Accelerating Access for All through Research and Innovation in Immunization: Recommendations from Strategic Priority 7 of the Immunization Agenda 2030

"...the relatively low levels of trust in immunization have highlighted the need for greater investments in research to understand the drivers of vaccine hesitancy."

Immunization Agenda 2030 (IA2030) features Research and Innovation as its seventh Strategic Priority (SP7). Research focuses not only on relevant scientific inquiry but also on socioeconomic determinants of vaccine efficacy and uptake, as well as the social and behavioural factors contributing to inequities in vaccine coverage. Innovation refers to new technologies and ways of working that accelerate the availability of vaccines and expand the reach and impact of immunisation programmes. SP7 is explicitly informed by country needs and priorities, and aims to strengthen the innovation ecosystem through capacity building and collaboration at country, regional, and global levels. This article examines recommendations that emerge from SP7, and the summary below highlights some of the communication-focused elements.

As outlined here, SP7 identifies four key focus areas: (i) "needs-based innovation", (ii) "new and improved products, services, and practices", (iii) "evidence for implementation", and (iv) "local capacity". These focus areas are interdependent. For example, local capacity includes the ability to communicate local needs, priorities, and the important attributes of locally acceptable and implementable solutions to the wider global community; in turn, these perspectives should inform needs-based innovation. Strategic interventions in these key focus areas apply the lessons of the Global Vaccine Action Plan and the Decade of Vaccines to emphasise local innovation, promote the use of research by countries to improve programme performance and impact, and encourage capacity building for the development and implementation of innovations.

One component of SP7 is evidence for implementation. Programmes that aim to expand the benefits of vaccination to underserved and hard-to-reach populations and to communities in emergency settings need evidence on how social factors, including gender barriers, affect uptake. An additional important barrier is low trust in specific vaccines or in immunisation programs more broadly that can lead to vaccine hesitancy and low vaccine coverage. Given that trust in vaccination has historically been lowest among populations with the highest risk of vaccine-preventable diseases, research that broadens the understanding of vaccine hesitancy can help promote equitable vaccine coverage. Generating this evidence will require greater capacity for research across many disciplines in low- and middle-income countries. 

When local capacity is viewed through the SP7 lens, it is clear that local problem-solving is critical for maintaining resilient immunisation systems. To that end, human-centered design approaches can improve the utility of innovations and promote their uptake within countries. The process entails activities aimed at understanding local contexts and using rapid "test and learn" cycles to evaluate innovations, learn from failure, and adapt and improve. However, countries do not always have environments to test and adapt innovations.

To enhance capacity for innovation, the article recommends that stakeholders, including national governments, should:
 

• Formalise and legitimise innovation as a discipline and develop a toolkit to foster collaboration between disciplines and create a common understanding of the role of innovation in health systems. Encourage iterative learning (including test and learn cycles) and adopt more agile approaches for innovation in digital tools, management, and practices.
• Foster a community of practice (e.g., a WhatsApp group) to support immunisation programme managers with peer-to-peer support.
• Promote inclusive innovation, with a focus on supporting the economically poorest and most vulnerable. To overcome gender bias, women and adolescent girls, including those with disabilities, should play a decisive role in the design, testing, learning and adoption of innovative solutions, and should be engaged both as recipients of innovation and as innovators.
• Strengthen capacity to develop and manage digital solutions by adapting existing data tools and systems, standardising approaches, and supporting the collaborative development of digital global goods.
• Identify and support innovation entrepreneurs who are closer to the problems and challenges faced by immunisation programmes. Mechanisms should add to local capacity, rather than disrupt existing resources, and could include innovation hubs, accelerators, and "sprint support".
• Coordinate with wider innovation efforts, including those in non-health sectors, such as the Technology Facilitation Mechanism for the Sustainable Development Goals.

The article provides several case studies to illustrate various SP7 strategies in practice:
 

• Case study: COVID-19 vaccine development, access, and delivery - COVID-19 elicited massive public investments in vaccine development and also led to other types of innovations. To help stakeholders keep up with current best practices, TechNet-21.org, a global network of immunisation professionals, is linking actors in the system to share technical information, guidance, advice, and lessons learned for COVID-19 vaccination.
• Case study: Accelerated development of novel oral polio vaccine (OPV) type 2 nOPV2 - Innovations that improve how immunisation programmes such as the delivery of nOPV are managed and how services are organised should be fostered and expanded. Examples include satellite maps used in combination with artificial intelligence (AI)-based estimation of household size to improve estimates of population size and planning for immunisation campaigns.
• Case study: Malaria vaccine decision making - Success will be contingent upon vaccine availability and uptake. Community engagement to facilitate RTS,S vaccine implementation at scale is being developed through a series of workshops.
• Case study: rapid immunisation skill enhancement digital learning system - India’s Universal Immunization Program has developed RISE, the Rapid Immunization Skill Enhancement Digital Learning System. This learning management system contains five modules designed according to adult learning principles that target gaps in health worker training. Health workers use a mobile app to learn the content through text, animations, games, and quizzes; take assessment tests; and receive certificates for completing each module. To build a learning community, RISE includes a dashboard, a regular gulletin that celebrates certificate winners, and WhatsApp groups where learners share progress with their peers, respond to quizzes, and troubleshoot technical issues.

In conclusion: "The proposed approach will maintain a focus on the development of new vaccines and the improvement of existing vaccines, and increase attention to innovation in service delivery. Monitoring and evaluation will foster evidence-based priority setting at the country level and help to ground the global research and development (R&D) agenda in the needs of communities. Together, these approaches are intended to harness the power of research and innovation more effectively, to meet the challenges of the future and achieve the ambitious goals of IA2030."