Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review

Abstract

Introduction: The Global Polio Eradication Initiative uses polio supplementary immunisation activities (SIAs) as a strategy to increase vaccine coverage and cease poliovirus transmission. Impact of polio SIAs on immunisation systems is frequently debated. We reviewed the impact of polio SIAs on routine immunisation and health systems during the modern era of polio eradication.

Methods: We searched nine databases for studies reporting on polio SIAs and immunisation coverage, financial investment, workforce and health services delivery. We conducted a narrative synthesis of evidence. Records prior to 1994, animal, modelling or case studies data were excluded.

Results: 20/1637 unique records were included. Data on vaccine coverage were included in 70% (14/20) studies, workforce in 65% (13/20) and health services delivery in 85% (17/20). SIAs positively contributed to vaccination uptake of non-polio vaccines in seven studies, neutral in three and negative in one. Some polio SIAs contributed to workforce strengthening through training and capacity building. Polio SIAs were accompanied with increased social mobilisation and community awareness building confidence in vaccination programmes. Included studies were programmatic in nature and contained variable data, thus could not be justly critically appraised.

Conclusion: Polio SIAs are successful at increasing polio vaccine coverage, but the resources and infrastructures were not always utilised for delivery of non-polio vaccines and integration into routine service delivery. We found a gap in standardised tools to evaluate SIAs, which can then inform service integration. Our study provides data to inform SIAs evaluations, and provides important considerations for COVID-19 vaccine roll-out to strengthen health systems.

Prospero registration number: CRD42020152195.

Keywords: epidemiology; immunisation; poliomyelitis; systematic review.

Figure 1

PRISMA flow chart to select included studies. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Timeline of global polio eradication efforts and study location for included papers the decade in which the last case of indigenous wild poliovirus was reported for each country is presented in different colours. Data from each country numbered were analysed by at least one study identified as meeting the inclusion criteria of our systematic review. Data on polio elimination certification year were sourced from the Global Polio Eradication Initiative. The figure was adapted from Our World in Data.