tetano
Editor, Senior Moderator
BMJ Glob Health
. 2025 Aug 26;10(8):e017035.
doi: 10.1136/bmjgh-2024-017035. Integrating COVID-19 vaccination into health systems: qualitative findings from seven countries
Cheickna Touré[SUP] 1 [/SUP], Marty Makinen[SUP] 2 [/SUP], Adriana Almiñana[SUP] 2 [/SUP], Grace Chee[SUP] 2 [/SUP], Natasha Kanagat[SUP] 2 [/SUP], Rebecca Fields[SUP] 2 [/SUP], Sakina Kudrati[SUP] 2 [/SUP], Laurel Hatt[SUP] 3 [/SUP], Leah Hughey Ewald[SUP] 3 [/SUP], Audrey Semevo Eunice Amoussou[SUP] 4 [/SUP], Roch Houngnihin[SUP] 4 [/SUP], Landry Kaucley[SUP] 5 [/SUP], Mulugeta Tamire[SUP] 6 [/SUP], Israel Mitiku Hatau[SUP] 6 [/SUP], Mebratu Massebo Cherinet[SUP] 7 [/SUP], Melkamu Ayalew Kokebie[SUP] 7 [/SUP], Aschalew Worku Ashagre[SUP] 8 [/SUP], Tewodros Alemayehu[SUP] 9 [/SUP], Isaac Yeboah[SUP] 10 [/SUP], Abraham R Oduro[SUP] 11 [/SUP], Manish Jain[SUP] 12 [/SUP], Thirumalaichiry Sivaprakasam Selvavinayagam[SUP] 13 [/SUP], Vinay Kumar[SUP] 13 [/SUP], Deepak Kotebagilu Guddemane[SUP] 14 [/SUP], Anil Gupta[SUP] 14 [/SUP], Gopal Krishna Soni[SUP] 14 [/SUP], Melvin B Moore[SUP] 15 [/SUP], Yara Voss De Lima[SUP] 16 [/SUP], Betuel Sigauque[SUP] 17 [/SUP], Graça Matsinhe[SUP] 18 [/SUP], Chinyere Okeke[SUP] 19 [/SUP], Adejoke Kolawole[SUP] 20 [/SUP]
Affiliations
Introduction: In May 2023, when the WHO declared that COVID-19 was no longer a public health emergency of international concern, countries began considering transitioning from the emergency phase to routine provision of COVID-19 vaccination. This paper presents the experience of seven countries with integrating COVID-19 vaccination into other health services and health system functions.
Methods: Data collection took place between August 2023 and April 2024 in Benin, Ethiopia, Ghana, India (Tamil Nadu State), Liberia, Mozambique and Nigeria using key informant interviews and focus group discussions. Interviewees included national and subnational representatives from across the Ministry of Health, COVID-19 task forces, civil society organisations and partners. Focus group discussions were conducted with health workers.
Results: While demand for vaccination was low at the time of data collection, six of seven countries had started integrating or planned to integrate COVID-19 vaccination with other health services. Relatively high integration was reported for certain health system functions such as supply chain, while others such as information systems were less integrated. The immunisation programme served as lead on integrating COVID-19 vaccination, but coordinating across other health programmes was a major challenge. Nearly all assessment countries relied on external funding for COVID-19 vaccines; none had plans to self-procure COVID-19 vaccines when external funding ends.
Conclusion: This article highlights challenges such as a lack of cross-programmatic coordination with clear roles and accountability mechanisms, absence of a clear strategy for sustainable procurement of COVID-19 vaccines, infodemics, as well as considerations countries face in transitioning from emergency response to a more routine approach to COVID-19 vaccination. Opportunities exist to focus COVID-19 vaccination integration efforts in a way that sets the stage for a strengthened life course approach to immunisation; lessons for future emergencies include designing for integration earlier to ensure systems and processes built are leveraged postemergency.
Keywords: COVID-19; Health services research; Health systems; Immunisation.
. 2025 Aug 26;10(8):e017035.
doi: 10.1136/bmjgh-2024-017035. Integrating COVID-19 vaccination into health systems: qualitative findings from seven countries
Cheickna Touré[SUP] 1 [/SUP], Marty Makinen[SUP] 2 [/SUP], Adriana Almiñana[SUP] 2 [/SUP], Grace Chee[SUP] 2 [/SUP], Natasha Kanagat[SUP] 2 [/SUP], Rebecca Fields[SUP] 2 [/SUP], Sakina Kudrati[SUP] 2 [/SUP], Laurel Hatt[SUP] 3 [/SUP], Leah Hughey Ewald[SUP] 3 [/SUP], Audrey Semevo Eunice Amoussou[SUP] 4 [/SUP], Roch Houngnihin[SUP] 4 [/SUP], Landry Kaucley[SUP] 5 [/SUP], Mulugeta Tamire[SUP] 6 [/SUP], Israel Mitiku Hatau[SUP] 6 [/SUP], Mebratu Massebo Cherinet[SUP] 7 [/SUP], Melkamu Ayalew Kokebie[SUP] 7 [/SUP], Aschalew Worku Ashagre[SUP] 8 [/SUP], Tewodros Alemayehu[SUP] 9 [/SUP], Isaac Yeboah[SUP] 10 [/SUP], Abraham R Oduro[SUP] 11 [/SUP], Manish Jain[SUP] 12 [/SUP], Thirumalaichiry Sivaprakasam Selvavinayagam[SUP] 13 [/SUP], Vinay Kumar[SUP] 13 [/SUP], Deepak Kotebagilu Guddemane[SUP] 14 [/SUP], Anil Gupta[SUP] 14 [/SUP], Gopal Krishna Soni[SUP] 14 [/SUP], Melvin B Moore[SUP] 15 [/SUP], Yara Voss De Lima[SUP] 16 [/SUP], Betuel Sigauque[SUP] 17 [/SUP], Graça Matsinhe[SUP] 18 [/SUP], Chinyere Okeke[SUP] 19 [/SUP], Adejoke Kolawole[SUP] 20 [/SUP]
Affiliations
- PMID: 40858336
- PMCID: PMC12382493
- DOI: 10.1136/bmjgh-2024-017035
Introduction: In May 2023, when the WHO declared that COVID-19 was no longer a public health emergency of international concern, countries began considering transitioning from the emergency phase to routine provision of COVID-19 vaccination. This paper presents the experience of seven countries with integrating COVID-19 vaccination into other health services and health system functions.
Methods: Data collection took place between August 2023 and April 2024 in Benin, Ethiopia, Ghana, India (Tamil Nadu State), Liberia, Mozambique and Nigeria using key informant interviews and focus group discussions. Interviewees included national and subnational representatives from across the Ministry of Health, COVID-19 task forces, civil society organisations and partners. Focus group discussions were conducted with health workers.
Results: While demand for vaccination was low at the time of data collection, six of seven countries had started integrating or planned to integrate COVID-19 vaccination with other health services. Relatively high integration was reported for certain health system functions such as supply chain, while others such as information systems were less integrated. The immunisation programme served as lead on integrating COVID-19 vaccination, but coordinating across other health programmes was a major challenge. Nearly all assessment countries relied on external funding for COVID-19 vaccines; none had plans to self-procure COVID-19 vaccines when external funding ends.
Conclusion: This article highlights challenges such as a lack of cross-programmatic coordination with clear roles and accountability mechanisms, absence of a clear strategy for sustainable procurement of COVID-19 vaccines, infodemics, as well as considerations countries face in transitioning from emergency response to a more routine approach to COVID-19 vaccination. Opportunities exist to focus COVID-19 vaccination integration efforts in a way that sets the stage for a strengthened life course approach to immunisation; lessons for future emergencies include designing for integration earlier to ensure systems and processes built are leveraged postemergency.
Keywords: COVID-19; Health services research; Health systems; Immunisation.