São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

The phased withdrawal of oral polio vaccine (OPV) associated with the Polio Eradication and Endgame Strategic Plan 2013-2018 began with the synchronized global replacement of trivalent OPV (tOPV) with bivalent OPV (bOPV) during April - May 2016, a transition referred to as the “switch.” The World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization recommended conducting this synchronized switch in all 155 OPV-using countries and territories (which collectively administered several hundred million doses of tOPV each year via several hundred thousand facilities) to reduce risks of re-emergence of vaccine-derived polioviruses. Safe execution of this switch required implementation of an associated independent monitoring strategy, the primary objective of which was verification that tOPV was no longer available for administration post-switch. This strategy had to be both practical and rigorous such that tOPV withdrawal could be reasonably employed and confirmed in all countries and territories within a discreet timeframe. Following these principles, WHO recommended that designated monitors in each of the 155 countries and territories visit all vaccine stores as well as a 10% sample of highest-risk health facilities within two weeks of the national switch date, removing any tOPV vials found. National governments were required to provide the WHO with formal validation of execution and monitoring of the switch. In practice, all countries reported cessation of tOPV by 12 May 2016 and 95% of countries and territories submitted detailed monitoring data to WHO. According to these data, 272 out of 276 (99%) national stores, 3,741 out of 3.968 (94%) regional stores, 16,144 out of 22,372 (72%) district level stores, and 143,050 out of 595,401 (24%) of health facilities were monitored. These data, along with field reports suggest that monitoring and validation of the switch was efficient and effective, and that the strategies used during the process could be adapted to future stages of OPV withdrawal.

The role of gender inequality in childhood immunization is an emerging area of focus for global efforts to improve immunization coverage and equity. Recent studies have examined the relationship between gender inequality and childhood immunization at national as well as individual levels; we hypothesize that the demonstrated relationship between greater gender equality and higher immunization coverage will also be evident when examining subnational-level data. We thus conducted an ecological analysis examining the association between the Subnational Gender Development Index (SGDI) and two measures of immunization—zero-dose diphtheria-tetanus-pertussis (DTP) prevalence and 3-dose DTP coverage. Using data from 2010–2019 across 702 subnational regions within 57 countries, we assessed these relationships using fractional logistic regression models, as well as a series of analyses to account for the nested geographies of subnational regions within countries. Subnational regions were dichotomized to higher gender inequality (top quintile of SGDI) and lower gender inequality (lower four quintiles of SGDI). In adjusted models, we find that subnational regions with higher gender inequality (favoring men) are expected to have 5.8 percentage points greater zero-dose prevalence than regions with lower inequality [16.4% (95% confidence interval (CI) 14.5–18.4%) in higher-inequality regions versus 10.6% (95% CI 9.5–11.7%) in lower-inequality regions], and 8.2 percentage points lower DTP3 immunization coverage [71.0% (95% CI 68.3–73.7%) in higher-inequality regions versus 79.2% (95% CI 77.7–80.7%) in lower-inequality regions]. In models accounting for country-level clustering of gender inequality, the magnitude and strength of associations are reduced somewhat, but remain statistically significant in the hypothesized direction. In conjunction with published work demonstrating meaningful associations between greater gender equality and better childhood immunization outcomes in individual- and country-level analyses, these findings lend further strength to calls for efforts towards greater gender equality to improve childhood immunization and child health outcomes broadly.

Checking vaccination status at school is widely recommended as a strategy to strengthen routine childhood vaccination coverage. Documentation of approaches, challenges, strengths, and impact of this strategy in a variety of contexts is key to enhancing adoption and implementation. However, there is limited information about the prevalence of policies and the implementation of checking vaccination status at school globally. A one-time supplementary survey was circulated with the annual World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) Joint Reporting Form in 2019 to all WHO member states and non-member state reporting entities. Additional publicly available country-level data, including primary school enrollment, home-based record (HBR) ownership, and World Bank income classification were linked to the supplementary survey responses, which were descriptively analyzed. We received survey responses from 130 of the 194 (67%) WHO member states and 15 non-member state reporting entities. Almost half (46%) of the respondents reported having a law requiring proof of vaccination to enter at least one level of education, and 60% of the respondents reported having a law that requires checking vaccination status at school in 2018. Three-quarters of the respondents (77%) reported the practice of routinely checking vaccination status at school. Both laws and the practice of checking were more common in the WHO Region of the Americas and the WHO European Region, and in high- and upper-middle-income countries. Individual HBR was the document most frequently checked. Catch-up vaccination occurred most frequently at health centers. Evaluation of checking vaccination status at school to determine what has worked and its effect was infrequently reported. Despite widespread implementation of checking vaccination status at school in 2018, documentation of the experiences in planning and implementing this strategy, and its effects remains sparse, particularly in low- and middle-income countries.

Background/Objective: Historically, immunization programs have focused on infants, children, and women of reproductive age. COVID-19 vaccination prompted countries to vaccinate adults. The objective of this manuscript is to provide a global overview of adult immunization policies post COVID-19 pandemic. Methods: We summarized WHO Strategic Advisory Group of Experts on Immunization (SAGE) recommendations by adult group and analyzed the data reported in 2024 (2023) by WHO Member States (MS) via the WHO/UNICEF electronic Joint Reporting Form on Immunization (eJRF) on national immunization schedules, and from other sources by WHO region and income group. Results: WHO policy recommendations exist for most of the licensed vaccines targeting adults; however, the inclusion in national immunization schedules is higher in high-income (HICs) and middle-income (MICs) countries. For pregnant women, 90% of MS reported vaccination against COVID-19 (65% in low-income countries [LICs]), 63% against tetanus-containing vaccines (73% in LICs), 57% against influenza (4% in LICs), and 21% against pertussis-containing vaccines (all MICs and HICs). For health workers, 91% against COVID-19 (92% in LICs), 59% against influenza (4% in LICs), and 25% against hepatitis B (10% in LICs). For adults with chronic diseases, COVID-19 vaccination data were not available, 58% against influenza, and 23% against pneumococcal disease. For older adults, more than 90% of MS across all income groups reported COVID-19 vaccination, 59% against influenza (8% of LICs versus 89% of HICs), 17% against pneumococcal, and 7% against herpes zoster (HZ). Conclusion: The disparities in adult immunization policies across income groups highlight the need to improve access and strengthen vaccination efforts. A life course approach is essential to maximize the full potential of immunization across all ages.

Most countries use tally sheets across immunization programmes for health workers to mark vaccine doses administered to every person, alongside home-based records, yet their design and use is poorly understood at the global level. This paper presents a multi-country analysis on routine childhood immunization tally sheet content and design sourced from the annual electronic WHO/UNICEF Joint Reporting Form on Immunization (eJRF), which collected these forms for the first time in 2024 (for 2023). Of the total submissions (N = 71) of tally sheets by reporting entities, 51 submissions met the criteria for inclusion as a valid tally sheet allowing for data extraction. The 51 tally sheets were from countries and territories across all six regions of the World Health Organization (WHO) and all four World Bank income classifications. Analysis showed heterogeneity in immunization tally sheet design, core data fields, and the extent to which the available tally sheets aligned with globally recommendations found in recent vaccine-specific and programmatic guidance related to catch-up vaccination. As national immunization programmes and vaccination schedules protect against more diseases, and thereby become more complex, fit-for-purpose tally sheet design and instructions as well as support mechanisms for health workers on tally sheet use are essential, similar to what is recommended for home-based records.