Advancing life course immunization in Ethiopia: A policy imperative for universal health coverage and equity.

Vaccination is a cornerstone of public health and a critical enabler of universal health coverage, yet Ethiopia's immunization system remains largely oriented toward early childhood. Although childhood coverage for key antigens has improved substantially, recent evidence shows persistent zero-dose and under-immunization among children, uneven uptake of vaccines for adolescents, pregnant women, adults, and older adults, and missed opportunities even among populations living near health facilities. Life course immunization (LCI), defined by Immunization Agenda 2030 as vaccination across all ages and life stages through integrated health systems, offers a policy pathway to close these gaps. This policy brief argues that Ethiopia should institutionalize LCI as a routine primary health care function rather than relying on fragmented campaigns or childhood-focused platforms alone. The evidence points to interacting demand-side, supply-side, and health-system barriers, including limited awareness of vaccines beyond childhood, low perceived risk, concerns about side effects, gender-related decision-making constraints, weak adolescent and adult service platforms, and insufficient age-disaggregated monitoring. By embedding LCI into national immunization policy, Ethiopia can create repeated vaccination contact points, strengthen risk communication, improve accountability across age and risk groups, and reposition vaccination as a lifelong public good for equity and universal health coverage.