Improving Immunization Coverage Through Policy in Georgia
In 2014, the Sabin Vaccine Institute began working with Georgia’s national government and partners to promote sustainable immunization financing and domestic resource mobilization for immunization. In more recent years, the focus has shifted to improving government immunization policy.
In the past, Georgia’s immunization program was heavily supported by Gavi, the Vaccine Alliance (Gavi), which co-finances immunization programs in low- and middle-income countries. However, as Georgia’s economy grew, the country gradually transitioned off Gavi support, assuming a greater and greater share of its immunization costs. Although Georgia is now independently financing vaccines, vaccine coverage remains a challenge.
New immunization policies would aim to address several shortfalls in Georgia’s immunization coverage. Currently, Georgia is one of 11 countries in the European region that have not yet eradicated measles and rubella. Vaccination rates for tetanus, diphtheria, the third dose of the vaccine against pneumonia and the second dose of the meningitis vaccine remain critically low, at or below 75 percent. Georgia has struggled to attain the regional targets for immunization coverage, with immunization coverage decreasing from 2015 to 2016.
On May 7, Sabin, together with the Ministry of Labour, Health and Social Affairs of Georgia, assembled senior officials and stakeholders from across the immunization system for a dialogue on routine immunization and policy in Tiblisi. The purpose was to evaluate and prioritize policies to improve routine immunization coverage in Georgia. Officials ranged from technical experts and representatives from the local offices of the World Health Organization, UNICEF, the U.S. Centers for Disease Control and Prevention, USAID and the World Bank, to regional insurance companies and public health officials.
The meeting leveraged research conducted by Sabin’s Field Officer for Georgia, Dr. Eka Paatashvili. Dr. Paatashvili identified legislative and regulatory gap challenges in the immunization system that stakeholders felt were slowing progress. As part of this research, Sabin led a series of in-depth interviews and focus groups in which respondents identified a number of issues for discussion, including: awareness of immunization, trust among the public and health professionals, insurance coverage, shortage of personnel to provide and monitor vaccination, and coordination of the immunization program among key stakeholders.
Georgian law already mandates that the government organize and supervise the supply, storage and transportation of all routine vaccines and further requires that healthcare providers provide timely information about vaccination and document any instances of parents refusing vaccination. Internal military forces and naval services are required to be vaccinated, and the Ministry of Health is working to identify other risk groups that would be obliged to be vaccinated.
Yet, questions linger on whether vaccination should be made compulsory, a key topic of discussion at the policy dialogue. The vaccination gap and low coverage rates lead many to suggest that it should, while others stressed the risk and factors that accompany compulsory immunizations, including community resistance against vaccinations. Participants pointed to the necessity of strengthening public education about immunization, as well as the need for additional immunization training for medical professionals to increase their sense of ownership over immunization.
"It is important to conduct trainings for doctors regularly, stay alert in this regard, and maintain statistics, show living examples. Vaccines are good, vaccination is necessary, and it is appropriate to remind about it," an official from the National Immunization Technical Advisory Group said.
Participants also emphasized the importance of a streamlined approach to ensure continual and easy access to immunization. Solutions like these have the potential to improve immunization coverage without the need for it to be compulsory.
By openly discussing and evaluating options to improve immunization coverage in Georgia and considering the experiences of other European countries, participants were able to build consensus around the solutions most appropriate for Georgia and prioritize the interventions most likely to successfully raise immunization rates. Participants committed to move forward together to increase demand for immunization through education, improve vaccine services, incentivize medical providers to achieve immunization targets, clarify roles and encourage collaboration.
“Georgian officials recognize the value of immunization and are leaders in the region,” said Sabin CEO Amy Finan. “Sabin is proud to support Georgia’s efforts to continue to improve its immunization programs and determine the appropriate next steps to ensure all Georgia’s children are safe from vaccine-preventable diseases.”
By working together to understand the country’s immunization challenges and develop a path forward, Georgia reaffirms its commitment to facilitating immunization coverage and protecting its people from vaccine-preventable diseases.