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​​Supporting Vaccination by Increasing Health System Resilience in the Pacific

  • Project Name: System Strengthening for Effective Coverage of New Vaccines in the Pacific Project
  • Region/Country: Pacific/Samoa, Tonga, Tuvalu, and Vanuatu
  • Sector and Themes: Health
  • Year: 2017-Present
  • Project Leaders: Inez Mikkelsen-Lopez
>​​Supporting Vaccination by Increasing Health System Resilience in the Pacific
The project forms part of the regional response to reduce the number of cervical cancer cases and other infectious diseases in children and women.

We want to empower women and others. We want to give them the knowledge they need to understand and appreciate how important vaccines are.

—Karlos Lee Moresi, chief executive officer, Ministry of Health, Tuvalu

Development challenge

The Pacific region, especially has a high incidence of cervical cancer, pneumonia, and diarrhea—all of which are easily preventable through vaccines. Cervical cancer resulted in 500 premature deaths in the Pacific region in 2010 alone. Pneumonia and diarrhea together take the lives of 3 out of 10 children under the age of 5 in the Pacific islands.

Samoa, Tonga, Tuvalu, and Vanuatu do not have vaccination programs to tackle these diseases. Their health systems, with limited capacity in diagnostic and specialist services, impedes early screening and treatment. They are disadvantaged by outdated equipment, shortages of skilled staff, and issues of last-mile connectivity. The countries need well-designed immunization programs that can be delivered through resilient local health systems.


ADB worked closely with the ministries of finance and health of these nations to procure three quality-assured vaccines through the United Nations Children’s Fund (UNICEF) global medical procurement scheme: HPV vaccine for cervical cancer, pneumococcal conjugate vaccine for pneumonia, and rotavirus vaccine for diarrhea. The project acquired cold chain equipment and associated supplies from UNICEF to strengthen vaccine delivery infrastructure. At the local level, the project ensured vaccine microplanning at 90% of health facilities.

The introduction of new vaccines
The project uses the introduction of new vaccines and early detection through communicable disease platforms to drive necessary improvements in the public health system in selected Pacific developing member countries.

The project promoted health system resilience and equity through immunization and cold chain management guidelines, and capacity building of health workers in vaccine planning, administration, data reporting, and waste management. Quality and equity of vaccine management was checked through data on sex-disaggregated immunization reporting and evidence from nationwide immunization and health surveys. A bottom-up community-based approach was used, which leveraged existing community structures and communication channels.

Knowledge products and services delivered

Apart from procuring vaccines and vaccine-related infrastructure, the project facilitated capacity building of health staff through training programs and workshops and introduced best practices in immunization and vaccine delivery to ensure equitable vaccine distribution. Community awareness programs with a focus on women improved the population’s attitude toward vaccines. Sex-disaggregated immunization reporting and evidence from nationwide health surveys were used to ensure quality and equity of the immunization programs.

Impact and results

The project will protect more than 580,000 young women and children against cervical cancer, pneumonia, and diarrhea. The project has received widespread, enthusiastic support from the participating countries and UNICEF.

The rollout of vaccines
The rollout of vaccines to protect children against cervical cancer, pneumonia, and rotavirus has begun in several Pacific developing member countries.

Lessons for Replication

The project highlights the importance of increasing resilience of health systems to tackle such diseases through health facilities and capacity building. Guidelines and processes established for immunization, cold chain management, and capacity building could serve as a helpful resource for other countries tackling HPV, pneumonia, and rotavirus. Sex-disaggregated immunization data collection creates an invaluable dataset for quantitative policy research on vaccination.

The consequences of the recent measles epidemic in Samoa have highlighted the need to strengthen immunization programs in the country.

—Take Naseri, Samoa