Global Routine Immunization Strategies and Practices (GRISP)

"To build on the undisputed past successes of immunization and realize its promising future, global partners must ensure that routine immunization coverage, equity and the actual delivery of vaccines to hard-to-reach populations remain high on the global health agenda by raising awareness of their importance, benefits and synergies among governments, donors and the global health community as a whole."

This document provides additional focus and detail on routine immunisation (RI) strengthening and coverage improvement activities and strategies resulting from the Global Vaccine Action Plan 2011-2020 (GVAP), endorsed by the World Health Assembly in May 2012 (see Related Summaries, below). It provides a cohesive delivery and advocacy platforms for RI globally, an integral part to achieving the vision expressed in GVAP. It also provides a commonly agreed upon RI mission statement within disease-specific initiatives to seek to emphasise the required systems strengthening and extension of the reach of RI to support child health aims. Finally, it describes 9 key investments that are viewed as critical to building RI systems and improving coverage in the next 5 years.

The term "routine immunisation" is understood in two distinct ways that relate to the foundation of the health system and activities to improve coverage, as described in the table on page 12. Within GRISP, "Securing the Foundation" is reflected in strategies and activities, such as programme leadership, human resource capacity building, vaccine availability and quality, political commitment, programme planning and financing, policy guidance, and monitoring and surveillance. Within GRISP, "Reaching towards Universal Immunization Coverage" is reflected in strategies and activities such as detecting and reaching marginalised and partially served populations, improving coverage equity, creating synergy with accelerated disease control activities, creating demand for vaccination, mobilising and communicating for vaccination, and addressing vaccine hesitancy.

In that light, GRISP calls on national governments, global partners, and donors to make 9 transformative investments to achieving better immunisation outcomes, such as: "Invest in the shared responsibility for immunization delivery between communities and the immunization programme to reach uniformly high coverage through high demand and quality services." The document organises strategies by 4 main areas of action:

1. Maximise reach - extend the coverage and reach of the programme to deliver immunisation services in an integrated manner using opportunities that present themselves with special vaccination efforts such as campaigns and new vaccine introductions. They contain key health systems components such as human resources development and the provision of vaccines. Strategies and activities include, for example: Investigate and address cultural, societal, and behavioural barriers or confidence gaps in immunisation. Explore health worker–client interactions, perceptions, and practices. Establish a culture, process, and budget for supportive supervision and mentorship throughout the programme. Exploit the raised awareness and interest around new vaccine introduction to improve routine coverage.
2. Manage the programme - focus on the political support and management functioning of the programme. In addition to strengthening the capacity of the national immunisation programme team, this action area involves ensuring that national policy setting and decision-making are adequately addressed. Strategies and activities include, for example: Develop national partnerships for immunisation, promoting the inclusion of non-governmental and civil society organisations. Communicate and demonstrate the cost effectiveness of immunisation to political and parliamentary decision-makers and participate actively in global advocacy events, including World Immunization Week. Enable opportunities for international peer-to-peer skill transfer between national immunisation teams and support collaboration and learning between national programme management teams through Expanded Programme on Immunization (EPI) managers' meetings and exchanges of practices and experiences. Encourage national programmes to review policy using their local expertise and experience and promote programme learning, including operations research, to identify and disseminate best practices.
3. Mobilise people - emphasise the demand side of immunisation services and encourage the building of resilient community structures and relationships to share the responsibility for immunisation services. This action area also focuses on addressing concerns and hesitancy about vaccination. Strategies and activities include, for example (see this section of the document for specifics):
   • Ensure good interaction and collaboration between communities and the immunisation services.
   • Promote community ownership of health facilities through clinic or health committees.
   • Educate the community through health talks, posters, and mobilisation drives.
   • Develop immunisation information for use in schools and training colleges and put together information materials to promote immunisation for child-to-child promotion.
   • Include communications and advocacy in immunisation planning at all levels.
   • Publicly communicate, in a way that is easy to understand, the benefits and safety of immunisation, while acknowledging and being transparent about risks.
   • Engage professional associations to promote vaccination among their members and involve them in policy-making and planning.
   • Use social media and mobile technology to promote immunisation.
   • Use celebrity appeal and community leaders to promote immunisation.
   • Include immunisation in facility-based and community-based health education.
   • Improve the interpersonal communication skills of community mobilisers.
   • Enable health workers to communicate on vaccination benefits and positively address vaccine and vaccination concerns.
   • Diagnose reasons for vaccine hesitancy, segmenting the population and developing specific and targeted strategies to address concerns.
   • Educate health workers on the appropriate handling, reporting and communication of adverse events following immunisation (AEFIs).
4. Monitor progress - outline the mechanism and process through programme reporting and disease surveillance with in-depth assessments and reviews. Strategies and activities include, for example: Explore the feasibility and utility of using information and communication technology in programme monitoring.

GRISP is a result of a collaboration among major stakeholders in this field. The ongoing oversight of activities resulting from this document will be coordinated by the World Health Organization (WHO) and overseen by the WHO Strategic Advisory Group of Experts (SAGE) for immunisation, with follow-up conducted in line with the GVAP reporting. "Using the comprehensive framework of strategies and practices outlined in GRISP, creative, locally adapted methods of improving the routine immunization system should be devised by national immunization programmes. Partners and donors should consider this framework in formulating their own strategic direction and planning."