Dear colleagues, I am sharing a recent article on vaccination timeliness that I found very interesting in the context of assessing immunization programme performance (in additon to, say, coverage):
"Vaccination timeliness is a key measure of immunisation system performance: A call to address priority research, policy and practice issues"
https://www.sciencedirect.com/science/article/pii/S2590136225001561
I wonder how relevant timeliness might be to understanding immunization supply chain performance. Perhaps not directly, but it does touch on some important themes in supply chain management, particularly around use of data for action.
"Traditionally, progress in routine childhood immunisation programmes (including progress towards reaching ‘zero dose’ children) has been measured by monitoring national routine vaccination coverage rates, i.e. the percentage of children vaccinated before a specific age [1]. While this metric remain essential, focusing on them alone can obscure other key aspects of immunisation programme performance, such as ensuring that children receive vaccine doses at the optimal times to provide maximum protection against serious vaccine-preventable diseases (VPDs). Vaccination timeliness, defined as the receipt of each dose within the recommended vaccination window, in an age-appropriate manner [2], therefore represents a necessary, yet often neglected, dimension of immunisation system performance. In 2019, a World Health Organization (WHO) white paper on harmonising vaccination coverage indicators emphasised that timely vaccination is a stronger proxy for valid or effective coverage, because doses administered at the recommended age and intervals are most likely to be immunogenic and protective [3]. Despite its importance, this metric has received relatively little attention in research, programme monitoring frameworks, and policy implementation. In this commentary, we examine why vaccination timeliness matters, identify key existing conceptual and measurement gaps, and outline priority actions needed to elevate timeliness as a core metric of immunisation system performance."
"As a key policy priority, global and national immunisation policy stakeholders should explicitly endorse timeliness as a core measure of immunisation programme performance, and issue technical guidance on how it should be defined, measured, and monitored. A consensus framework, developed through the Strategic Advisory Group of Experts (SAGE) and national technical advisory bodies, would help standardise definitions across settings and facilitate comparability between countries."
"As a key policy priority, global and national immunisation policy stakeholders should explicitly endorse timeliness as a core measure of immunisation programme performance, and issue technical guidance on how it should be defined, measured, and monitored. A consensus framework, developed through the Strategic Advisory Group of Experts (SAGE) and national technical advisory bodies, would help standardise definitions across settings and facilitate comparability between countries. Timely vaccination should be defined pragmatically as administration within the recommended national windows, ensuring flexibility and contextual relevance but avoiding arbitrary cutoffs that obscure cross-country learning.
Strengthening the quality of immunisation data is a critical prerequisite for any meaningful analysis of vaccination timeliness. As programme priority, investment in data systems, training and re-training of health workers is needed to ensure complete and accurate recording of vaccination data, including dates of birth and vaccination. DHS remain a key data source for assessing vaccination timeliness, and recent funding uncertainties surrounding these surveys represent a setback. Countries should therefore strengthen civil registration and vital statistics systems, including birth registries, and explore innovative approaches for maintaining vaccination records. Mobile applications, barcode scanning, and linkages with national digital health platforms can be leveraged as smartphone and internet penetration expand across LMICs. In settings with substantial data gaps, strengthening recording systems should precede any analysis of vaccination timeliness. When analyses are undertaken, methodological innovations are needed to address missing birth or vaccination dates. Approaches such as imputation, survival analysis, or machine learning may be appropriate, and all analytic decisions should be carefully documented and reported to ensure transparency and reproducibility.
Finally, governments and partners should consider how best to integrate timeliness indicators into routine programme dashboards and global monitoring frameworks. Doing so will enable early detection of emerging vulnerabilities, facilitate resource targeting, and ensure that timeliness becomes part of the accountability architecture of immunisation programmes. Strengthening the measurement and use of vaccination timeliness is therefore not only a technical necessity but a public health imperative. Embedding timeliness within global and national monitoring systems will help ensure that every child receives life-saving vaccines at the right time, advancing equity and effectiveness of immunisation programmes."