Jordan’s National Immunization Programme experienced a complex decline in programme performance at all levels which, exacerbated by the COVID-19 pandemic, resulted in a decrease in routine vaccine coverage. Coverage with the third dose of hexavalent vaccine, which protects children against multiple communicable diseases, dropped from 99% in 2017 to 96% in 2018, 89% in 2019, and 77% in 2020 [1, 2]. Syrian refugees and vulnerable Jordanians had been particularly affected. In 2020, WHO Jordan received a large grant of 43 million Euros from the European Union to strengthen the immunisation programme under the leadership of Jordan’s Ministry of Health (MoH). This allowed for comprehensive support to all components of the national immunization program, reaching children who had not previously been immunized and vaccinating 20% of Syrian refugee and vulnerable Jordanian infants. This led to an increase in the nationwide hexavalent vaccine coverage rate to 91% in 2021 [1, 2]. The improved vaccine equity and coverage is expected to reduce the incidence of vaccine preventable diseases and associated morbidity and mortality.

 “The National Expanded Programme on Immunization at the Ministry of Health of Jordan strongly appreciates the support provided by the World Health Organization. The technical and financial support helped the Ministry to build back better after COVID-19 pandemic, strengthen the programme capacity at all levels and significantly increase routine immunization rates.”

Dr Nizar Maswadeh, Jordanian Ministry of Health

How did Jordan, with the support of the WHO Secretariat, achieve this?

In 2021, financial, technical, and consultative support was provided from the WHO Jordan and WHO Regional Office for the Eastern Mediterranean to conduct a series of assessments of the immunization programme. WHO’s Expanded Programme on Immunization (EPI) Review provided a better understanding of the strengths and weaknesses of the immunization programme at the national, subnational, and service-delivery levels; WHO’s Data Quality Self-Assessment methods toolbox was deployed to evaluate different aspects of the immunization monitoring system at the district and health unit levels; and WHO and UNICEF’s Effective Vaccine Management (EVM) assessment tool was used to generate evidence about bottlenecks in the supply chain. Multiple gaps were identified in all components of immunization programme and outlined in the assessment reports to enable targeted action.

WHO Jordan worked with the MoH to strengthen the National Immunization Programme's (NIP) management and service delivery capacity. This included developing an organogram to define roles and responsibilities, producing Terms of Reference (TORs) for staff and the National Immunization Technical Advisory Group (NITAG), as well as training 27 managers in WHO's mid-level management course for Expanded Programme on Immunization (EPI) managers. The modules covered programme management and monitoring, and effective vaccine management. To support the operationalization of mobile immunization sessions, WHO Jordan procured vaccines and equipment for transportation and storage (47 cars, four refrigerated vehicles, and 10 refrigerators) through international and local tenders with the support of the WHO Global Service Centre.

“WHO Jordan supported the country’s National Expanded Programme on Immunization with assessments, procurement of vaccines, cold chain equipment, vehicles, and capacity building of the immunization staff. The strong leadership and ownership of the Ministry of Health is truly commendable; it resulted in long-term sustainable changes and improved immunization coverage.”

 Dr Chinara Aidyralieva, WHO Jordan Country Office

Jordan's existing vaccination programme information system relies heavily on paper-based materials (76 percent of records are paper based), so WHO Jordan offered technical support to the MoH to create an Electronic Immunization Information System (IIS). This will help health professionals record and report the vaccinations, ensuring their timeliness and allowing the MoH to monitor the performance of immunization programmes, identify gaps in immunization coverage and address them efficiently. In order to determine the most appropriate platform for Jordan's needs, WHO evaluated a range of information management platforms, including DHIS2 and Jordan's national platform for COVID-19 vaccination. The latter is under consideration by the MOH as the potential platform for tracking of routine vaccines.