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Potential Role of School-

Based Immunization inProtecting More Children

Results of e-mail survey

Global Immunization Meeting 2009

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Method• Standardized questionnaire sent to countries through WHO and

UNICEF regional offices.

• Data collected on: – Target ages, groups, size – Vaccines given, coverage

 – Responsibilities, organization – Costing and Financing – Difficulties encountered

• Focus on the use of school-based routine immunization:

 – Not on school-based immunization during Supplemental Immunization – Not on immunization as a requirement to enter school.

• Replies received from 143 countries.

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Survey Results

61 countries report some kind of school-based immunization program!

(as of August 2008)

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Countries with and without school-based

immunization, 2006- 2008

The boundaries and names shown and the designations used on this map do not imply the

expression of any opinion whatsoever on t he part of the World Health Organization

concerning the legal status of any country, territory, city or area or of its authorities, or

concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent

approximate border lines for which there may not yet be full agreement.

© WHO 2004. All rights reserved

Countries with a school-based immunization program (n=61)

Countries with no school-based immunization program (n=82)

No information (n=49)

Source: WHO-UNICEF E-mail Survey on school-based

immunization, 2006-2008Date of slide: 14 August 2008

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Most countries with a school-based immunization

approach use it to deliver TT-containing vaccines,and (less) polio and measles-containing vaccines

Proportion of countries with a school-based immunization program delivering

tetanus, measles, polio and other vaccines (n=61)

0%

20%

40%

60%

80%

100%

Total

(n=61)

AFRO

(n=8)

AMRO

(n=9)

EMRO

(n=7)

EURO

(n=15)

SEARO

(n=5)

WPRO

(n=17)

      P     e     r     c     e     n      t     a     g     e

TT-containing vaccine Measles-containing vaccine Polio vaccine Other

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School-based immunization programs mainly target

children in early primary school, and late primary/earlysecondary school.

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In secondary school, school-based immunization targetsmainly Grades 7, 8, 9, and delivers relatively more of the

"other" vaccines.

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Target Groups% of countries

• Nation-wide Implementation: 85% (52/61) – In Africa only 2/8 countries nation-wide – Survey result includes pilot, early implementers etc

• Boys and Girls Targeted : 93% (57/61) – 4 countries use TT for girls only

• School-entry level Targeted : 77% (47/61)

• Ages 9-13 Targeted : 54% (33/61) – Importance for HPV

• Information on size target population: 52% (32/61)

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Implementation% of countries

• Implemented by local HW: 46% (28/61)

• Implemented by School Health Staff: 20% (12/61)

• Other interventions added:

 – Anti-helmintics 7% (4/61)

 – Vitamin A / Micronutrients 5% (3/61)

 – Health Education 3% (2/61)

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Achievements% of countries

• Information available on number

children reached: 49% (30/61)

• Interpretation difficult

 – lack of standardization (numerator by vaccine or for all vaccinescombined?, denominator?,…)

 – Computed coverage: range: 25% - 151%

• Weak or no strategies to reach out-of-school children – except where health systems allows close tracking and follow-up.

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Costing / Financing.• Limited information on costing and financing.

 – Often considered as part of routine work, and therefore notcosted separately

 – Government main contributor

• Operational Cost per child immunized : Range: US$ 0.12 - 0.70(info from 3 countries)

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Summary of Survey Findings• At least 61 countries have introduced school-based immunization

• Wide range of vaccines given in school-based approach; TT almostuniversal.

• Mostly targeted at early primary school

• Aimed at boys and girls; usually nation-wide implementation

• Needs of out-of-school children poorly addressed

• Collaboration between MoH and MoED

• Coverage monitoring is poor

• Not widely used to deliver other interventions.

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Is School-Based Immunization agood idea?

• High primary school attendance rates

 – except in Africa – >80% of children who start primary school, also finish it

Proportion of children going to Primary School(source: State of the World's Children 2009)

0

20

40

60

80

100

East &Southern

Africa

West &CentralAfrica

Middle-East& NorthAfrica

South Asia East Asia &Pacific

LatinAmerica &Caribbean

CEE/CEIS

      P     e     r     c     e     n      t     a     g     e

Primary School Enrollment Boys Primary School Enrollment Girls

Survival Ratio to last Primary Grade

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Summary• School-based immunization has the potential of

being a suitable delivery strategy for immunizationof school-aged children.

• School attendance levels are key to reaching highcoverage. Special measures need to be

implemented to reach out-of-school and absentpupils.

• Ways to implement can vary (year-round vsspecific period; local vs school health staff; antigens

used;…)• Coverage data need to be standardized and

systematically collected.

 – Inclusion in WHO-UNICEF Joint Reporting Form 2009

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More informationIn-depth summaries of school-immunization

programs available for – Indonesia

 – Malaysia – Sri Lanka

http://www.who.int/immunization_delivery/ 

systems_policy/school-based-immunization/en/index.html

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Thanks to:• UNICEF, WHO, MOH staff at country levels

• UNICEF, WHO staff at Regional Levels

(Any additional information is welcome!)

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Primary School Attendance Levels offer

opportunities for school-based immunization

Sources: UNICEF: State of the World's Children 1999 and 2008