Advancing sustainable development goals through immunization: a literature review

Abstract

Background: Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this.

Methods: We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges.

Results: We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030.

Conclusions: In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.

Keywords: Health systems modeling; Immunization; Low- and middle-income countries; Sustainable development goals; Systems thinking.

Fig. 1

Paper structure. Paper structure combining literature analysis results with both the WHO Health System building blocks [11] and the WHO Immunization Agenda 2030 [2]

Fig. 2

Conceptual model. Green items depict the impact of immunization on sustainable development goals which is realized through the mechanisms of (1) protecting people and communities against infectious diseases, (2) providing access to immunization services for all and (3) creating an environment for health system development. Blue arrows indicate the indirect consequences of immunization on SDGs. Black items show the overarching elements of sustainable immunization

Fig. 3

Sustainability challenges papers. Distribution of included papers, dealing with sustainability challenges of immunization in LMICs, categorized according to the WHO Health System building blocks [11]

Fig. 4

WHO Health System building blocks. Selected key sustainability challenges from the reviewed literature, according to the WHO Health System building blocks

Fig. 5

Strategic Priorities. Amount of papers with model-based solutions to Immunization system challenges classified according to the Strategic Priorities (SPs) of Immunization Agenda 2030 (version April 2020)

Fig. 6

Immunization sustainability hurdles

Fig. 7

Recommendations for future research