Bridging the Immunization Gap: Community-Driven Strategies for Enhanced Vaccine Coverage

The impacts of the COVID-19 pandemic have been broad and far-reaching, with the reverberations still being felt largely by routine immunization programs in low- and middle-income countries. According to the 2023 WHO/UNICEF Estimates of National Immunization Coverage (WUNEIC), the proportion of vaccinated children remains at 84%. Furthermore, the number of unvaccinated – or zero-dose – children has risen by approximately 600,000, since 2022, with “drop out” rates also increasing by kids aged 12 to 23 months who have not received the first dose of diphtheria-tetanus-pertussis containing vaccine (DTP-1). Understanding the diverse reasons behind the existence of ZDC is essential for developing effective strategies to ensure all children aged 12 to 23 months who have not received the first dose of diphtheria-tetanus-pertussis containing vaccine (DTP-1). Understanding the diverse reasons behind the existence of ZDC is essential for developing effective strategies to ensure all children are reached and can receive life-saving vaccines. Zero-dose children (ZDC) are defined as kids aged 12 to 23 months who have not received the first dose of diphtheria-tetanus-pertussis containing vaccine (DTP-1). Understanding the diverse reasons behind the existence of ZDC is essential for developing effective strategies to ensure all children are reached and can receive life-saving vaccines.

In response to this persistent concern, Sabin’s Vaccine Acceptance & Delivery (VAD) Initiative decided to team up with the United Nations Children’s Fund (UNICEF) to collaborate on a new initiative through Sabin’s Social and Behavioral Research Grants Program (SBRG) to generate evidence-based, context specific, and culturally appropriate strategies that aim to increase uptake of routine immunization among zero-dose children. The underlying reasons for zero dose children are complex and heavily influenced by the local context of communities, and even individual families, and requires local community-based approaches to both understand the reasons behind zero-dose children and co-design solutions to address it at a local level.

Since 2019, the SBRG program has supported 25 multidisciplinary, close-to-community teams across 15 countries to conduct locally driven research studies to investigate the social and behavioral factors influencing vaccine acceptance and demand. Teams are asked to co-design, pilot, and assess community-based interventions, with the goals of providing tailored evidence and strategies which enhance vaccination uptake by addressing specific contextual challenges in these communities. Evidence is then used to inform policy, programs, and practice with key multi-level decision-makers through numerous outlets including peer-reviewed publications, policy briefs, in-person policy dialogues, case study reports, a video narrative series, and conference presentations.

This fifth cohort of the SBRG program will focus on addressing the challenges faced by zero-dose children and their families through partnerships with researchers in countries that are within the top 10 countries with the highest proportion of zero dose children in the world: Cameroon, the Democratic Republic of Congo (DRC), Ethiopia, Indonesia, Nigeria, Pakistan, and the Philippines. These teams will conduct a 2-phased project focused on zero-dose children over 12 months. Phase 1 is a ‘diagnostic’ social listening and rapid community assessment exercise, while Phase 2 will use evidence gathered in Phase 1 to co-design, pilot, and assess a Social and Behavior Change Communication (SBCC) intervention using human-centered design.

In upcoming posts, we’ll be highlighting the 5th cohort teams in more depth, giving you an inside look at each of these projects, including their aims and objectives, location, and investigators. These studies aim to understand and address the local and multifaceted reasons behind low vaccination rates in these specific countries and with key high-risk communities, highlighting the urgent need to strengthen health systems and address inequities to achieve global immunization targets. Stay tuned to learn more about the innovative work and dynamic members of our latest cohort!