The Americas

New challenges threaten even the highest health performers

The Challenge

Can the Americas modernize their approach to demand generation and maintain their immunization edge?

The Context

As a pioneer in the global polio eradication effort, and with the highest global immunization rates, the Americas have a proud history of universal public health. In many ways, the Americas are now challenged by their success. Some people don’t perceive the threat of diseases they can no longer see or remember from their youth. In countries with mass urbanisation and migration, social networks and norms that have historically created solid immunization habits, are now severed. And for caregivers who do make the choice to vaccinate their children, they may have to wait for hours, or worse, be turned away at clinics, because of low vaccine stocks and health worker shortages.






The Americas has historically been a global leader with its high vaccination rates.

Now, this progress is threatening to slide.

3 out of 25
children are left behind or under-vaccinated.

For every 25 children in the Region, two are completely left behind, and one has not received all the vaccines she needs.

The Quechuan language alone – spoken mainly in Peru and also in Bolivia, Ecuador, Colombia and Argentina – has 9 dialects – making generic vaccination messages challenging.

What We Heard

We listened to Ministry of Health staff from 8 countries tell us about their struggles to design behavioral solutions. Getting messages, health workers and vaccines to remote locations was the most frequently mentioned challenge. We heard that vaccination schedules are often confusing and inaccessible to parents, especially if they don’t perceive a threat of disease. Working parents struggle to find appointments outside of their working hours. Behaviour is not modelled in ways that are visible among people caregivers value.

Immunisation managers told us they need a better way to organise the long list of problems they face so they can see behavioral solutions more clearly.

Our Solution

We created a way for the region to organise its common challenges and see the most urgent solutions more clearly. Immunisation journeys vary across countries, so we crafted a framework that could help immunization managers classify problems and guide them towards a set of solutions.

Key pillars of the framework include solutions to: increase vaccine access to remote areas, explain vaccination benefits to caregivers in ways and through dialects they can understand, extend opening hours at health facilities, and viewing success through a lens that ensures the most vulnerable are receiving care.

See the tool ›

  1. Improving Vaccine Hesitancy in The Americas (WHO)
  2. Mumps cases in Bolivia
  3. PAHO-WHO/UNICEF 2019 joint reporting form (JRF) on immunisation (2018 data)


We can do great things together.