HSD104 Strengthening Routine Childhood Immunization Post-COVID: Global Strategies to Improve Coverage and Equity

Abstract

Objectives: Global progress in immunisation has stalled, with many countries falling short of coverage targets. Measles outbreaks have resurfaced even in high income countries such as England, Ireland and the United States. Political instability and conflict have further disrupted immunisation efforts in several regions. The COVID-19 pandemic further amplified vaccine hesitancy and disrupted service delivery. This scoping review aimed to identify strategies that have been employed globally to sustain and improve routine childhood immunisation coverage, with a particular focus on equitable access. Methods: A scoping review was conducted following PRISMA guidelines. Comprehensive searches were performed in Medline, Elsevier, Scopus, and Web of Science. The Population, Concept, Context (PCC) framework guided the development of the question and eligibility criteria. Studies reporting strategies to enhance equitable access to and coverage of routine childhood immunisation were included. Screening and data extraction were performed independently by two reviewers. Data were synthesised using descriptive and thematic analysis. Results: The database search, conducted in April 2025, identified 17,692 articles. Following a two-stage screening process, 58 studies were included for data extraction and synthesis. Most studies originated from high-income countries. Interventions were categorised both by nature and by the immunisation outcomes they targeted. Thematic categories included educational interventions, community engagement strategies, pro-equity approaches, health system strengthening, and communication strategies. With respect to outcomes, interventions were classified as addressing equity, access, or adaptability of immunisation services. Conclusions: The review highlights the global emphasis on multi-modal, targeted communication strategies to address vaccine hesitancy and improve coverage. However, significant gaps remain regarding the effectiveness and cost-effectiveness of these interventions, particularly in low and middle-income countries. Further research is needed to evaluate the economic viability and real-world impact of these strategies to inform sustainable, equitable immunisation policies.