Supporting Young Children’s Health and Wellbeing through Immunization

The early years of childhood constitute a vital period for establishing lifelong protection against infectious diseases. Children under five years of age are especially susceptible to severe illness from vaccine-preventable diseases due to their developing immune systems. In low- and middle-income countries, comprehensive immunization during these formative years becomes fundamental to child survival and optimal development.

Current WHO recommendations outline protection against 13 essential diseases, often delivered through combination vaccines such as the pentavalent vaccine protecting against diphtheria, pertussis, tetanus, hepatitis B, and haemophilus influenzae type b.

The Expanded Program on Immunization (EPI) was established to provide a structured framework ensuring universal access to routine childhood vaccines. However, gaps in coverage remain, particularly among zero-dose children – those who have never received a single routine vaccine. These children are often found in marginalized communities, including:

• Remote rural areas with limited health infrastructure.
• Urban slums, where poverty and migration hinder access to immunization services.
• Conflict zones and humanitarian settings, where displacement and insecurity disrupt routine healthcare.

Identifying and reaching zero-dose children is crucial for achieving universal immunization coverage and preventing the resurgence of deadly diseases. Local governments, healthcare workers, and community leaders play a critical role in strengthening immunization programs, closing coverage gaps, and ensuring every child, regardless of location or circumstance, receives their life-saving vaccines.

This section provides practical guidance and high-impact strategies for implementing and strengthening childhood immunization programs. By implementing these strategies, local governments and healthcare workers can create stronger, more resilient immunization systems, ensuring no child is left behind in the fight against preventable diseases.

What Are the Benefits of Immunization for Children under 5?

• Reduces Child Mortality: Vaccination prevents deadly diseases such as measles, diphtheria, polio, and pneumonia, significantly lowering infant and child mortality rates.
• Prevents Disease Outbreaks: Achieving high immunization coverage prevents the resurgence of vaccine-preventable diseases.
• Cost-Effective Public Health Measure: Immunization saves healthcare costs by reducing hospitalizations and long-term disabilities.
• Promotes Herd Immunity: High coverage levels protect even those who cannot be vaccinated due to medical conditions.
• Improves Overall Community Health: Vaccination contributes to healthier families and communities.

How to Implement

What’s the Evidence?

• Routine immunization coverage in LMICs has increased dramatically from less than 5% in 1974 to over 80% by 2019, resulting in substantial reductions in child mortality rates across Africa, Asia, and Latin America (UNICEF State of the World’s Children, 2023).
• Every $1 invested in childhood immunization yields an estimated $44 return on investment in LMICs through reduced healthcare costs, increased productivity, and economic growth (Ozawa et al., Health Affairs, 2016).
• Integration of immunization with other maternal and child health services in LMICs has shown promise for improving vaccination coverage and health system efficiency (Wallace et al., Vaccines, 2024. Maternal and neonatal data collection systems in low- and middle-income countries: scoping review protocol – PMC).

Key Indicators

The indicators below are outcome and impact indicators that can be monitored and may vary based on the setting. Consider your country-specific indicators as your country may monitor additional indicators.