Potential Role of SchoolBased Immunization in

Protecting More Children

Results of e-mail survey
Global Immunization Meeting 2009

Method
Standardized questionnaire sent to countries through WHO and
UNICEF regional offices.
Data collected on:

Target ages, groups, size

Vaccines given, coverage
Responsibilities, organization
Costing and Financing
Difficulties encountered

Focus on the use of school-based routine immunization:

Not on school-based immunization during Supplemental Immunization
Not on immunization as a requirement to enter school.

Replies received from 143 countries.

Survey Results

61 countries report some kind of school-based immunization program!

(as of August 2008)

Countries with and without school-based

immunization, 2006- 2008

Countries with a school-based immunization program (n=61)

Countries with no school-based immunization program (n=82)
No information (n=49)
Source: WHO-UNICEF E-mail Survey on school-based
immunization, 2006-2008
Date of slide: 14 August 2008

The boundaries and names shown and the designations used on this map do not imply the
expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement.
WHO 2004. All rights reserved

Most countries with a school-based immunization

approach use it to deliver TT-containing vaccines,
and (less) polio and measles-containing vaccines
Proportion of countries with a school-based immunization program delivering
tetanus, measles, polio and other vaccines (n=61)
100%

Percentage

80%
60%
40%
20%
0%

Total
(n=61)

AFRO
(n=8)
TT-containing vaccine

AMRO
(n=9)

EMRO
(n=7)

Measles-containing vaccine

EURO
(n=15)

SEARO
(n=5)

Polio vaccine

Other

WPRO
(n=17)

School-based immunization programs mainly target

children in early primary school, and late primary/early
secondary school.

In school-based immunization, the first year of primary

school is most used to deliver several vaccines

In secondary school, school-based immunization targets

mainly Grades 7, 8, 9, and delivers relatively more of the
"other" vaccines.

Target Groups
% of countries

Nation-wide Implementation:

85% (52/61)

In Africa only 2/8 countries nation-wide

Survey result includes pilot, early implementers etc

Boys and Girls Targeted :

93% (57/61)

4 countries use TT for girls only

School-entry level Targeted :

77% (47/61)

Ages 9-13 Targeted :

54% (33/61)

Importance for HPV

Information on size target population:

52% (32/61)

Implementation
% of countries

Implemented by local HW:

46% (28/61)

Implemented by School Health Staff:

20% (12/61)

Other interventions added:

Anti-helmintics
Vitamin A / Micronutrients
Health Education

7% (4/61)
5% (3/61)
3% (2/61)

Achievements
% of countries

Information available on number

children reached:

49% (30/61)

Interpretation difficult
lack of standardization (numerator by vaccine or for all vaccines
combined?, denominator?,)
Computed coverage: range: 25% - 151%

Weak or no strategies to reach out-of-school children

except where health systems allows close tracking and follow-up.

Costing / Financing.
Limited information on costing and financing.
Often considered as part of routine work, and therefore not
costed separately
Government main contributor

Operational Cost per child immunized : Range: US$ 0.12 - 0.70

(info from 3 countries)

Summary of Survey Findings

At least 61 countries have introduced school-based immunization
Wide range of vaccines given in school-based approach; TT almost
universal.
Mostly targeted at early primary school
Aimed at boys and girls; usually nation-wide implementation
Needs of out-of-school children poorly addressed
Collaboration between MoH and MoED
Coverage monitoring is poor
Not widely used to deliver other interventions.

Is School-Based Immunization a
good idea?
High primary school attendance rates
except in Africa
>80% of children who start primary school, also finish it
Proportion of children going to Primary School
(source: State of the World's Children 2009)

100

Percentage

80
60
40
20
0
East &
Southern
Africa

West &
Central
Africa

Middle-East South Asia East Asia &

Latin
& North
Pacific
America &
Africa
Caribbean

Primary School Enrollment Boys

Survival Ratio to last Primary Grade

CEE/CEIS

Primary School Enrollment Girls

Summary
School-based immunization has the potential of
being a suitable delivery strategy for immunization
of school-aged children.
School attendance levels are key to reaching high
coverage. Special measures need to be
implemented to reach out-of-school and absent
pupils.
Ways to implement can vary (year-round vs
specific period; local vs school health staff; antigens
used;)
Coverage data need to be standardized and
systematically collected.
Inclusion in WHO-UNICEF Joint Reporting Form 2009

More information
In-depth summaries of school-immunization
programs available for
Indonesia
Malaysia
Sri Lanka
http://www.who.int/immunization_delivery/
systems_policy/school-based-immunization/en/index.html

Thanks to:
UNICEF, WHO, MOH staff at country levels
UNICEF, WHO staff at Regional Levels

(Any additional information is welcome!)

Primary School Attendance Levels offer

opportunities for school-based immunization

Sources: UNICEF: State of the World's Children 1999 and 2008