Abstract for: RESIST-Building a Resilient and Sustainable Immunization System in Tanzania; A Human-centered Approach with Systems Thinking

The immunization system in Tanzania, like many African countries, is facing barriers, including administrative and infrastructural challenges, socioeconomic disparities and vaccine hesitancy. The COVID-19 pandemic caused disruptions in the healthcare system, affecting the provision of essential health services, highlighting inadequate resilience against large scale disruptions. Intermittent outbreaks of vaccine-preventable diseases raise questions about sustainable access to immunization services. Stakeholder-based systems science methods help in anticipating immunization needs by considering all aspects and feedback, through capturing mental models. This study describes the complex feedbacks influencing vaccine demand and supply, using systems thinking to understand causal relationships and identify root causes of potential immunization problems. By examining intrinsic dynamics, the study highlights the importance of adequate investment on vaccine operations, public awareness programs, healthcare access, workforce development and healthcare capacity. Investment is largely reactive in nature and heavily relies on political willingness and external donation. In addition to investment, leadership and accountability appear essential in enhancing vaccine operations. Further research can be done to perform further analyses and identify policies with greatest leverage.