Implementing the Immunization Agenda 2030: A Framework for Action through Coordinated Planning, Monitoring & Evaluation, Ownership & Accountability, and Communications & Advocacy

"A key aim will be to mobilize stakeholders regularly around important milestones and crucial moments, creating a drumbeat of activities throughout the decade."

The Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030) defines what needs to happen to achieve the global vision of a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being. IA2030 operates through 4 elements: (i) regional and national strategies (operational planning); (ii) a mechanism to ensure ownership and accountability (O&A); (iii) a monitoring and evaluation (M&E) framework to guide implementation; and (iv) communication and advocacy (C&A) to ensure that immunisation remains high on the health agenda and to rally support for IA2030. This article first summarises a set of overarching considerations and then addresses the following aspects: how the 4 elements work as a framework for action (Section 2); how they will implementated at country, regional, and global levels (Section 3); considerations in the context of COVID-19 (Section 4); and how a learning agenda will help inform the path ahead (Section 5).

While the World Health Organization (WHO) was asked to lead the development of IA2030, all stakeholders co-created, co-developed, and now co-own it. Having described this process, the article examines guiding principles for the framework for action, including:

• Instilling country ownership to achieve the IA2030 vision among all immuniation and non-immunisation stakeholders;
• Leveraging and strengthening existing mechanisms for coordination, accountability, planning, M&E, and advocacy at country, regionalm and global levels;
• Promoting continuous quality improvement cycles using timely, reliable, and fit-for-purpose data;
• Building and strengthening stakeholder accountability and technical alignment to address country needs; and
• Aligning and harmonising with existing regional and national plans and global strategies, including the Sustainable Development Goals (SDGs), universal health coverage (UHC), and Gavi 5.0.

Returning to the 4 elements, highlights from the article include: (i) Coordinated operational planning by Member States, regional bodies, development partners, and civil society organisations (CSOs) is the means to translate the vision of IA2030 into concrete, near-term actions. (ii) A "good practice" framework guides the design of an O&A approach, integrating the necessary structures, tools and information flow (see Figure 3). One aspect of O&A: Consultative engagement with countries, regions, CSOs, and other partners on IA2030 implementation topics will be organised to provide real-time exchange on immunisation programme successes and challenges and to offer peer-to-peer learning and knowledge sharing across sectors and countries. (iii) In terms of M&E, diverse evaluation methods will be needed to assess policies, strategies, and interventions across different contexts. (iv) The C&A strategy will align with the work of other communication initiatives to promote confidence in, and demand for, vaccines. The approach aims to be acceptable, both technically and culturally, in different regional and Member State contexts and to help create a broad social movement for immunisation. Language and concepts that intend to be broadly accessible are being used so as to engage with all sectors of the community.

Next, the article examines how the IA2030 framework for action will be taken forward at country, regional, and global levels, supported by various tools, structures, and processes. For example, at the regional level, CSOs will increase the transparency of commitments, roles, and contributions to immunisation. They will reflect their commitments in pledges. Independent review by SAGE will include: a) assessing regional/national and partner/CSO progress using tailored indicator scorecards, and b) recommending actions for performance improvement and areas for further evaluation by working groups and disease-specific initiatives to identify root causes of success and failure.

As reported here, the COVID-19 pandemic has starkly illustrated the strengths and fragilities of immunisation programmes. The IA2030 strategy's technical annexes provide guidance that can be applied to COVID-19 responses, such as: Commitment and Demand (Strategic Priority 2): Guidance on how to maintain political commitment beyond COVID-19 vaccines and how to maintain trust and demand for vaccines at all ages.

IA2030 is a living and evolving strategy, so the authors stress that the framework should be reviewed and updated at least once every three years in response to changing needs and improvements. An initial set of core questions and topics for each of the 4 elements are outlined for the IA2030 learning agenda: (i) operational planning (e.g., opportunities for more efficient, timely and reliable data collection and use through digital innovations); (ii) O&A (e.g., the most efficient means to engage diverse CSOs to strengthen community-level ownership and accountability for immunisation); (iii) M&E (e.g., linkages with existing monitoring processes and data sources, including use of the WHO Immunization Information System (WIISE); and (iv) C&A (e.g., means to respond to misinformation about vaccines disseminated through changing social media platforms and other ways mis- and dis-information are spread).