The policies and practices discussed in this volume cannot be implemented without the support of governments. Although ministries of health and finance implement the relevant policies, national parliaments also play a crucial role. Legislative power is typically held by a parliament or other representative body. Parliaments also have the power to direct the flow of public funding to public projects, which are then implemented by the executive branch. Parliaments or congresses can enact legislation that mandates the introduction of new vaccines, approve and amend the budgets for immunization programs, establish financing mechanisms for immunization services, and oversee the implementation of new immunization-related policies.
This brief explores how immunization advocates can engage effectively with parliaments to build support for sustainable immunization financing.
How Parliamentary Functions Affect Immunization Financing
Parliaments have four main functions, each relevant to sustainable immunization financing:
Lawmaking/legislating. Members of parliament introduce bills, propose amendments, and vote on legislation that affects all government functions. Immunization legislation is an example of this function. (See Brief 16.) Parliamentarians can also endorse resolutions and make declarations that express support for a particular issue; these can be important milestones toward future legislation. One example is the Kathmandu Declaration, endorsed by parliamentarians in Nepal in 2010. The declaration voiced a commitment to working for sustainable immunization financing in Nepal. Following the declaration, the government drafted an immunization bill, and in 2016 the parliament passed Immunization Act 2072, which the president of Nepal signed into law.
Budgeting. Parliaments approve the collection and allocation of national revenues by setting the country’s annual budget. The executive branch typically proposes the budget, but parliament must approve it. The budget for the ministry of health includes, in most countries, a line item for vaccines.
Oversight. The parliament oversees and monitors executive branch actions to ensure that public resources are used responsibly and consistently with legislative directives. In practice, it does this primarily through the annual budget process, which provides a regular check on the executive’s power and involves review by multiple committees and members of parliament. Parliamentary committees can also hold hearings and call expert witnesses to provide testimony on the operations of government and matters of national policy. This can provide immunization advocates with an opportunity to press for sustainable immunization financing. The relationship between parliament and the executive branch can vary—some parliaments have significant capacity to check the powers of the executive, while others have less authority to direct and oversee executive action.
- Representation. Members of parliament serve as representatives of the people and, more specifically, of the constituents in their legislative districts. They can amplify the voices of constituents by advocating for their interests in the chambers of parliament and in parliamentary committees. Advocates for immunization can therefore influence parliament by mobilizing local constituencies.
Strategic Entry Points for Working with Parliaments
Although parliamentary structures vary (for example, in the number of chambers and the makeup of committees), a number of discrete actors within the parliamentary process are most influential in determining immunization financing agendas. They include:
Parliamentary leaders. The leaders of the majority and opposition parties and other senior members of parliament tend to set the legislative agenda, assign bills to particular committees, and rally support for legislative initiatives.
Committees. Much of the work of parliament is conducted through standing (permanent) or ad hoc committees, whose members and leaders reflect the parliament’s political configuration and generally set a committee’s agenda. Support staff, including staff attached to members, committees, and nonpartisan secretariats, can play an important role behind the scenes and therefore merit engagement by advocates. In terms of immunization financing, committees can review legislation related to public immunization services, ensure consistency with existing national and international legal frameworks, and evaluate the government’s performance in implementing new laws.
Specific committees. Standing committees on finance and appropriations are a key target for issue advocates because they review all requests for government spending. Without the approval of these committees, a spending bill is unlikely to be adopted by parliament as a whole. Health committees, which consider immunization programs and budgets, are another obvious target of advocacy efforts. These might be organized as separate committees or subsumed under committees on social affairs or social welfare or grouped with women, youth, sports, or labor. These broad committees generally have subcommittees dedicated to health issues.
Secretariat staff. Secretariat staff ensure that members of parliament have the information they need to make informed legislative decisions. They help arrange committee meetings and hearings and can be important sources of institutional memory. Advocates can ensure that secretariat staff are copied on all communications to committees and members of parliament. They can also maintain contacts with parliamentary library, research, and documentation staff to ensure access to relevant documents and information related to immunization programs and financing.
Influential members of parliament. Particularly well-regarded, charismatic, or effective members of parliament can be influential without holding positions of seniority within the formal parliamentary structure. They often become champions for particular issues and collaborate with advocates to further their agenda.
- New members of parliament. With each election cycle, new members of parliament look for areas of legislative focus where they can have a lasting influence. If engaged early on issues of immunization and immunization financing, they can become active champions.
International unions of parliaments can be influential in shaping and determining regional agendas and policies. In 2009, for instance, the Latin American Parliament, a consultative assembly, generated a Model Vaccine Law, drawing on the experience of countries within the Pan American Health Organization (PAHO). The law provides a framework for PAHO region countries to ensure adequate and effective access to, and financing and operation of, national immunization services.
Key Messages to Parliaments on Immunization Financing
Parliamentarians need timely, accurate, and targeted information in order to make informed legislative decisions. The key points presented in the briefs in this volume offer a succinct summary of the major issues, challenges, and opportunities related to immunization financing. Among the most important of these for parliamentarians to understand and act on are the following:
Vaccines are among the most powerful and effective public health interventions ever developed.
Immunization is good value, and one of the best uses governments can make of limited public resources for health. For every $1 invested in immunization, countries can realize $16 in returns for the broader economy.
Governments must plan carefully to ensure adequate and sustainable financing for immunization programs. Failure to invest in immunization—or unstable immunization financing—increases the risk of disease outbreaks and endangers public health.
- Strong immunization program performance depends not only on funding for vaccine purchases but also on adequate financing of primarily local-level health workers and facilities, who deliver routine immunization as part of a broader program of health services.
Key questions parliamentarians may have about the country’s immunization services include:
How is my country’s immunization program performing? (What are the coverage rates for vaccines in the national schedule, how equitable is coverage, and how do they compare to targets? What vaccines are in the national schedule compared to WHO’s recommended schedule?)
What does the future of the immunization program look like? (Will coverage change over time? Are new vaccines likely to be introduced?)
Is the immunization program adequately funded? (Are vaccine budgets adequate? Are investments in the cold chain suitable?)
- As financing is only one part of the picture, what other bottlenecks are impeding program performance and how might they be addressed?
Efforts to Engage Parliamentarians on Immunization Financing
Many organizations—including UNICEF, the World Bank, and the World Health Organization—have actively engaged with parliamentarians on issues of health and human development. The Sabin Vaccine Institute has been a leader in this effort through its Sustainable Immunization Financing (SIF) Program. The program has worked in 22 countries—12 in Africa, six in Asia, and four in Eastern Europe—to provide technical and legislative guidance on promoting and protecting immunization financing.
The SIF Program convenes national and subnational briefings for policymakers, parliamentarians, and other government officials and facilitates peer-to-peer exchanges, workshops, and meetings on best practices and progress in achieving sustainable immunization financing. As of mid-2016, the program had contributed to the launch of legislative initiatives in several SIF countries, all of which are transitioning or close to transitioning from Gavi support. In 2014, Nigeria became the first SIF country to pass new immunization financing legislation, thanks in large part to the efforts of parliamentarians in the health committees of the senate and house of representatives.
Sources and Further Reading
Advocacy for Immunisation [Internet]. PATH, IVAC, and Gavi resources to assist in advocacy for immunization. Available from: http://advocacy.vaccineswork.org/
Committee for the Future of Vaccination in Latin America (COFVAL). Framework act on vaccination for Latin America. 2009. Archived at: https://perma.cc/C2NR-YBMW
Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker DG. Return on investment from childhood immunization in low- and middle-income countries, 2011–20. Health Affairs. 2016 Feb 1;35(2):199-207.
UNICEF. Guide to working with parliaments. New York: UNICEF; 2009. Archived at: https://perma.cc/6KUR-B6PE
World Health Organization. Immunization advocacy library. WHO Regional Office for Europe. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/immunization-advocacy-library