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  1. Yvette Madrid
  2. Immunization information systems & coverage monitoring
  3. Tuesday, 05 November 2019

A recent article in Science authored by Michael Mina and colleagues concludes that measles infection reduces antibodies that provide protection against infections thereby reducing the benefits of prior vaccination (

Measles vaccination acts as an essential complement to other vaccines; hence, defining system strength by DTP3 or MCV1 coverage appears inadequate. Because coverage can also be seen as a probability, it is possible to multiply DTP3 and MCV1 coverage to obtain the probability that an infant has received both. With this joint coverage approach, there is still a reassuringly high number of countries where coverage exceeds 90%. However, not surprisingly, there are about twice as many countries with coverage less than 70% using the joint methodology than through the use of either DTP3 or MCV1.

The use of a joint coverage approach may be better at identifying weaknesses and fragility in immunization systems.

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Yvette Madrid Accepted Answer

Thank you.  Very much agree that systems are multi-faceted and ways of understanding their fragility should be as well.  The challenge is to capture and yet distill the complexity in ways that can be easily understood and acted upon.  Can we improve on what we are doing today?  All thoughts welcome.

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murat hakan ozturk Accepted Answer

Dear Colleague,

If we really want a different way of looking weaknesses and fragility in immunization systems, focusing only on coverage issues would not let us go further. Unfortunately, most of the indicators are about coverage but without strong cold chain system and effective vaccine management practices, how can we be sure about the potency/effectiveness of the injected/dropped vaccines? Can we comfortably talk about high immumity profile just being obsessed about coverage indicator while neglecting cold chain and EVM considerations? 

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