As immunization coverage has plateaued in many countries – with perpetually 10-20% children unvaccinated – countries need to identify the mix of service delivery and demand generation strategies that are most likely to be effective in overcoming barriers and reaching unimmunized and under-immunized children, as well as ‘zero-dose’ communities, i.e., communities with large numbers of children who have not received even a first dose of diphtheria toxoid, tetanus toxoid and pertussis vaccine (DTP1). Zero-dose communities are often characterized by multiple deprivations due to location, wealth, education level, gender, ethnicity, religion, language, etc. For example, it is not uncommon to find large pockets of unvaccinated children living in urban poor, remote rural or conflict affected settings. As women are primary care-givers and often the majority of health workers in communities, prevailing gender norms and inequalities intersect with other social factors to further compromise demand and supply of childhood immunization regardless of the sex of the child. As a result, gender inequalities that exist in those settings can play an important role in influencing immunization uptake – whether or not the child is a boy or a girl.

Intentionally identifying and addressing the existing equity issues, including gender equity issues, is an important step toward reaching the global ambitions of IA2020 and GAVI 5.0. A better understanding of barriers and potential solutions to inequities, particularly those related to gender, in immunization uptake will strengthen programmes and policies to improve coverage in local contexts, particularly among zero dose populations.

Designed by UNICEF, this online tool presents an opportunity for programme staff, managers and policymakers to strengthen their understanding of gender issues in immunization uptake and delivery through the LEARNING tool and to explore SOLUTIONS that countries have reported using to address various issues relating to immunization equity, including gender equity.

• The LEARNING tool presents potential barriers and solutions to pressing gender issues from the perspectives of both caregivers and service providers.
• The SOLUTIONS collated in this resource are based on those reported by countries in their annual Joint Appraisal reports to Gavi, The Vaccine Alliance between 2016 and 2020. However, the tool also provides a template to enable users to submit their own additional solutions to the database SHARE.

Both the LEARNING and SOLUTIONS sections are organized according to the Journey to Health and Immunization framework, which includes six steps: (1) knowledge, awareness and belief; (2) intent; (3); preparation, costs and effort; (4) point of service; (5) experience of care; and (6) after service. As users will discover as they review the materials included, equity specific barriers to immunization can exist at any of these points, and solutions can target service demand and/or service provision.

Finally, this tool includes a list of additional RESOURCES relating to immunization equity, including gender equity, that can be accessed for additional information.

This user-friendly, online resource aims to help programme staff, managers and policymakers better understand and respond to the various ways in which equity, including gender equity, can influence immunization uptake and delivery at every point along the Journey to Health and Immunization framework – from generating demand to providing the service and its uptake. The user can do this by gaining a better understanding of gender-related barriers and solutions through the LEARNING tool, by exploring the database of country-specific SOLUTIONS and considering which might be applicable to their local contexts and / or by SHARING their own experiences that have worked to improve equity in immunization by submitting the information through a template.