Difficult geographical terrain, less importance given to COVID-19 booster dose vaccination following a decline in COVID-19 cases, and lack of strong reporting and recording mechanisms were identified as some of the key challenges impeding Nepal's vaccination coverage during a nationwide review of COVID-19 vaccination and routine immunization program.
Key stakeholders including officials from Provincial Health Directorates, Provincial Health Logistic Management Centers, District COVID-19 Vaccination Coordination and Monitoring Committee, District Immunization Coordination Committee, Health Office, municipalities, health facilities, and immunization partners, participated in the review program held at the district level between February to March 2023.
Participants identifying low coverage areas of COVID-19 vaccination and routine immunization at the Review Meeting of COVID-19 Vaccination and Routine Immunization program held in Kavrepalanchowk, Bagmati Province, Nepal. Photo credit: WHO Nepal
Organized by the Family Welfare Division (FWD), Department of Health Services (DoHS), under the Ministry of Health and Population, with support from WHO, Country Office for Nepal, the review program sought to guide the development of local-level strategies for strengthening vaccination efforts at the sub-national levels.
Participants pose for group photo after the end of the Review Meeting of COVID-19 Vaccination and Routine Immunization program held in Kavrepalanchwok, Bagmati Province, Nepal. Photo credit: WHO Nepal
As elsewhere in the world, the COVID-19 pandemic affected the delivery of essential healthcare services in the country, including its routine immunization program, resulting in a decline in vaccination coverage in the fiscal year 2019/2020.
The percentage of children who have not received any vaccinations increased from 1% in 2016 to 4% in 2022, according to the findings of the National Demographic Health Survey.
"Our data showed that children are missing out on routine vaccination, and the uptake of COVID-19 booster doses has also been quite slow. The review program was organized at the district level with the objective to identify key issues and target groups and to work in collaboration with local stakeholders to draft action plans aimed at increasing vaccination coverage, reaching the unreached, and reducing dropouts," said Dr Abhiyan Gautam, Chief of the Child Health and Immunization Services Section, FWD.
The draft district action plans created during the review program emphasize wider involvement of the communities, elected officials, schools, and female community health volunteers, particularly in the planning and implementation of vaccination campaigns to make it more participatory and community-centric. This is expected to correctly identify and address the needs of the municipalities which currently have low coverage. The FWD will further review the draft action plans with technical assistance from the WHO prior to its implementation.
Participants engaged in drafting local-level action plans for increasing vaccination coverage in under-vaccinated areas. Photo credit: WHO Nepal
"Aligned with the action plans, we will increase advocacy activities and stakeholder involvement, work on improving service delivery by ensuring regular supply of vaccines, and building capacity of local level healthcare workers, particularly those serving in low-coverage areas," said Dr Gautam, the Child Health and Immunization Section Chief.
WHO provided technical support to develop micro plans during the meeting and conducted a briefing on the latest vaccination guidelines for participants. Similar support was provided in 2021 when Nepal first launched the National Deployment and Vaccination Plan for COVID-19 Vaccines. WHO is committed to continuing its support in Nepal’s target to achieve 100% vaccination coverage against COVID-19, leaving no one behind.
Dr Vinod Kumar Bura, Team Lead of the Immunization Preventable Diseases Programme at WHO, Country Office for Nepal, says: "WHO will continue to support the government to enhance the capacity of health care workers, strengthen the recording and reporting system, and conduct supervision and monitoring activities in high-risk areas to identify zero doses and under-immunized individuals and communities."
A woman gets her child vaccinated during a routine immunization session in Surkhet, Karnali Province, Nepal. Photo credit: WHO Nepal/A.Maharjan
As of 5 July 2023, a total of 59,655,379 doses of COVID-19 vaccines have been safely administered which includes 11,009,757 booster doses. With 83% coverage of the primary series, Nepal ranks second in WHO South-East Asia Region in terms of COVID-19 vaccine coverage.
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