Challenges to the Sustainability of Iran's National Immunization Program Achievements

Vaccination is recognized as one of the most effective public health interventions for promoting child health, preventing the deaths of an estimated ۴ million children under the age of five worldwide each year. Despite the notable achievements of Iran's national immunization program, several challenges continue to threaten its progress. The current payment system for healthcare workers has reduced their motivation for timely identification, follow-up, and case management. Economic sanctions, declining national income, and difficulties in international financial transactions have disrupted vaccine procurement, causing shortages of essential vaccines like DTP, combination, and pentavalent. These shortages have forced the country to request emergency support from WHO and UNICEF. Financial constraints have slowed the modernization of cold chain infrastructure. While organizations such as WHO, UNICEF, and UNHCR have provided support, further financial backing from the Ministry of Health is needed. The central vaccine storage facility lacks the capacity to meet current needs, and although construction of its third phase has started, additional funding is required to complete the project. Aging cold chain equipment across universities needs annual replacement and maintenance. Critical items include vaccine transport vehicles, refrigerators, digital thermometers, remote temperature monitoring systems, and other logistics tools. Even universities that have adopted remote monitoring systems require funding for their upkeep. The lack of financial resources for operational research has limited the ability of the National Immunization Technical Advisory Group (NITAG) to support evidence-based policymaking. Human resource shortages in its secretariat have further impacted its effectiveness. Training and capacity building efforts are ongoing, supported by WHO. Iran's location among countries with low vaccine coverage (Afghanistan, Pakistan, and Iraq), high cross-border movement, and a significant population of non-Iranian nationals increases the risk of importation and reintroducing diseases like polio, measles, and rubella. Additionally, rising anti-vaccination sentiments have led some families to refuse immunization. Misuse of religious beliefs and unscientific messages, often spread under the name of traditional medicine, have undermined public trust. Misinformation circulating in some religious centers has contributed to vaccine hesitancy among religious leaders and their followers. With reduced vaccination coverage, diseases that were once controlled may flare up again, potentially impacting other countries as well.