Consultation with Member States of the WHO European Region on Use of Immunization Data for Decision-Making

A consultation with and workshop for Member States of the World Health Organization (WHO) European Region on the availability, quality, and use of immunisation data for decision-making took place in Sarajevo, Bosnia and Herzegovina and in Copenhagen, Denmark in May 2018. The goal of the gathering was to facilitate the exchange of practices, challenges, and solutions between participants and for WHO/Europe to develop ways of supporting countries in the Region in the collection, analysis, and use of data for awareness-raising and decision-making. This is the meeting report.

In resolution WHA65.17, the World Health Assembly urged Member States to report every year to the regional offices on progress made to reach the national immunisation targets. Thus, it is essential that annual reporting on the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form (JRF) by Member States is timely and complete, with high-quality data. To support this, 3 identical workshops were organised to facilitate collaboration among countries and to identify practical challenges and opportunities to improve the quality and presentation/communication of immunisation data. Among the attendees were representatives of the United States Centers for Diseases Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), UNICEF, WHO headquarters, and the WHO Country Office in Bosnia and Herzegovina (Sarajevo workshops only).

As reported here, the data provided by countries to WHO are compiled, analysed, summarised, and made available through various channels, a list of which is included in Annex 1 of the report. Globally, many publications make use of immunisation data, including the WHO and UNICEF estimates on national immunisation coverage (WUENIC). WHO-UNICEF Joint Reporting Form data are also used for assessment of disease burden, the WHO vaccine prequalification process, published articles, and analyses performed for the Strategic Advisory Group of Experts (SAGE) on Immunization and other regional advisory bodies.

At the time of these meetings, one of the main means of immunisation reporting, the JRF, was scheduled to be revised later in 2018 as part of a regular biannual revision process. Taking the opportunity provided by this workshop, the participants were asked to provide feedback on the JRF's format and content. Some of the main points raised by the participants were related to the appropriateness of the language (including the Russian translation of specific terms), mode of reporting, and use of different data elements requested in the JRF. As various entities may be involved in providing the required information, the participants requested that any change to the form be communicated well in advance to the countries so that relevant departments responsible for its completion are made aware of upcoming data needs. To facilitate reporting, participants believed that an electronic form and the possibility of copying and pasting available data would be useful, as would additional fields for comments. As not all questions in the JRF are relevant for all countries, the participants requested the option of filtering out questions for which the countries do not have relevant data, thereby reducing the form's size and better reflecting the immunisation data available in the countries.

The participants discussed the fact that complete data that is representative of a population and gathered in a timely manner plays an essential role in measuring progress towards immunisation goals. However, data on its own is of limited use. After a set of data is made actionable and coherent through consolidation, analysis, synthesis, and review, data should be communicated - to increase population awareness, inform healthcare professionals, and/or to support policy-planners and decision-makers.

As noted here, to maximise impact, data should be communicated in a way that is tailored to fit the communication objective and intended audience, with careful consideration of the optimal format and presentation for this purpose. In general, communication products should be easy to interpret, with images favoured over descriptions. The content can be used to tell a story and be kept simple and to the point so that the audience is not overwhelmed by excessive information.

Examples of best practice regarding data visualisation, as provided in an annex to the report:

• Keep it simple with graphs and charts - less is more. Avoid unnecessary visual enhancements, such as 3D and extra lines.
• Stick to basic shapes, as it is difficult to judge and calculate the volume of unusual or complicated shapes.
• Include fewer than 6 numbers represented in a pie chart; more can become difficult to interpret.
• Use colour to encode information. However, remember that too many colours can be distracting.
• Draw shapes with mathematical calculations - not just by estimating size. And always make sure the math is correct.
• Include the date of data being published.
• Consider closing with a call to action.
• Know your audience, and craft messages and visualisations accordingly. Get to know their preferences and assumptions by holding a focus group discussion or by pilot-testing the product.

Working in groups, participants were given an exercise based on hypothetical scenarios in which data needed to be communicate to an intended audience to achieve a specific goal. Each group developed a concept for a communication product to address the described need. The participants requested that WHO/Europe develop this exercise further into a practical handbook on presenting and communicating immunisation data to be used by immunisation programme managers at the national and subnational levels.

Click here for the 17-page report in English in PDF format.
Click here for the 15-page report in Russian in PDF format.