Table 5 Challenges in terms of indirect and synergetic effects of immunization on SDGs

Transdisciplinarity, cross-sectoral collaboration and capacity building

Create a common vision and language, cross-sectoral alliances supporting OneHealth and Planetary Health

[12, 42, 44,45,46,47]

Measuring and modeling progress in multiple dimensions

Indicators for health & health environments, Composite indices

[48]

Systems thinking to avoid trade-offs between SDGs

[49]

Holistic approach: health and well-being (SDG3) as part of broader development plan

Seek solutions closer to the source of the disease and link with SDG3 health outcomes, Ecosystem approaches. Planetary health approaches

[6, 8, 12, 44, 50,51,52]

WASH interventions: provide reliable services and monitor health outcomes

[53, 54]

Reduce vulnerability of communities.

Need to quantify and understand dynamics of burden of disease from environmental change, conflict and displacement.

[44, 55]

Lack of predictive power to accurately model human disease outcomes resulting from environmental change

[8]

Equity

Core nexus environment-economy-health, SDG integration, interdependence and implementation

[12, 26, 56, 57]

Policymaking

Considering full value of immunization.

Direct and indirect effects on different SDGs, beyond cost-effectiveness

[4]

Priority setting between long term and short term interventions

[54]

Foster resilience and adaptation, long term effects, implementation science

Long term effects, secondary effects following adaptation

[58, 59]

Capacity building for resilience, Creating conditions that enable systems’ effectiveness

[60, 61]

Effect of immunization on antimicrobial resistance

[62]

Monitor sustainability of vaccine-induced immunity

[63]

Pathogen adaptation, serotype circulation

[64, 65]

Implementation design

[66]

Tipping points at local level: outbreaks

Surveillance at local scale, vulnerability monitoring, modeling

[67]

Pandemic preparedness at global and local scale

[7, 68]

Complex interactions

Disease interactions, coinfections and comorbidities

[69]

Technology and innovation

Role of artificial intelligence for diagnostics

[69]