Early Experiences of Low- and Middle-Income Countries with Integration of COVID-19 Vaccination into Health Systems and Routine Health Services

Abstract Background Vertical and fragmented tactics used in the global introduction of COVID-19 vaccination strained health systems in low- and middle-income countries (LMIC). Global strategy has shifted from achieving short-term coverage goals towards sustainable integration of COVID-19 vaccination into health systems. The COVID-19 Vaccine Implementation Program (CoVIP) examined early experiences of LMIC with COVID-19 vaccine integration, gaining insights to inform policy, decision-making, and financing. Methods COVIP surveyed 24 countries to assess COVID-19 vaccination integration occurring between March 2021 and March 2023 among immunization programs, public health campaigns, primary care, and other health services. Countries were surveyed on integration experience and activities across planning and leadership, service delivery, demand generation, vaccine safety, logistics and cold chain, and data management systems. Integration was categorized as structured or opportunistic based on the degree of planning, analysis, and systems change. Formal planning for future integration and monitoring was also assessed. Results All surveyed countries had integration experience, and the majority had experience with integrating service co-delivery, planning, demand generation, and vaccine safety. Two-thirds of countries had experience with integrating logistics and cold chain systems; half of countries had integration experience with data management systems. Service delivery integration was frequently opportunistic, and vaccine safety and data systems integration was more structured. Most countries had a formal plan for full or partial integration of COVID-19 vaccine with childhood immunization, primary health care, or other activities. Half had initiated planning and preparation for future integration, and less than a third had an implementation and monitoring plan to assess integration effectiveness. Conclusions Data management, logistics, and cold chains are critical health system domains requiring focused investment to support sustainable integration. Integration can be facilitated through expansion of adult immunization programs to better serve at-risk populations throughout the life course. Other key recommendations include evaluating demand dynamics and customizing IEC strategies, addressing knowledge gaps, and leveraging successful partnership and technical assistance models for future vaccine introductions. These findings should inform investment and decision-making to reach high-risk populations, build capacity to respond to future public health emergencies, and increase global health security. Trial registration: N/A