DOI: 10.11648/j.jher.20261202.12 ISSN: 2472-3592

Nursing Leadership in Vaccine Delivery in Low-resource Settings: Evidence from Nepal’s National Immunization Program

Parvati Bista, Nabin Joshi
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Background: Vaccination is one of the most cost-effective public health interventions, preventing an estimated three to five million deaths annually worldwide (WHO, 2023). Nepal has achieved substantial progress through its National Immunization Program (NIP), supported by international partners including GAVI, the Vaccine Alliance (which has provided over USD 150 million since 2002), UNICEF, and WHO. Despite this progress, ensuring equitable vaccine access across geographically diverse and resource-constrained settings remains a persistent challenge. Nurses constitute the primary frontline workforce responsible for vaccine delivery across health facilities, outreach clinics, and large-scale national campaigns, yet their leadership contributions remain underexplored in the academic literature. Objective: To examine the multi-dimensional leadership roles of nurses within Nepal's immunization system, identify structural strengths and workforce challenges, and propose evidence-based policy recommendations for strengthening nursing-led immunization programs in low-resource settings. Methods: A narrative review was conducted of peer-reviewed literature, national policy documents, and reports from WHO, UNICEF, GAVI, and Nepal's Ministry of Health and Population (MoHP) relating to Nepal's NIP. Five key domains were analyzed: vaccine administration, cold chain management, community engagement, immunization surveillance, and health workforce dynamics. Results: Nurses perform central roles across all five domains. More than 27,000 health workers--predominantly nurses and Auxiliary Nurse Midwives--were deployed during Nepal's 2025 HPV vaccination campaign targeting over 1.46 million adolescent girls, supported by over 51,000 Female Community Health Volunteers (FCHVs). Nepal achieved 82.48% first-dose COVID-19 coverage. However, persistent challenges include health workforce shortages, limited competency-based immunization training, geographic barriers, vaccine hesitancy, and continued dependence on external donor funding. Conclusion: Nurses are the backbone of Nepal's immunization system and are indispensable for sustaining vaccination coverage in resource-constrained settings. Strengthening nursing competencies, expanding workforce capacity in underserved areas, and enhancing policy recognition of nursing leadership are essential to achieving the goals of the Immunization Agenda 2030 and Universal Health Coverage.

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