By Godwin Lasisi

A Global Push Backed by Numbers

Each year, immunization prevents 4 to 5 million deaths globally, yet nearly 20 million children remain under-vaccinated or unvaccinated according to WHO in 2024¹. In South Asia, an estimated 1 in 10 children still miss out on essential vaccines, placing them at risk for preventable diseases according to UNICEF in 2024². Despite challenges like regional disparities, supply chain inefficiencies, and inconsistent program management, there has been remarkable progress. The global coverage for the DTP3 vaccine reached 84% in 2023,⁴ with Nepal achieving 90% coverage according to WHO This year’s World Immunization Week theme “Immunization for All is Humanly Possible”, is more than a slogan; it is a call to action to strengthen accountability, equity, and resilience within national immunization systems. Nepal, with the support of Gavi and Sydani Group, is taking significant and decisive steps in that direction.

In Nepal, Sydani’s commitment to health systems strengthening and immunization is transforming the EPI landscape through the Nepal Accountability Framework Development. By reinforcing transparency and shared responsibility, this project helps local and international partners monitor outcomes, make informed decisions, and ultimately build trust with the communities they serve. The accountability framework is a tool of empowerment to make data informed discussions, and evidence-based action that strengthens and drives health systems to optimize EPI programmes.

Accountability: The Backbone of Immunization Equity

To achieve universal immunization and advance UHC, countries must ensure that vaccines reach every child irrespective of geography, socioeconomic status, or background. But access alone is not enough; systems must be transparent, responsive, and well-governed. In Nepal, the Expanded Programme on Immunization (EPI) has made tremendous strides in vaccine availability and uptake. Nepal’s EPI Accountability Framework is a practical realization of the Immunization Agenda 2030 (IA2030), which emphasizes country ownership, strong governance, and equitable access to immunization across the life course. By aligning with IA2030’s strategic priorities, such as strengthening health systems, generating and using quality data, and fostering community engagement. The approach in developing the Nepal Accountability Framework exemplifies how local actions can contribute to global goals. The framework not only monitors programmatic performance but also embeds transparency and accountability into the immunization ecosystem, creating a resilient foundation for achieving the IA2030 vision of a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being.

To address these gaps, Nepal’s Ministry of Health and Population (MoHP), with support from Sydani Group and in collaboration with Gavi, the Vaccine Alliance, is developing an EPI Accountability Framework, toward performance-driven, transparent immunization systems that leave no one behind.

Designing the Future: A Co-Creation Model for Inclusive Health Systems

In February 2025, a two-day Co-Creation Workshop was held in Nepal, bringing together key actors from the MoHP, Gavi, WHO, UNICEF, civil society, and Sydani Group. This workshop marked the beginning of an inclusive journey toward creating a comprehensive, measurable, and implementable accountability framework for Nepal’s EPI.

The design process focused on defining indicators to assess service delivery, human resource capacity, vaccine-preventable disease (VPD) surveillance, cold chain logistics, and demand generation. By embedding monitoring tools within the health system, stakeholders aim to build a real-time feedback loop that empowers decision-makers and ensures provincial and community-level responsiveness. This kind of participatory planning represents the human element in the Immunization Week theme, people coming together to make immunization systems work for everyone.

From Policy to Practice: Mapping Out the Road Ahead

The accountability framework goes beyond theory, it is being structured for real-world application. Implementation will follow a clear roadmap with finalization of the Accountability Framework, pilot testing and implementation, expansion to other provinces, and continuous iteration to ensure effectiveness and efficiency of the framework. The goal is simple and ambitious: to enhance transparency and visibility in Nepal’s EPI by strengthening governance structures, optimizing immunization financing, and improving program performance through a robust model that other low- and middle-income countries (LMICs) can replicate in alignment with Gavi’s Full Portfolio Planning (FPP) approach, which emphasizes robust monitoring and strategic investments (Gavi, 2023).

Innovation Meets System Resilience

Sydani’s Group work in Nepal underscores a broader truth: building resilient immunization systems requires more than vaccines it requires people-powered accountability, community participation, and evidence-based planning. The EPI Accountability Framework is not just a document; it is a tool to elevate immunization coverage, strengthen institutional capacity, and respond to local realities with real-time evidence-based data.

In a world where trust is essential to uptake of vaccines and realization of immunization targets through strengthened health systems, the Nepal Accountability Framework reminds us that accountability is a wholistic process of oversight, evaluation, feedback and ownership, all of which is foundational to achieving Universal Health Coverage in alignment with the IA2030 Agenda.

As we reflect on World Immunization Week 2025, Nepal’s Accountability Framework Development reminds us that immunization for all is not a distant ideal, it is a tangible reality within reach. With strategic partnerships, local leadership, and global solidarity, we can ensure that no child is left behind.

References

UNICEF. (2024). State of the World’s Children 2023: For every child, vaccination. Retrieved from https://www.unicef.org/reports/state-worlds-children-2023

World Health Organization. (2023). Nepal immunization programme review: Key findings and recommendations. Retrieved from https://www.who.int/publications/i/item/9789240074155

World Health Organization. (2023). Global vaccine market report 2023. Retrieved from https://www.who.int/publications/i/item/9789240071109

World Health Organization. (2024). Immunization coverage. Retrieved from https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

World Health Organization. (2025). World Immunization Week 2025 – Immunization for all is humanly possible. Retrieved from https://www.who.int/campaigns/world-immunization-week/2025

Gavi, the Vaccine Alliance. (2023). Gavi’s Full Portfolio Planning (FPP) approach. Retrieved from https://www.gavi.org/programmes-impact/strategic-focus/full-portfolio-planning