Immunization Training and Capacity Building: Empowering Healthcare Workers for Effective Vaccine Delivery

By Dr. Liji Thomas, MDReviewed by Lily Ramsey, LLM

The importance of immunization training
Challenges in immunization training
Strategies for effective training programs
Capacity building for healthcare workers
Case studies: Successful immunization training programs
Conclusion
References

Immunization programs are among the most essential instruments and achievements in public health globally, clubbed together with clean water and better healthcare access in their importance for longer lifespans and reduced mortality rates. The World Health Organization (WHO) credits them with saving 4-5 million lives a year worldwide.¹

Recruiting and training healthcare staff is crucial in improving the performance of immunization programs. This builds core competencies, including professional attitudes, required vaccine administration skills, and documentation skills.

In addition, it ensures a trained workforce that implements vaccine-related programs and policies.² It also builds healthcare capacity to meet immunization needs at all levels, minimize attrition, and optimize outcomes.²

The importance of immunization training

Vaccination is a key part of the fight against vaccine-preventable diseases (VPDs) like polio, diphtheria, and whooping cough. Immunization programs aim to protect as many children as possible.

“Training for immunization staff is one of the most important factors in enhancing immunization performance and effectively introducing new vaccines, technologies, practices and policies.”⁸

These programs involve multiple steps from data collection, planning campaigns, vaccine storage, providing appropriate advice to beneficiaries, collecting and keeping data, and reporting regularly on the progress of the programs. Attention to all steps is important to achieve high-quality outcomes.³

Workers also need training to identify access and utilization barriers, pinpoint priority areas and associated health centers, and form a roadmap to ensure expanded coverage.⁴

Training non-medical immunization staff is vital to ensure best practices are followed.⁴ Infants need to be assessed before vaccination.

The vaccine cold chain is crucial to the success of an immunization program. Knowledge of the cold chain, practical and theoretical, and the ability to maintain, use, and monitor it is essential. Being able to evaluate and demonstrate the viability of the vaccine without sophisticated tests is also key to winning public trust and building credibility.⁴

Immunization data must be recorded and reported promptly and reliably and transmitted periodically.⁴ Data on unvaccinated and vaccine-covered children is important to plan education campaigns to communicate the need for routine immunization of children as part of parental care.³ It also helps to optimize expenditures, streamline vaccine ordering, ensure safe storage, and minimize wastage of vaccines.³

Community engagement is key to the success of any immunization program. This includes education about the need for and benefits of vaccines, as well as their safety. This is essential to dispel misconceptions, reduce resistance, and improve vaccine coverage.

Read more World Immunization Week Content

Challenges in immunization training

Challenges to extended immunization coverage include economic and social inequities, which allow VPDs to flourish in many parts of the world. One in ten babies worldwide remains completely unimmunized, and 20 million babies have not completed a primary course of routine childhood vaccines at the basic level.⁵

Many immunization programs build on the services of community volunteers, like the ASHA (accredited social health activist) workers in India. However, volunteers cannot be recruited or expected to serve indefinitely without continued and expanded training, mentorship and supervision, remuneration, and encouragement.

Yet many countries face resource constraints in providing remuneration and financial task-based incentives. This involves providing career growth opportunities via educational advancement and admission quotas in programs that could help them get paid paramedical jobs in the future.

Moreover, there is a gap in the training program that ignores the huge shift in services rendered and populations served by immunization at present compared to earlier periods. For today’s immunization workforce, “Now they’re expected to do data. They’re expected to counsel. They’re expected to reach out to other groups,” says Lora Shimp, senior immunization technical expert in communication and behavior change at JSI, an organization that promotes public health.⁷

These workers also need to be constantly updated about newly introduced vaccines. Finally, the whole vaccine workforce must be provided with logistical support for last-mile delivery of the vaccine message and vaccines themselves.⁷

Image Credit: PeopleImages.com - Yuri A/Shutterstock.com

Strategies for effective training programs

The WHO has designed training programs and materials for personnel involved in immunization at multiple levels, from medical officers to frontline and community workers.

While volunteer workers have been fundamental to vaccine programs and healthcare programs throughout the world for decades, this requires constant improvement in learning relevant administrative and paramedical skillsets. Many tools to provide mentorship and guidance are available today.⁷

This includes online platforms like the Boost Network, Geneva Learning Foundation, and Gavi Learning Hub. These are “virtual, safe, low-cost, and have wide reach”,⁹ but not all are locally available.⁷ Also, older workers may need help navigating these platforms.

In addition, most countries have not migrated completely to digital records. The need to maintain both paper-based and digital systems increases the workload and stress levels and decreases the efficiency of healthcare workers.⁷

The immunization workforce must also receive training, supervision, and infrastructural support to use digital tools. These help supply real-time data, promote rapid surveillance for decision-making, and facilitate international communication of health-related data.⁷

Hands-on workshops are essential to provide practice in basic skills like stocking and storing vaccines in a cold chain, or data collection and analysis on the ground, promoting top-down solutions.⁷

Continuing education is crucial to ensure immunization personnel keep their skills sharp and remain up to date with vaccine-related developments.  

Capacity building for healthcare workers

The worldwide paucity of immunization health workforce, with a deficit of 15 million workers, hampers immunization efforts, especially in underserved areas. It also overloads untrained personnel, generating suboptimal results.⁷

For instance, community health workers are key to immunization programs. However, they lack the skills and time for effective communication in many areas, preventing vaccine acceptance and uptake rates.⁵ In addition, there is a lack of supervision, of incentives, and a structured framework that spells out tasks and endpoints.⁷

Capacity building involves training workers to understand and execute the various steps of program planning and execution at fixed and mobile outreach points, vaccine storage and handling to preserve safety and efficacy, and communicating with and mobilizing the public. Establishing competency is critical to prevent attrition of the healthcare workforce.⁷

Case studies: Successful immunization training programs

National immunization programs (NIPs) have been set up in many countries since the inception of the Expanded Program on Immunization (EPI) in 1974. This has seen the rollout of vaccines against a score of infectious diseases.

The recent entry of partners such as Gavi, the Vaccine Alliance, and those behind the Decade of Vaccines Collaboration with its 2012 Global Vaccine Action Plan (GVAP), focused on extending immunization to all corners of the world.⁶

During this period, the mortality rate among under-five children went down from 1 in 19 in 2010 to 1 in 26 by 2017. The primary (three-dose) course of diphtheria, pertussis and tetanus toxoid (DTP) is now being given to at least 90% of children in almost 130 countries.⁶

During the coronavirus disease 2019 (COVID-19) pandemic, a lot of short-term resource allocation allowed millions or billions of doses of COVID-19 vaccines to be delivered successfully. This was preceded and accompanied by the training of healthcare workers, ensuring better vaccine management and service delivery.⁶

In Yemen, the work of UNICEF offers training to frontline immunization workers. “The training covered the theoretical and practical aspects of vaccinating children as well as preparing monthly reports of the used vaccines and the number of vaccinated children. I learned how to calculate and use graphs to illustrate the monthly and cumulative percentage of unvaccinated children and immunization coverage,” says Rowaida Al-Aqili, an immunization officer at Al-matar health center, in Marib, Yemen.³

Conclusion

Expanded vaccine coverage at high quality and reliable and extensive surveillance is essential to achieve the Expanded Program on Immunization (EPI) goals. This depends on training for competency in this area, both preparatory and ongoing.²

In addition, many more workers need to be recruited from all communities to build trusted and accessible capacity for the immunization of a rapidly growing population.

This underlines the need for funding and for resource investment into building and supporting context-specific training programs for immunization workers. The government's long-term financial commitments and innovative financing plans are essential to achieve this.

References

1. Safadi, M. A. P. The importance of immunization as a public health instrument. Journal de Pediatria. 2023; Mar-Apr; 99 (Suppl 1): S1–S3. doi: 10.1016/j.jped.2022.12.003.
2.  Nicol, E., Turawa, E. and Bonsu, G. Pre- and in-service training of health care workers on immunization data management in LMICs: a scoping review. Human Resources in Health. 17, 92 (2019). https://doi.org/10.1186/s12960-019-0437-6.
3. Training health workers improves children immunization services. 2022. Accessed March 12, 2024. https://www.unicef.org/yemen/stories/training-health-workers-improves-children-immunization-services.
4. Immunization in Practice: A practical guide for health staff. 2015. Updated May 31, 2015. Accessed March 12, 2024. https://www.who.int/publications/i/item/immunization-in-practice-a-practical-guide-for-health-staff.
5. Gumani, V., Haldar, P., Aggarwal, M. K., et al. mproving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. British Medical Journal 2018; 363. doi: https://doi.org/10.1136/bmj.k4782.
6. Mantel, C. and Cherian, T. New immunization strategies: adapting to global challenges. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63(1): 25–31. doi: https://doi.org/10.1007%2Fs00103-019-03066-x.
7. Strengthening the health workforce to reach global immunization goals. https://www.csis.org/analysis/strengthening-health-workforce-reach-global-immunization-goals. Accessed on March 25, 2024.
8. Essential Programme on Immunization. https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/training. Accessed on March 27, 2024.
9. Deussom, R., Lal, A., Frymus, D., et al. Putting health workers at the centre of health system investments in COVID-19 and beyond. British Medical Journal. https://doi.org/10.1136/2Ffmch-2021-001449.