Tag: Health

Strengthening National Immunization Programs in Asia: A Lifesaving Journey with Challenges Ahead

The Power of Vaccines

Picture this: A world where smallpox—a disease that once killed millions and scarred survivors for life—has been eradicated. Thanks to vaccines, this nightmare is now history. Polio, another dreaded illness that paralyzed countless children, is on the brink of extinction, with cases plummeting by over 99% since 1988[1]. Globally, vaccines have saved an astonishing 154 million lives in the last 50 years – saving 6 lives every minute[2]. Most of these are infants, given a chance to grow up healthy and strong. 

Yet, the battle is far from over. In Asia, home to 60% of the world’s population, millions of children still miss out on lifesaving vaccines. While some countries have made remarkable progress, others struggle with uneven access, slow vaccine rollouts, and preventable diseases claiming lives. 

Asian Development Bank (ADB) is helping developing member countries in closing the gaps and overcoming the hurdles – because every child deserves a shot at a healthy future. 

Immunization in Asia: A Tale of Three Groups

A recent study by Duke Kunshan University, supplemented with data from the People’s Republic of China (PRC), reveals stark differences in how Asian countries fund and run their immunization programs [3]. Here’s the breakdown: 

  1. GAVI[1]-Funded Countries (e.g. Cambodia, Myanmar, Pakistan):
  • Rely on global funding to provide and expand access to vaccines.
  • Tend to prioritize core vaccines, though some have introduced new vaccines with external support.
  1. Middle-Income Countries (MIC) with Partial Support (e.g. Indonesia, Vietnam):
  • Benefit from transitional financing but face gaps in newer vaccines.
  • Often lag behind in offering WHO-recommended options like HPV or rotavirus or PCV
  1. Self-Funded Countries (e.g. PRC, Singapore, Thailand):
  • Fund programs domestically, enabling broader coverage.
  • PRC, in particular, maintained 99% coverage for key childhood vaccines like measles, polio, and hepatitis B—even during COVID-19—while many other countries experienced declines.


The Missing Vaccines

Even in advanced programs, critical vaccines like pneumococcal (PCV), HPV, and rotavirus (RV) are often excluded. For instance, PRC’s program lacks four WHO-recommended vaccines—PCV, HPV, Hib, and RV—leaving gaps in protection.  See the table below for more information.



Money Matters: How Financing Shapes Immunization

The cost to fully vaccinate a child varies wildly from $18.50 per child in Sri Lanka to $77.63 in Thailand.

Although partially supported countries are wealthier and expected to spend more, some Gavi-funded countries surpass them per child due to stronger donor support. However, reliance on external funding isn’t sustainable. As countries grow richer, they must find ways to fund vaccines themselves—or risk backsliding. 

ADB’s Supports Vaccine Access and Resilience

The Asian Development Bank (ADB) has played a pivotal role in supporting developing countries across Asia and the Pacific to secure COVID‑19 vaccines through its Asia Pacific Vaccine Access Facility (APVAX). With nearly $ 9 billion in funding, APVAX enabled governments to procure vaccines and strengthen critical health systems, including cold-chain storage, logistics, delivery networks, and vaccine tracking mechanisms. Countries such as India, Sri Lanka, and the Maldives leveraged this support to enhance their national vaccination campaigns during the pandemic.

Building on this emergency response, the ADB launched REVITALIZ, a forward-looking initiative aimed at fostering long-term health resilience[4]. The program assists countries like Bangladesh in establishing domestic vaccine manufacturing facilities, training healthcare personnel, bolstering safety protocols, quality control, and data management systems. By addressing gaps in production capacity and regulatory frameworks, REVITALIZE seeks to ensure equitable access to safe, reliable vaccines and medical treatments, thereby fortifying regional preparedness for future health crises.

The Road Ahead: 4 Key Steps

  1. Speed Up New Vaccine Rollouts
  • Prioritize HPV and Hib vaccines in PRC—they’re cost-effective, with sufficient supply of domestic made products, and tackle high-burden diseases. 
  •    – Expand to PCV, Rotavirus vaccine, and Penta within 3-5 years. 
  1. Secure Sustainable Funding
  • Countries transitioning from donor support must ramp up domestic budgets. 
  • ADB can guide innovative financing models to keep immunization programs alive. 
  1. Close the Equity Gap
  • Invest in mobile clinics and outreach to reach remote communities. 
  • Tailor campaigns to overcome cultural and economic barriers. 
  1. Share Knowledge Across Borders
  • ADB hosting regional forums to spread best practices. 
  • Let high-performing countries (like PRC) mentor others. 

Final Thoughts: No One Left Behind

Vaccines are one of humanity’s greatest triumphs. But until every child in Asia—whether in a megacity or a mountain village—gets the same protection, our work isn’t done. With smart investments, regional teamwork, and unwavering commitment, universal immunization isn’t just a dream. It’s a goal within reach. 

Which vaccine gaps surprise you the most? How can we ensure no child is left unprotected? Share your thoughts below. 

References

  1. WHO Polio Fact Sheet https://www.who.int/health-topics/poliomyelitis#tab=tab_1 
  2. WHO Global Vaccine Market Report 2024  https://iris.who.int/bitstream/handle/10665/380367/B09198-eng.pdf
  3. World Health Organization. Regional Office for the Western Pacific & Asia Pacific Observatory on Health Systems and Policies. (‎2025)‎. Comparative analysis of the national immunization programmes in select ASEAN and SAARC countries: progress and challenges. 8 (‎1)‎, WHO Regional Office for the Western Pacific. https://iris.who.int/handle/10665/380387.
  4. ADB REVITALIZE Program https://www.adb.org/projects/58071-001/main

[1] GAVI, the Global Alliance for Vaccines and Immunization, is an international organization that provides financial support to help low-income countries obtain vaccines and improve immunization coverage.

Shenglan Tang
Shenglan Tang

Director of VaxLab; Co-Director of Global Health Research Center, Duke Kunshan University; Mary D.B. T. & James H. Distinguished Professor, Duke University

Xinyu Zhang
Xinyu Zhang

Associate Director for Research, VaxLab; Research Assistant Professor of Global Health Research Center, Duke Kunshan University

Zhangyang Pan
Zhangyang Pan

Associate Director for Communication and Advocacy, VaxLab, Duke Kunshan University

Najibullah Habib
Najibullah Habib

Senior Health Specialist, Human and Social Development Sector Office, Asian Development Bank

Pengfei Zhao

Staff Consultant, Human and Social Development Sector Office, Asian Development Bank

Ye Xiao
Ye Xiao

Staff Consultant, Human and Social Development Sector Office, Asian Development Bank

Digitalization for Improving Elder Care

Greater Mekong Subregion Health Cooperation Strategy 2024–2030

ADB Supports PRC to Strengthen National Health Insurance Funding

Meeting with NIPH

Realizing PRC’s Healthy China 2030 plan requires a strong health insurance system that ensures access to high quality and affordable healthcare. As such, PRC’s National Healthcare Security Administration (NHSA) was formed in 2018 to streamline the performance of several insurance schemes. ADB supported a multidisciplinary delegation from NHSA, health insurers and academia to visit Australia and Japan, to exchange knowledge with national and subnational governments, research institutions, hospitals and nursing homes and to explore different models of health funding with a view to instituting reforms that will drive efficient, low-cost health services that are also safe and meet the needs of patients and their families.

Meeting with Department of Health

Strengthening the Life-Science Industry in the PRC

Elderly Care System Development in Yichang, PRC

This video introduced ADB’s comprehensive support in elderly-case system development of Yichang City, PRC, with well-integrated technical assistance, loan projects and knowledge work.

Related event: Elderly Care System Development Forum

Regional Solutions for COVID-19 Response and Vaccine Delivery in Selected Developing Member Countries

Welcome

0:00 / 0:00

ADB health expert Najib Habib headed a project on Regional Solutions for COVID-19 Response and Vaccine Delivery in Selected Developing Member Countries. The research and first-person accounts are on the RKSI microsite. He introduces some public health insights in the following episodes and his discussions with ADB economist Marzia Mongiorgi-Lorenzo, who tells of her personal experiences in Beijing at the height of the pandemic.

Najib: Hello everybody, this is Najib Habib, health expert at the East Asia Department of the Asian Development Bank. Welcome to the RKSI Health podcast. We are here with Ms. Marzia Mongiorgi, a principal economist at the East Asia Department, Asian Development Bank in Manila. And we are here to talk about some experiences and lessons learned related to the COVID-19 pandemic in People’s Republic of China (the PRC), but also related to our other developing member countries. We consider that the COVID-19 pandemic was a great learning experience. Not only did COVID-19 provide very valuable experiences and lessons learned to healthcare workers, but also policy makers in all ADB developing member countries and beyond on very key issues such as managing a massive public health crisis, but also even major crises that could be related to, for example, climate change or disasters.

Now we try to highlight some lessons learned focusing on experiences of healthcare frontliners in [the PRC] and maybe how these can be applied to other countries in our region.

Ep 1. The Shock of the New: An Expat’s Life Is Upended by a Yet-Unknown Flu

0:00 / 0:00
Ep 1

When the world started shutting down in early 2020, Marzia had only a vague idea what she and her family were facing. Her life in Beijing was about to change drastically.

Marzia: The hotel told us to pack up our bags and go back to Beijing. Once we arrived in Beijing, we found a very different city from what we left a few days before. We realized quickly. There was something serious happening.

Najib: We are talking to Ms. Marzia Mongiorgi, principal economist at the Asian Development Bank, who lived in Beijing during the beginning of the outbreak of COVID-19 in [the PRC].

Marzia: So in January 2020, I was living in Beijing with my family. I have two children and we were getting ready for the Chinese New Year vacation. We usually go to Chongli to ski. Chongli is where the 2022 Winter Olympics were held and we were looking forward to it, to see a lot of people. We don’t speak Chinese. So we were a bit detached from what was happening and we have heard about this strange flu. We didn’t anything too seriously.

To our surprise, the hotel was empty. The slopes were empty and we stayed there for 4 days. Totally ignoring what was happening in the rest of [the PRC]. But at one point, we were on the slopes and we were trying to go up again on the chair lift, when we realized that the mountain was closing down. And at that point we realized that there was probably something serious happening and that the flu or this strange flu, this virus was getting worse. And the cases were increasing in other parts of [the PRC] and that also there was a case in Chongli. A girl, I remember. The hotel told us to pack up our bags and go back to Beijing.

Once we arrived in Beijing, we found a very different city from what we left a few days before. People checking entry of people into the building. I remember very clearly the deliveries, which are a big, big business in [the PRC] were not reaching the lobby nor the apartment door, but they were left at the gate of buildings. And that was something that in years we have never seen. So we realized quickly that there was something serious happening. The office informed us that the virus was spreading that there was not enough knowledge of the virus to warn us on what to do. From outside [the PRC], families were calling us. What’s happening? This is serious. You might need to leave. What if it spreads into all [the PRC] and you are stuck there? So we had a lot of pressure from the families outside [the PRC] to leave [the PRC].

But I think that was fear talking. We tried to live our normal life. There was online work and online school for the kids and we had to get used to things we did not have anymore.

We did have a lot of support from the community, people in the building and I remember they were helping us carrying the drinking water, the big bottles. They were very nice to help us, because not speaking Chinese, we needed extra attention and extra help.

Najib: How did you get a sense of the scale of the outbreak then in Beijing? Did you feel that the outbreak was kind of like other seasonal flus or other diseases like dengue? Or did you get the feeling that this was something bigger?

Marzia: The feeling that it was something different and bigger came very quickly from calls from outside [the PRC]. Family friends. The fact that a lot of flights were cancelled. We were looking into ways to leave [the PRC]. There was absolutely no understanding or no knowledge of what was happening. Flights were either cancelled or full, so we finally did manage to get the flight.

We flew to Hong Kong, [China]. To go to Manila because my husband is from the Philippines. And also the headquarters of the Asian Development Bank is in the Philippines. The flight from Beijing to Hong Kong, [China] was full. Once we landed in Hong Kong, [China], the Philippines had just closed their borders to non-Filipinos. I was not allowed to fly on to the Philippines. And so we had to go back to Beijing. We got stuck two days in in Hong Kong, [China]. There was complete chaos in the airport. We couldn’t get our luggage for a day and but finally we managed to go back to Beijing.

Najib: Thanks a lot, Marzia. This shows the unprecedented nature of a global pandemic.

Ep 2. Anxiety on the Frontlines: Health Workers and Others Face Fear and Uncertainty

0:00 / 0:00
Ep 2

Najib describes health workers’ psychological hardship and Marzia relates how she and her family coped during the pandemic.

Najib: Among the healthcare workers in [the PRC] what we found was one of the biggest challenges was psychological.

Healthcare workers were working almost 24 hours a day to deal with this unprecedented unknown flu, eventually called COVID-19. Healthcare workers were responsible for testing, treating, and tracking suspected cases, especially difficult when people are traveling either within the city, across the province, or even across borders. When people returned from areas that are considered higher risk, they were quarantined in a hotel for 14 days and then 7 days at home, they underwent repeated nucleic acid tests.

Healthcare workers monitored the returning people’s close contacts and those who have been deemed exposed to COVID-19, including possible COVID-19 contaminated food such as fruits and vegetables. The health centers in [the PRC] regularly collected samples from workers who delivered these food packages. Healthcare workers assisted the whole population in cities and provinces to deal with the mass testing. Healthcare workers worked closely with neighborhood communities, health professionals, collecting samples every day, and collected samples from those who are bedridden or sick with the disease, and also those who are quarantined. Healthcare workers were so busy they could not go for lunch, restaurants were closed and the township health centers and others had to give them instant noodles and self-heating rice just so they could take turns eating and also sleeping so the testing and vaccination of the large population shouldn’t stop.

Many of them would go home very late at night, have a few hours’ sleep and do the whole thing all over again. Sometimes it would be difficult to agree to the quarantine measures. For example, some gaps in procedures, incomplete information, or ability to correctly follow the protocols would give rise to confusion and complaints and anger in the early days of the pandemic. Sometimes coordination mechanisms and networks did not function adequately to many health workers. People who took responsibility for rolling out these essential public health measures sometimes felt wrongly blamed for a process that was unprecedented and sometimes, of course, confusing and overwhelming. How did you cope with this stress and anxiety when you were there with your family?

Marzia: We tried to have a normal routine. We had clear times for studying or working, for lunch together, for cooking. We also would set a time for some exercise together. We could still go down and go to the park. But again, the stress of not knowing how the spreading was and how you could get it. There was really complete ignorance at the time.

Najib: Transparent and consistent communication is the most important thing to do when preventing and responding to an infectious disease. Communication through trusted sources that are consistent and regular reduce anxiety and also assist the people in making correct decisions that reduce their risk.

Among the healthcare workers in [the PRC], what we found was one of the biggest challenges was psychological. Though health workers may have mastered the procedures and the skills of how to test, treat and track the disease, still, many health workers experience difficulties in communication, difficulties on how to collaborate effectively with large teams, and even psychological difficulties. Technical issues can be resolved and overcome with skills, effort, study, and practice, but anxiety is invisible. Anxiety is something that needs to be resolved and addressed almost on a personal basis, and we need to empower people to try to address this very, very important issue when dealing with large-scale pandemics such as COVID-19. Consistent and reliable communication was seen as one of the best ways to deal with this issue.

Sometimes healthcare workers felt that communities were not being helpful because they did not understand. And this method of communication, again, often with incomplete information, but to the best of expert knowledge helped a lot in trying to reduce risk of everybody.

Marzia: I completely agree that communication is critical, especially at the beginning of the pandemic, of which there is very little knowledge. And that probably was the good thing and the bad things for us. The good thing was that not understanding Chinese, I was not fully aware of what was happening. But when information came in and I understood the scale of what was happening, we didn’t really have a sense of what’s happening.

Najib: What did you do to take care of your mental health in the pandemic, and what did you do to maybe even as a mother and as a spouse?

Marzia: We were running around the apartment, we were jumping, we were using our Xbox for We Dance, being active and making it fun for the kids. There are a lot of testimonies around the world that this work from home and this living indoors and not being able to go to work and the kids to school was heavier on women, because when kids don’t feel well or they are scared or they need help with the homework, they tend to be to go to the mother.

Maybe I was in a meeting with management and I had my son asking me how to solve the problem of math and then I would have to tell him to wait. But we had clear roles for all four of us—who cooks, who does a bit of cleaning, who helps with the homework. We were working as a team.

Najib: It shows to me that in times of stress and even disaster, you really rely on your family and your community, not just for food, shelter, protection, but also for mental health resilience and just coping with the pandemic. I really admire you and what you did.

Marzia: It was not always easy. We really had to alternate being strong for our kids.

© 2025 Regional Knowledge Sharing Initiative. The views expressed on this website are those of the authors and presenters and do not necessarily reflect the views and policies of the Asian Development Bank (ADB), its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data in any documents and materials posted on this website and accepts no responsibility for any consequence of their use. By making any designation of or reference to a particular territory or geographic area, or by using the term “country” in any documents posted on this website, ADB does not intend to make any judgments as to the legal or other status of any territory or area.