The Regional Lead for Asia, Poorni Sampath, welcomed the participants and briefly introduced the Gavi CSO Constituency. As a platform of over 450 civil society organisations (CSOs) actively engaged in vaccination-related issues, the Constituency’s vision is to ensure that every person is reached with vaccination and basic health services—regardless of their origin, gender, or social status. It aims to achieve this by serving as the voice of civil society in advocating for better health outcomes and increased immunisation coverage.

Poorni noted that this convening comes at a critical time, following the release of Gavi 6.0, Gavi’s new five-year strategy for 2026 to 2030. The strategy emphasizes that efforts should be country-led, sustainable, community-owned, and inclusive, with a priority focus on reaching zero-dose and missed communities. Gavi 6.0 underscores a gender-focused, innovative, collaborative, and accountable approach, aligned with the World Health Organization’s (WHO) Immunisation Agenda 2030 (IA2030) strategy.

Civil society organisations, being closely engaged with communities, play a vital role in advocacy, service delivery, capacity strengthening, and collaboration with key stakeholders to ensure impactful results. The Asia CSO Dialogue Series, the first of its kind in the region, aims to convene CSOs to enable experience sharing, cross-learning, and to create opportunities for collaboration in advancing the Gavi 6.0 and IA2030 agendas.

Dr. Nizam Uddin Ahmed, Chair of the Gavi CSO Constituency and Executive Director of the Shastho Shurokkha Foundation (Bangladesh), opened the session by introducing the Gavi CSO Steering Committee (SC). He highlighted its vision and mission in alignment with Gavi 6.0 and invited CSOs to engage in scaling up and network-building efforts.

Dr. Nizam emphasized the importance of this convening as a platform where CSOs can significantly influence strategic partnerships at the country level for sustainable immunisation. He introduced the SC as a global body of 18 CSO leaders that initially founded the Gavi CSO Constituency. The primary objective of the Constituency is to ensure civil society participation in shaping global policy and implementing immunisation programmes.

He outlined the leadership’s renewed vision: equitable access to life-saving vaccines, especially for vulnerable families and communities. He called for strong collaboration—particularly around demand generation, capacity building, and resource mobilisation for CSOs.

Reflecting on the journey since 2010, Dr. Nizam acknowledged the foundational roles played by colleagues from Asia, Africa, and beyond. He reaffirmed that CSOs remain Gavi’s key partners, especially in prioritising zero-dose and missed communities.

He urged CSOs in Asia to join the 450+ member Constituency, lend their voices to policy development, and take leadership in regional immunisation agendas. He also encouraged understanding what drives performance in countries with strong immunisation indicators, advocating for increased funding at the national level.

The session closed with a call to action: CSOs must be ready to engage unvaccinated populations, collaborate with governments through the Expanded Program on Immunisation (EPI), and leverage Gavi’s new funding streams, including the 10% allocation for CSOs. Dr. Nizam underscored the need for tailored interventions in conflict-affected areas and deeper coordination across all levels—from global to local—to ensure no one is left behind.

Ms. Bhavna Mukhopadhyay, Chief Executive of the Voluntary Health Association of India and Executive Board Member of the IUHPE, led this session focusing on immunisation progress and gaps in Southeast Asia.

She began by citing data from the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), updated to 2023, noting that South Asia—home to 2 billion people—plays a pivotal role in advancing the IA2030 goals.

Despite demographic challenges like high birth rates, diverse geographies, ethnicities, and religious and socioeconomic variations, the region has seen remarkable progress:

• Polio eradication (since 2014)

• Elimination of maternal and neonatal tetanus (since 2016)

• Measles elimination in Bhutan, DPR Korea, and Timor-Leste

• Measles and rubella elimination in Maldives and Sri Lanka

• Hepatitis B elimination in Bangladesh, Bhutan, Nepal, and Thailand

Using data from India, Bangladesh, Nepal, Pakistan, Afghanistan, and Indonesia, Ms. Bhavna showed increased coverage of essential vaccines (e.g., BCG, DPT, MMR, Polio), but also noted persistent gaps that need urgent attention.

Key challenges identified:

• Limited access in remote areas

• Inconsistent antenatal care

• Migration and displacement

• Low maternal literacy

• Resource constraints and poor infrastructure

• Shortage of trained health workers

• Uneven vaccine supply

Mitigation strategies included:

1. Multi-sector partnerships (government, NGOs, private sector)

2. Public-private collaboration on new vaccine development

3. Digital technologies to improve tracking and follow-ups

4. Regional networks for monitoring, surveillance, and cross-border outbreak response

Role of CSOs:

• Advocate for immunisation at national and subnational levels

• Push for sustained investments in vaccination programmes

• Leverage community networks for awareness and outreach

• Address hesitancy and cultural resistance through local engagement

• Ensure transparency and monitoring of service delivery

• Collaborate with governments and international partners to reach last-mile populations

This session was led by Dr. Remesh Kumar, Director of Medical Services and Head of Pediatrics at Apollo Adlux Hospital, Kerala, and President of the Indian Academy of Pediatrics.

He began by explaining the term “zero-dose children”—infants who have not received even the first dose of DTP (diphtheria, tetanus, and pertussis) vaccine. In 2023, 14.5 million infants were identified as zero-dose globally, while 6.5 million were partially vaccinated.

Dr. Remesh shared regional insights:

• Immunisation coverage is over 90% in the US, Europe, and Russia.

• Coverage is between 60% and 69% in Africa and Southeast Asia.

• India ranked second globally in the number of zero-dose children (2.7 million), after Nigeria (2.2 million), as reported by Times of India.

Contributing Factors:

• Poverty and fragile contexts (e.g., war, conflict)

• Migration and homelessness

• Religious or cultural marginalisation

• Gender-related barriers such as:

  • Limited maternal education

  • Gender-based violence

  • Child marriage and teen pregnancies

  • Male-dominated healthcare decisions

Dr. Remesh emphasized the critical role of female literacy in improving immunisation rates and called for a gender-sensitive, rights-based approach.

Way Forward:

• Collaborate closely with government agencies.

• Ensure data collection and evidence generation for policy advocacy.

• Drive political will to implement targeted strategies.

• Involve CSOs in planning and delivery, as they have grassroots connections.

He concluded by encouraging participants to contribute ideas and experiences that can shape zero-dose strategies across the region.

Q1: What strategies can achieve full immunisation in semi-arid regions with infrastructure and literacy challenges?

A: Both CSOs and governments must collaborate. A clear strategy is required—one that includes funding, programme design, and data generation. Government adherence to national policy frameworks is also key.

Q2: What Gavi CSO Constituency programmes exist, and how can CSOs contribute?

A:

• CSOs can register via the Constituency portal.

• They can participate in consultations and national platforms.

• The Steering Committee periodically invites applications for leadership positions, enabling CSOs to influence Gavi policies and programme designs.

Q3: How is the Gavi CSO Constituency addressing the Hepatitis community’s call regarding vaccine investment?

A:

• Gavi is advocating for inclusion of life-saving vaccines.

• It received and acknowledged an open letter from the World Hepatitis Alliance.

• The Alliance is now part of the Constituency, enabling deeper engagement and collaboration.

Q4: How can a Nigerian CSO participate and receive support, given Nigeria’s similarity to Asia in scale and need?

A: Nigeria is a priority country alongside India. Your participation confirms your membership in the Constituency, and you’re encouraged to join the Steering Committee. Your advocacy and partnership are welcomed.

Q5: Are there shared research or learning agendas CSOs can contribute to—especially on zero-dose children?

A: Yes. Gavi runs Learning Hubs in six countries, including Bangladesh and Nigeria. These hubs test strategies to reach zero-dose children and complement routine immunisation.

1. Bangladesh – Successes and Challenges

Dr. Nasrin Akhtar, Executive Director of Radda MCH-FP Centre, outlined the impact of Bangladesh’s Expanded Program on Immunization (EPI), which vaccinates:

• 3.8 million children and

• 6 million women annually

Notable outcomes:

• Neonatal tetanus eliminated

• Polio-free status since 2014

• 73% reduction in under-5 mortality since 1990

• Gavi awards in 2009 and 2012

Innovations include:

• E-tracker and GIS-based microplanning

• Mobile clinics, evening/weekend sessions

• Real-time tracking apps

Challenges:

• Transitioning from Gavi to full government funding by 2026

• Shortages of health workers (31% vacant)

• Urban-rural coverage gap (urban: 73.9%, rural: 85%)

• Coordination issues between ministries

• Migration in urban slums

• Physical access and session frequency in hard-to-reach areas

Recommendations:

• Expand NGO and CSO partnerships

• Enhance public-private collaboration

• Strengthen primary healthcare infrastructure

• Increase awareness through media and community outreach

• Scale up flexible vaccination sessions

• Increase domestic health budget by 20–25%

2. Pakistan – Barriers and Opportunities

Huma Khawar, a journalist and CSO consultant, provided an overview of Pakistan’s EPI.

Key facts:

• 7 million children targeted annually

• National coverage: 76%

• Punjab: 89%; Balochistan: 37%

• 18 polio cases in 2024

Challenges:

• Geographic disparity in infrastructure and funding

• Insecurity in border/slum areas

• Administrative bottlenecks (e.g., NOCs)

• Cultural norms limiting female outreach workers

• Lack of CSO autonomy and funding dependence

Opportunities:

• CSOs enjoy growing government trust

• 10% Gavi allocation can enhance CSO impact

• Urban slums offer untapped potential for outreach

• Microplanning improvements underway to reach underserved communities

3. Nepal – Social and Behaviour Change (SBC) Success

Humberto Jaime, Chief of SBC at UNICEF Nepal, described SBC’s role in reaching zero-dose children.

Key Successes:

• Community-led planning involving influencers and CSOs

• Improved communication between caregivers and health providers

• Capacity building for frontline workers

• Evidence-based advocacy, especially in Madhesh Province

• Rapid outbreak response during the 2023 measles surge

Outreach reached 1.5 million children using schools, community events, and megaphone campaigns.

Opportunities:

• Institutionalise SBC through health and social protection systems

• Promote multi-sector collaboration (e.g., education, nutrition, child protection)

• Scale up evidence collection for data-driven policy shifts

Conclusion: SBC efforts demonstrate how culturally rooted, community-driven approaches can significantly improve immunisation equity and sustainability.

Hamzah Zekrya, Lead for Public Partnership Engagement and CSO Liaison at Gavi, addressed participants, reiterating Gavi’s commitment to strengthening engagement with civil society in Asia, building on its foundational work in Africa.

He emphasized the need for tailored, country-specific support, acknowledging the diversity and complexity of challenges across the region. Hamzah noted that Gavi is moving beyond viewing CSOs as “partners” and instead positioning them as essential components of national health systems.

He underscored that sustainable health systems require treating CSOs, governments, and local organisations as interdependent and collaborative actors. Gavi believes that CSOs should not just be recipients of aid but should actively shape and inform health strategies at the community level.

Gavi is aligned with the Lusaka Agenda, which calls for a unified and less fragmented approach to global health initiatives. Hamzah affirmed that Gavi is working toward a cohesive framework for CSO engagement that complements other global health organisations, aiming for more impactful and aligned CSO support.

The Gavi CSO Secretariat conducted a session to gather CSO feedback on current immunisation partnerships, challenges, and network development opportunities across Asia.

1. Current Immunisation Programmes and Collaboration Opportunities

Nepal:

• Existing Networks: Nepalika Society works with the Ministry of Health and Population (MoHP), provincial health offices, UNICEF, Rotary, and the Nepal Red Cross.

• Improvements Needed: Deeper Ministry recognition, and better integration with WASH, nutrition, and maternal and child health (MCH) initiatives.

Indonesia:

• Existing Networks: Collaborative efforts with pediatric associations and parent groups; use of digital campaigns to raise awareness.

• Improvements Needed: Scale grassroots social mobilisation through family welfare programmes and trusted community-based mechanisms.

General Trends:

• CSOs are integrating immunisation with broader health programmes.

• Governments are increasingly open to multi-sectoral approaches involving WASH, nutrition, and reproductive health.

• There is growing recognition of the value of CSO-led advocacy and communication integrated into vertical health programmes.

2. Key Challenges in Reaching Communities and Solutions for EPI

Transportation and Infrastructure:

• Challenge: Poor infrastructure limits access to remote areas and delays vaccine delivery.

• Proposed Solutions: Invest in local transport networks; establish mobile clinics or decentralised vaccination hubs through CSO partnerships.

Urban Slums:

• Challenge: Populations in slums are often transient and underserved.

• Proposed Solutions: Engage Red Cross and CBO volunteers who are familiar with communities to support outreach and trust-building.

3. Existing Immunisation Networks and Areas for Strengthening

Pakistan:

• Network: Pakistan Civil Society Coalition for Health and Immunization (PCCHI)

• Needs:

  • Strengthen coordination and expand reach.

  • Address funding gaps that limit coverage and impact.

Recommendations:

• Gavi and international partners should consider dedicated funding streams for national and sub-national immunisation networks.

• With improved financial support, networks can better reach infants and women in underserved areas, addressing critical immunisation gaps.

1. Gavi CSO Constituency to organise the next regional convening by the end of November 2024.
2. Interested participants wishing to present or contribute to future convenings are encouraged to contact the Gavi CSO Constituency directly.

This regional convening marked an important milestone in bringing together CSOs across Asia to collaborate, share strategies, and amplify their impact in reaching zero-dose and under-immunised children. With the momentum of Gavi 6.0 and the global Immunisation Agenda 2030, CSOs have a critical role in shaping and delivering equitable, inclusive, and community-owned health outcomes across the region.