The coronavirus disease 2019 (COVID-19) International Vaccine Implementation and Evaluation (CIVIE) program have been established by the US Centers for Disease Control and Prevention (CDC) to support countries’ health ministries and related organizations in planning, implementing, and evaluating COVID-19 vaccination programs.

Study: CDC’s COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Image Credit: Viacheslav Lopatin/Shutterstock
Study: CDC’s COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Image Credit: Viacheslav Lopatin/Shutterstock

A team of CDC scientists has recently published an article in the journal Emerging Infectious Diseases to discuss the role of the CDC in the management of COVID-19 vaccination programs. 


The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has burdened the global healthcare system. Several vaccines have been developed globally to break the chain of infection and control the pandemic. The World Health Organization (WHO) has issued an emergency use listing (EUL) and policy recommendations for these vaccines. A total of 10 COVID-19 vaccines have been included in the EUL.

COVID-19 Vaccines Global Access (COVAX) is a global initiative to accelerate the development of vaccines and ensure equitable global distribution of vaccines. A total of 145 countries are participating in COVAX, with the US government being the largest contributor. 

CIVIE program

The CIVIE program has been established by the US CDC to work with the countries’ ministries of health to support the planning, execution, and evaluation of COVID-19 vaccination programs. A total of 55 countries have been supported by CIVIE, which includes 27% of the global population.

CIVIE has set 7 priority areas, including vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation.  

Challenges in COVID-19 vaccine implementation

The global-level implementation of COVID-19 vaccines has faced many challenges. The major challenge was the intra- and inter-country delivery and distribution of vaccines.

During the initial phase of vaccination campaigns, there was a significant imbalance between vaccine production and supply and vaccine demand. In addition, there were other factor, including inequitable vaccine distribution, multidose vaccination regimen, lack of evidence for some vaccines, manpower shortage, exhausted healthcare system, inadequate vaccine safety monitoring process, and spread of misinformation, which collectively made the initial vaccine rollout challenging.

Achievements in COVID-19 vaccination program

Despite initial hurdles, the global COVID-19 vaccination program has provided an immense opportunity to manage the growth of the pandemic and restore the global healthcare and economic systems.

The support provided by CIVIE to the countries’ health ministries has offered many benefits, including partnership strengthening and new collaboration establishment. In addition, evidence collected from clinical trials and real-world setups has significantly helped improve immunization systems.

These improvements could provide long-term benefits, including developing a novel vaccination platform, strengthening national vaccination programs, establishing new strategies to counteract future public health emergencies, and introducing non-COVID vaccines that were put on hold during the pandemic.  

Experience gathered from previous vaccination programs

Many lessons were learned from the vaccination programs implemented during the large outbreak of Ebola virus in 2014 – 2016 in West Africa. These programs faced similar challenges as the COVID-19 vaccination programs, including lack of production and supply and inequitable distribution and access to the vaccines.

Since the Ebola outbreak mainly occurred in rural areas, identifying traditional healers and community healthcare workers has been difficult. This challenge highlighted the need for robust microplanning and the development of a healthcare worker registry to ensure effective immunization.

Ebola vaccination programs highlighted the importance of public communication in developing trust and willingness for vaccination. These experiences helped CIVIE develop effective strategies to improve the uptake of COVID-19 vaccines.  

For the expansion of seasonal influenza vaccination programs in low-to-middle income countries, CDC initiated the Partnership for Influenza Vaccine Introduction (PIVI) with the Task Force for Global Health (TFGH) and WHO in 2013. This combined initiative immensely helped develop invaluable skills, including policy development, microplanning, communication, and staff training, which in turn accelerated the distribution of COVID-19 vaccines.

Meningococcal serogroup A conjugate vaccine (MACV) was developed to prevent meningitis epidemics in Africa. The lessons learned from MACV programs include strategies to rapidly launch mass vaccination campaigns in low-resource setups, introducing public communication services, and developing sustainable vaccination programs.


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