Training Module Syllabus:  Introduction to immunization systems

Last updated:  July 2021

Contact person:  Aaron Wallace; ccu7@cdc

[Download Word document of this training syllabus]

About this training module

 The purpose of this training is to provide a step-by-step introduction to global routine immunization (RI) systems. 

This training covers the following main areas:

1.       Overview of immunization systems worldwide

2.       Critical components of the immunization system

3.       Common challenges, research areas and key solutions to implementing an immunization system

4.       Global historical performance of immunization systems

5.       Global strategic frameworks for implementing immunization systems

6.       Global organizations supporting immunization systems, including key formal and informal groups organized to share knowledge, guide policymaking for immunization and key meetings

How to use this training module

This training module is organized such that there is a core curriculum you should start with to become familiar with the world of immunization services.  The curriculum is listed so that each section builds on the previous one.  If you are very short on time, I recommend covering sections 1 to 6 and thoroughly reading the following three guides:  Immunization essentials, Immunization in Practice and The RED guidelines.  Additionally, a new Core References document from WHO and partners was just released and provides a nice overview of key resources by topic area as well as a new Immunization Resources Database focused on Immunization Coverage & Equity.

CORE CURRICULUM

About:  The following training modules are the minimum you should cover to get a basic understanding of how global immunization systems work.

#

Training category

Title

Learning objectives

Assigned document & location

Additional reading

Presentation video

Related orientation videos

Related online courses

1

Global overview

The global effort to vaccinate children

Broad introduction to the Expanded Program on Immunization

Presentation: Crash course on the global effort

·         Immunization essentials Chapter 1

 

·         Immunization In Practice (IIP) section 1

To be completed

·         2021 webinar on the new Immunization Agenda 2030 global strategy & vision

 

2

Global Performance

Historical performance of immunization programs worldwide

Become familiar with global and regional immunization program coverage performance

Presentation:     WHO presentation on 2020 immunization program performance

·         2020 MMWR on global immunization coverage & progress

To be completed

 

 

4

Global Action Plans

Immunization Agenda 2030: The global strategic plan for immunization work 2021 -2030

Become familiar with major goals of the global immunization partnership 

Document:  Immunization Agenda 2030 strategic plan

·          IA2030 website has additional key documents: Link

 

·         IVAC-hosted panel on IA2030 with WHO colleages

 

5

Overview of the routine immunization system components

Introduction to the immunization system

overview of the global immunization system and immunization system components

Presentation: Orientation to routine immunization systems (GID presentation)

·        Immunization essentials Chapter 2

 

·         Immunization system diagram handout #1

 

·         Immunization system diagram handout #2

 

 

To be completed

 

 

6

RI system: Monitoring

Monitoring and evaluation for immunization systems

Become familiar with common immunization monitoring tools and evaluation activities

Presentation: Monitoring & evaluation for routine immunization

·         Immunization essentials Chapter 4

 

·         Examples of monitoring tools handout

 

·         MLM Module 5: Monitoring the immunization system

To be completed

 

·         Immunization Academy: Monitoring coverage at the health facility level

7

RI System: Microplanning

Microplanning for routine immunization

In depth review of microplanning for routine immunization

Document:  WHO guide on microplanning for routine immunization

·          WHO presentation on microplanning and supervision – for COVID-19 vaccination, but generically covers any vaccination situation

Not applicable

●WHO video overview on microplanning and supportive supervision (in COVID-19 context but generic info)

 

●IA:  Mapping the health facility catchment area

 

8

RI System:  Surveillance

The vaccine preventable disease surveillance system in developing countries

In depth review of VPD surveillance systems

Presentation:  Integrated disease surveillance

·         Immunization essentials Chapter 8

·         Global Framework for Immunization Monitoring and Surveillance

·         MLM Module 8:  Making disease surveillance work

 

To be completed

 

 

9

RI System:  Supervision

Guidelines for supportive supervision

In-depth understanding of supportive supervision activities in immunization

Presentation: WHO presentation on microplanning and supervision – for COVID-19 vaccination, but generically covers any vaccination situation

 

Read:  Guidelines for Supportive Supervision

·         MLM Module 4:  Supportive Supervision

 

Not applicable

●WHO video overview on microplanning and supportive supervision (in COVID-19 context but generic info)

·         Immunization Academy: Supportive Supervision

10

RI system: Supply chain

The immunization supply chain (cold chain overview)

Become familiar with how the vaccine supply chain works

Presentation:  the vaccine supply chain

·         Immunization essentials Chapters 5,6

·         Immunization in Practice Section 3

 

To be completed

 

        Immunization Academy: Keeping vaccines safe in the health facility cold chain

11

RI system:  outreach

The outreach approach for increasing access to immunization services

Gain in-depth understanding of outreach services

Read:  Sustainable Outreach Services

·          

Not applicable

 

●IA: Creating fixed and outreach session plans

12

RI system:  Demand generation

Partnering with the community for immunization services

Gain in-depth understanding of how to increase demand for vaccinations in the community

Read:  MLM Module 2 – partnering with the community

 

Read:  IIP Module 8 – Building community support for immunization

To be completed

 

 

13

challenges & solutions to high vaccination coverage

Common immunization system challenges and solutions (including an introduction to the RED strategy)

Provides an overview of common challenges to high immunization coverage and key strategies to overcome challenges

Presentation: Common Problems & Solutions to High Routine Immunization Coverage

·         Immunization essentials Chapter 3

 

To be completed

 

 

14

challenges & solutions to high vaccination coverage

Strategies for improving coverage at the district and facility level

Further introduction to the RED approach and other sub-national approaches

Presentation: RED strategy

·         AFRO RED guidelines

To be completed

●IA: Identifying solutions to overcome barriers to vaccine access

 

IA: Identifying solutions to overcome barriers to vaccine utilization

 

 

16

PRACTICE!

A case study on visiting health facilities and reviewing the routine immunization system as a supervisor / monitor

Excellent overview of what to do when visiting a health facility in regards to supervision/monitoring/assessment of routine immunization services

Read:

·  Routine Immunization Case study (Facilitator Version)

·          

 

 

 

 

 

ADVANCED CURRICULUM: IN-DEPTH MODULES ON IMMUNIZATION SYSTEM COMPONENTS

 

#

System category

Topic

Learning objective

Assigned document & location

Additional reading

Presentation video

Related training video

Related online courses

A

Overview

The partners of the global immunization world

Become familiar with the general structure of the global immunization world

Presentation: Partners, alliances and meetings presentation

·          

To be completed

 

 

A1

challenges & solutions to high vaccination coverage

Risk factors for under-immunization

Become familiar with common risk factors for under-immunization

Paper: peer-reviewed literature review  of common risk factors for under-immunization

·         Paper:  Grey literature review of common risk factors for under-immunization

 

 

 

A2

challenges & solutions to high vaccination coverage

Evidence for strategies to increase immunization coverage

Become familiar with published evidence on strategies for strengthening routine immunization services

Read the following articles:

·         Batt et al: cost effectiveness of strategies to increase coverage

·         Ryman et al:  strategies to increase coverage

·         Briss et al, Reviews of evidence regarding interventions to improve coverage

·         NA

 

 

 

A3

challenges & solutions to high vaccination coverage

Strategies to Strengthen immunization coverage at the health facility level

Become familiar with ways health workers can use their data for decision making

Document:  increasing immunization coverage at the health facility level  (WHO)

 

 

 

 

A4

challenges & solutions to high vaccination coverage

Missed opportunities for vaccination

Become familiar with reasons why children miss being vaccinated even when they show up at the facility

Presentation:  Overview of missed opportunities for vaccination – why they happen, how to address them.

·         Systematic review of missed opportunities for vaccination (2014)

 

·         Planning Guide to Reduce Missed opportunities for Vaccination (2017)

 

·         Presentation: Lessons from MOV assessments

To be completed

·         Recognizing Common Reasons for Missed Opportunities for Vaccination
 

·         Interventions to Reduce MOV: Health System Issues

 

 

15

RI system:  Immunization safety

The basics of immunization safety

Learn about how to ensure vaccinations are given safely and how to manage vaccine wastage

Read: MLM Module 2 – immunization safety

·         Immunization in Practice Section 4

 

 

 

 A6

RI system:  vaccination session planning

Planning immunization sessions to reach every infant

 

Read:  Immunization in Practice – Section 5

·          

 

 

 

A7

RI system:  vaccination session implementation

The basics of holding an immunization session

 

Read:  Immunization in Practice – Section 6

·          

 

 

 

A1

challenges & solutions to high vaccination coverage

Strategies for using supplementary immunization activities to improve routine immunization activities

Become familiar with specific SIA-RI synergy activities

Presentation:  Campaigns and routine immunization services

·         Nine opportunities to strengthen routine immunization during campaigns

To be completed

 

 

 

 

ADVANCED CURRICULUM:  IN-DEPTH MODULES ON GLOBAL SYSTEM TOPICS

 

#

System category

Topic

Learning objective

Assigned document & location

Additional reading

B1

Global action plans

CDC’s strategic immunization action plan

Overview of CDC’s strategic framework for improving immunization programs globally

Read:  CDC Global Immunization strategic framework 2021-2030

 

B2

Monitoring & evaluation

Overview of EPI review methodology

Become familiar with how to conduct an EPI review

Presentation:  How to conduct an EPI review

Document:  AFRO EPI review guidelines

B3

Monitoring & evaluation

The EPI coverage survey

Become familiar with the WHO method for coverage surveys

Read:  MLM Module 7 – The EPI coverage survey

 

 Read:  Draft revision of the WHO Immunization coverage survey guidelines

B4

GID strategic planning

GID routine immunization research agenda report

Become familiar with research areas in routine immunization

Read:  GID routine immunization research agenda article on gaps in research on routine immunization

B5

New vaccines

Introduction to new vaccines and technologies

 

Read:  Immunization essentials, Chapter 11

 

 

 

 

 

 

 

 

#

System category

Topic

Learning objective

Assigned document & location

Additional reading

Presentation video

Related training video

Related online courses

B6

Global Action Plans

WHO Vision and Mission in Immunizations and Vaccines (2015-2030)

 

Read: WHO Vision and Mission 2015-2030

 

 

 

 

B7

Global Action Plans

Global Measles and Rubella Strategic Framework 2021-2030

 

Read: Global MR Strategic Plan 2021-2030

 

 

 

 

B8

Global Action Plans

Polio Endgame Strategic Plan 2019 - 2023

 

Read: Polio Endgame Strategy 2019 - 2023

 

 

 

 

B9

Global Action Plans

Global Routine Immunization Strategies and Practices (GRISP)

A companion piece to the GVAP, focused on routine immunization strategies

Read: GRISP Plan

 

 

 

 

B10

Global Evaluation Methods

GAVI Joint Appraisals

GAVI Joint appraisals are conducted annually in GAVI supported countries to identify key areas for investment and potential partners to support those investments

Read: How to plan and conduct a joint appraisal

 

Frequently Asked questions

 

 

 

 

 


 

 

Summary List of Priority Global Immunization Reading Materials

Immunization Implementation Guidelines

1.       Immunization Essentials (Guidelines): The "bible" of the immunization world; how to implement immunization services. Covers all components, activities, strategies etc. in a comprehensive manner

2.       Immunization in Practice (Guidelines): The "other bible" of the immunization world. This guide is focused more at the health worker and discusses how to implement sessions, how to plan for sessions, gives great details on injection practices, injection safety etc.

3.       Reaching Every District (RED) Guidelines (African Region): Main strategy for strengthening routine immunization services

4.       Increasing Immunization Coverage at the Health Facility Level: WHO handbook for strategies which shows how health workers can use their “data for action".

5.        Guidelines for Supportive Supervision: Detailed description of how to conduct supportive supervision for immunization

6.       India Immunization Program - medical officer's guide for managing an immunization program : A very nicely done handbook covering all the basics for being a district health officer.  Made for India, but applicable for everywhere.

7.         India Immunization Program Facilitator's guide for training medical officers on managing immunization programs  : A very nicely done handbook covering all the basics for being a district health officer (facilitator version)

Global Immunization Strategic Documents

8.       Global Vaccine Action Plan 2011-2020 (Global Action Plan): The global goals, objectives and major strategies endorsed by immunization partners for the Decade of Vaccines; replaces the GIVS

9.       Global Measles and Rubella Strategic Plan 2012-2020 (Global Action Plan): Global goals, objectives and major strategies to eliminate and eradicate measles and rubella

10.   Global Eradication and Endgame Strategic Plan 2013-2018: Global goals, objectives and major strategies to eradicate polio and use polio resources to strengthen health systems

11.   Global Routine Immunization Strategies and Practices (GRISP):  a companion piece to the GVAP, focused on routine immunization

12.   WHO Vision & Mission in Immunization and vaccines 2015-2030: Strategic plan for immunizations from WHO

13.   WHO Core References materials list for all things related to immunization:  excellent resource list by topic area, created in January 2019.

 

Key Global Immunization Research Articles: Determinants of Immunization

 

14.   Article:  Systematic Grey Literature Review of why children are not vaccinated (Favin et al, 2012)

15.   Article:  Systematic Peer-reviewed Literature Review of reasons related to non-vaccination and under-vaccination of children in low and middle income countries (Rainey et al, 2011)

16.   Article:  Systematic review of vaccine hesitancy in the global context ( Larson, 2014)

Key Global Immunization Research Articles: Immunization Strategies

 

17.   Article:  Systematic Review of Integrated Service Delivery with Immunizations 2012 and 2009 (Wallace et al, 2012 and 2009)

18.   Article:  Systematic Review of urban-based strategies to strengthen urban immunization systems (Nelson et al, 2016)

19.   Article:  Systematic review of strategies to improve routine immunization in low and middle income country settings (Ryman et al, 2008)

20.   Article:  Systematic review of strategies to improve routine immunization in any country settings (Briss et al, 2000)

21.   Article:  Systematic review of costs, effects and C/E of strategies to improve routine immunization in low and middle income country settings (Batt et al, 2004)

22.   Article:  Systematic review of strategies to improve routine immunization in low and middle income country settings, Cochrane Review (2012)

23.   Article:  Overview of WHO/ UNICEF global immunization coverage estimate processes and procedures (Burton et al, 2009)

24.   Article:  Global Measles and Rubella Research Priorities Meeting Report (Goodson et al, 2012)

25.   Article: Global Routine Immunization Research Priorities Meeting Report (2011)

 

 

Important Routine Immunization Web Links

·         Technet-21:  WHO-sponsored website with an excellent online community of immunization experts, excellent technical library of documents