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Table 6 Sustainability challenges and selected references from Cat2 papers

From: Advancing sustainable development goals through immunization: a literature review

Sustainability Challenge References
People
 Vaccine acceptance HPV vaccination: cultural acceptance, reaching girls at age of high absenteeism, education about HPV vaccines [70]
[71,72,73,74,75,76,77]
 Community engagement For eradication of polio [78]
Measles elimination after COVID-19 pandemic [79]
[80,81,82,83,84,85,86,87,88,89]
Impact of functioning health system and stable communities [90]
 Socio-economic determinants of health [91]
Electrical infrastructure investments needed for UHC [92]
[23, 26, 93]
Migrating populations: Mixing of under-immunized with higher immunized populations in Turkey-Syria [94]
Governance
 Measuring performance, Data for health [13, 69, 95,96,97,98,99].
 Political commitment Investments for health systems strengthening [21]
Political endorsement and communication for vaccination. E.g., HPV vaccination [71, 90]
 Need for systems thinking to connect interventions with SDG3 and other SDGs [14, 62, 74, 75, 100,101,102,103,104,105,106,107,108]
 New vaccine introduction and vaccination coverage [22, 76, 109,110,111,112,113]
NITAG decision support, absence of reliable burden of disease data [114]
 Disease elimination and eradication Behavioral challenges of strict polio strategies near eradication [59, 115, 116]
 UHC and equity Universal primary health care instead of disease-specific programs [21]
[117,118,119,120,121,122,123].
health insurance [124]
Need for Global Health Diplomacy to promote SDG10 as IHR were violated with COVID-19 [125]
 Decision making Decentralized decision making [13, 109, 126,127,128,129,130]
Applying Health Technology Assessment for universal health coverage [131]
 Resilience and preparedness [132,133,134,135]
Sustainability of health system through strengthening immunization, COVID-19 pandemic [136]
 Collaboration [43, 54, 82, 137,138,139,140,141,142,143]
Cross-country collaboration for disease prevention, e.g. cross-border Health Initiative in Kenya and Somalia [144]
Financing
 Donor funding dependency Dependency on development partner support [76, 107, 108, 145,146,147,148,149,150,151,152]
In SSA the effect of ODA on under-five mortality is higher than elsewhere [153]
 Transitioning out of donor funding Transitioning out of donor funding or emergency funding [154,155,156,157,158,159]
Difficulty of finding reliable data on budget and execution poses an issue for financial sustainability [160]
Creating fiscal sustainability and efficiency [108, 124, 146, 148, 156, 161,162,163,164]
Human resources
 Capacity building, accountability, commitment [13, 46, 82, 99, 126, 149, 163, 165,166,167,168,169,170,171,172]
Technical support, open data (GIS), and supportive supervision for surveillance and disease eradication (Polio) [173]
Health worker motivation and resilience [174,175,176]
Information
 Health Information Systems [13, 72, 177,178,179,180,181]
Home-based records must be user-centered and appropriate for local burdens of disease [182]
Improvement of data quality is needed at the HC level related to staff but investments are usually at higher levels and in technology [183]
Data collection, disease surveillance, Electronic health records [13, 93, 171, 184,185,186,187,188,189,190]
 Vaccine supply chain data Security through traceability, e.g., barcoding, GS1 [191]
 Burden of disease evidence for decisions [67, 69, 114, 123]
 Data exchange systems and training [13, 82, 121, 126, 149, 172]
Medicines and technology
 Vaccine distribution Challenges of vaccine supply chains in LMICs [13, 19, 76, 107, 163, 168, 192,193,194,195,196,197,198,199]
Technical innovations that lead to unaffordable transportation costs are not sustainable, e.g. vaccine direct delivery in Nigeria [200]
 Vaccine availability to LMICs [13, 201,202,203,204,205,206,207,208,209]
Vaccine manufacturers from emerging countries. Need for good pharmacovigilance practice to build trust in vaccines [33], need for traceability, stockpiling and new packaging technologies [191, 210]
Structural dependency of countries on global vaccine manufacturers, e.g. Brasil [211]
 New vaccine development [13, 63, 97, 106, 111, 212,213,214,215,216,217,218,219,220]
NTDs: Need for incentives for development of vaccines for the poor [221,222,223]
Packaging development for increasing coverage [224]
Service Delivery
 Implementation barriers and need for tailored solutions
Tailored solutions
Acknowledging implementation barriers and developing strategies [25, 48, 58, 67, 79, 117,118,119, 225,226,227,228,229,230]
 Integrated delivery platform [70, 76, 127, 186, 189, 231,232,233,234,235,236]
Implementation design equally important as intervention design [66]
Public-private partnerships for community health [237]
 Continuity [63, 65, 175, 213, 238,239,240,241]
 Resilience in service delivery [100, 172, 242,243,244,245,246,247]
Effect of conflict on performance of childhood vaccination [133]
Effect of outbreaks on ongoing health prevention [248]
  1. ODA Official Development Assistance