*Commentary* **Addressing Determinants of Immunization Inequities Requires Objective Tools to Devise Local Solutions**

**Siddhartha Sankar Datta 1,\*, Federico Martinón-Torres 2, Nino Berdzuli 3, Niyazi Cakmak 1, Michael Edelstein 4, Simon Cottrell <sup>5</sup> and Mark Muscat <sup>1</sup>**


**Abstract:** Universal immunization substantially reduces morbidity and mortality from vaccinepreventable diseases. In recent years, routine immunization coverage has varied considerably among countries across the WHO European Region, and among different populations and districts within countries. It has even declined in some countries. Sub-optimal immunization coverage contributes to accumulations of susceptible individuals and can lead to outbreaks of vaccine-preventable diseases. The European Immunization Agenda 2030 (EIA2030) seeks to build better health in the WHO European Region by ensuring equity in immunization and supporting immunization stakeholders in devising local solutions to local challenges. The factors that influence routine immunization uptake are context specific and multifactorial; addressing immunization inequities will require overcoming or removing barriers to vaccination for underserved individuals or populations. Local level immunization stakeholders must first identify the underlying causes of inequities, and based on this information, tailor resources, or service provision to the local context, as per the organization and characteristics of the health care system in their countries. To do this, in addition to using the tools already available to broadly identify immunization inequities at the national and regional levels, they will need new pragmatic guidance and tools to address the identified local challenges. It is time to develop the necessary guidance and tools and support immunization stakeholders at all levels, especially those at the subnational or local health centre levels, to make the vision of EIA2030 a reality.

**Keywords:** immunization; inequities; local determinants; pragmatic; operational guidance; European Immunization Agenda 2030
