already are moving toward integration. India is adapting a COVID electronic registration system used to track priority groups, schedule appointments, and monitor adverse events for use in broader immunization services. Nepal used COVID resources to expand its overall immunization cold chain. Other countries, including Nigeria and Ethiopia, are using childhood immunization sessions to offer COVID vaccines to adults while a 2021 pilot project in Cambodia successfully incorporated non-communicable disease screening with COVID vaccinations at ten sites.

COVID-19 disrupted every aspect of health care delivery and its ripple effects will be felt for years to come. Shielding future generations from vaccine-preventable diseases and ensuring continued protections for high-risk adults are recovery priorities. With proactive planning and effective follow through, countries can capitalize on resources and advances from the COVID-19 response to regain lost momentum and prepare for future health emergencies.