Big Catch-Up Initiative Making Strides in Eastern Mediterranean Region

724 Hits

WHO PANOS PAKISTAN 72February 2025 - The Big Catch-Up (BCU) initiative, a targeted global effort to boost vaccination among children following declines driven by the COVID-19 pandemic, is making significant progress in addressing immunity gaps among children under five in six countries across the Eastern Mediterranean Region.

Afghanistan, Pakistan, Somalia, Sudan, Syria, and Yemen have updated their Expanded Program on Immunization (EPI) policies to include children under five years and have developed national schedules to cover delayed vaccinations.

Somalia and Yemen have gone a step further by integrating outreach activities with other essential health services, including Integrated Management of Childhood Illness (IMCI), nutrition, reproductive health (RH), and deworming. Syria has also begun piloting similar integrated outreach activities in 17 districts.

Vaccine Distribution and Utilization

To support the initiative, these six countries have received approximately 25 million additional vaccine doses from total of 62 million approved doses. The distribution of delivered doses, relative to approved allocations, is as follows:

  • Afghanistan: 58%
  • Pakistan: 50%
  • Somalia: 50%
  • Sudan: 31%
  • Syria: 80%
  • Yemen: 12%

Syria has successfully conducted three rounds of outreach efforts, while Pakistan, Somalia, and Yemen have completed two rounds each. Despite the ongoing security challenges, Sudan has managed to implement outreach activities in four accessible states. Across these countries, over five million doses of various vaccines have been administered to children aged 12-59 months.

However, vaccine utilization rates vary significantly:

  • Somalia: 41%
  • Pakistan: 32%
  • Syria: 23%
  • Sudan: 16%
  • Afghanistan: 4%
  • Yemen: 2%

Challenges and Mitigation Strategies

The BCU initiative faces multiple challenges, including political instability, funding gaps for operational costs—particularly in Pakistan and Somalia—resistance to vaccinating older children, concerns over multiple injections during single visits, and difficulties in deploying mobile teams to remote regions such as Baluchistan.

To address these hurdles, countries have developed innovative strategies. In security-compromised areas, they have adopted "hit and run" approaches supported by non-governmental organizations (NGOs). Health worker training and sensitization efforts are being intensified, while digital tools such as the District Health Information System 2 (DHIS2) and Electronic Immunization Registry (EIR) are improving data collection and monitoring.

Efforts to secure additional funding through Gavi and other international partners are ongoing to ensure the sustainability of the initiative.

Building Momentum for Immunization

Despite the obstacles, the BCU initiative is gaining momentum, strengthening immunization efforts, and ensuring that vaccines reach the most vulnerable children. With continued support and innovation, these efforts will contribute to closing immunity gaps and protecting millions of young lives across the region.

-----

Authors: Mohammed Osama Mere and Mohamad Nihad Alyousfi, World Health Organization/Eastern Mediterranean Region
Photo credit: WHO / Panos Pictures / Saiyna Bashir

1