Integrating nutrition and immunization to strengthen primary health care

Immunization is a backbone of primary health care. Not only do vaccines protect children from infectious diseases like rotavirus, measles, and pneumonia, but immunization can also serve as an entry point to provide other health services, like nutrition.

Building strong primary health care systems that integrate immunization with nutrition and other health interventions has never been more critical. Nearly half of deaths among children under 5 years of age are linked to undernutrition, while one in five children lacks access to lifesaving vaccines. Infection and malnutrition also create a vicious cycle: diseases deplete nutrients and weaken immunity, while malnutrition impairs development and makes children more vulnerable to disease.

The International Rescue Committee (IRC) helps people affected by humanitarian crises to survive, recover, and rebuild their lives. The IRC supports essential primary health care services and systems in conflict- and crisis-affected settings, with the commitment to ensure that children in these areas survive and thrive. Nutrition and immunization (INI) integration is one of the IRC’s priority interventions and part of the holistic and child-centered service delivery model. IRC’s approach to INI, which combines vaccination with nutrition promotion, malnutrition detection, and treatment, shows the benefits of integration: reducing costs, reaching more children, and helping break the cycle of infection and malnutrition. 

Reaching underserved areas with mobile clinics

Immunization and nutrition services create multiple opportunities for integrated delivery that can save funds and time for the healthcare sector and caregivers, responding to caregiver preferences. IRC’s CMAM Avancé project, funded by GiveWell, delivers malnutrition treatment to children across five African countries: Somalia, Burkina Faso, Niger, Chad, and the DRC. In Somalia, IRC created a strategy to integrate immunization with malnutrition, leveraging mobile clinics to reach rural, underserved, and crisis-affected areas. In the program’s third year, the clinics administered more than 34,000 vaccine doses and treated more than 7,500 children for malnutrition.

By sending a single team to deliver both immunization and nutrition services, IRC’s approach maximizes the impact of mobile clinics—both by lowering the overall cost of delivery and by making the most of visits in hard-to-reach communities where children may not be up to date on vaccinations.  

Preventing disease and malnutrition in conflict-affected areas

Integrated service delivery significantly improves the quality and responsiveness of care, particularly vital in conflict and crisis settings where healthcare access is scarce. The Reaching Every Child in Humanitarian Settings (REACH) project, funded by Gavi, the Vaccine Alliance, combines humanitarian approaches with routine immunization to gain access in humanitarian and conflict-affected regions across the Horn of Africa. Since its inception in 2022, the project has delivered more than 14 million vaccine doses in conflict-affected settings in Chad, Ethiopia, Nigeria, Somalia, Sudan, and South Sudan.

REACH integrates immunization and nutrition at every opportunity. In Ethiopia, REACH teams combine vaccination with malnutrition outreach, reaching families through mobile outreach, community health days, routine facility visits, school events, places of worship, and market days. One hundred and twenty-seven sites—more than a third—also offer outpatient therapeutic programs and supplementary feeding alongside immunization. An integrated model enables REACH teams to have a greater impact and efficiency in settings where conflict and instability leave children vulnerable to overlapping health risks.

Integrating immunization and nutrition is cost-effective and impactful

Quality and sustainable primary health care is founded on ensuring that children have access to lifesaving vaccines and nutrition services. Combining these two interventions can both lower costs and maximize programs’ impact, especially for children in hard-to-reach or conflict-affected communities.

Globally, more than 80 million people lived in internal displacement in 2024, including 3.1 million in Somalia. As conflict, disasters, and climate change continue to disrupt routine immunization, integrated programs like REACH and CMAM Avancé can reach zero-dose children where they are while also providing essential malnutrition treatment.

Now more than ever, building strong primary health care systems depends on coordinated, efficient programs that can achieve more with less. Quality and holistic care that can flex and adapt to communities’ needs is often more impactful than siloed health services. Integrating immunization and nutrition is one way to close gaps in coverage and deliver smarter, more efficient care where it’s needed most.

Cover photo: A Zero Dose Vaccination Campaign in Biadoa, Somalia, August 2024. Credit: The International Rescue Committee.