Late Infancy Immunization Study
A multi-country study to explore the drivers of delay and dropout at the 9-month immunization touchpoint, centering caregivers and health care workers to improve immunization coverage.
Carlota’s Mission: Bringing Vaccines Closer to Every Child in Rural Mozambique
For years, the remote community of Nawitela-Namuli in Mozambique’s Zambézia Province faced a difficult choice: walk long distances with young children to the nearest health facility or risk missing routine vaccinations that protect against preventable diseases.
Carlota's Mission: Bringing Vaccines Closer to Every Child in Rural Mozambique
For years, the remote community of Nawitela-Namuli in Mozambique’s Zambézia Province faced a difficult choice: walk long distances with young children to the nearest health facility or risk missing routine vaccinations that protect against preventable diseases. Carlota, a community health worker serving Nawitela-Namuli in Gurué District, refused to accept...
What happens when a caregiver keeps returning and the vaccine is still not there?
This article was originally published on VaccinesWork In the Democratic Republic of the Congo, VillageReach analysed vaccination from end to end – from forecasting to vaccine administration – and learned that predictability and reliability are the keystone of trust. For some families in the...
What happens when a caregiver keeps returning and the vaccine is still not there?
In the Democratic Republic of the Congo, VillageReach analysed vaccination from end to end – from forecasting to vaccine administration – and learned that predictability and reliability are the keystone of trust.
Mothers and Fathers Together: Why Both Parents Matter for 9-Month Vaccination
In Malawi, many children miss the measles, polio and typhoid vaccines due at 9 months, but not because their families oppose vaccination. During the first months of life, immunization is reinforced through a steady rhythm of monthly visits to health facilities. But after the...
What Human-Centered Design Reveals About Nigeria’s 9-Month Vaccination Gap
On a warm morning in Unguwar Rimi, a densely populated neighborhood in Kaduna North, Fatima did what the health system asked of her. She wrapped her nine-month-old son, Abubakar, to her back and walked to the health center for his measles, yellow fever and...
“You Have to Keep Going Back”
Sameena is 25, a nurse and single mother, living with her own mother in a one-room home in Karachi East, Pakistan. Soon after giving birth to her daughter, Amina, just months after her divorce, she returned to work. Alone, she was managing long days,...
New Film “Protecting Every Child: Bridging the 9-Month Immunization Gap”
In the Democratic Republic of Congo (DRC), more than 2 million children miss essential vaccines at 9 months of age, leaving them vulnerable to measles, rubella and yellow fever. This gap at the late infancy touchpoint is part of a broader global challenge: measles,...
Malawi Sees Immunization Increase Thanks to Community Engagement, New Report Reveals
A new evaluation report has spotlighted the success of the Let’s Talk About Vaccines! project to improve under-two immunization coverage in Lilongwe and Mzimba North, Malawi. The three-year initiative, funded by Wellcome and implemented by VillageReach in partnership with the Malawi Ministry of Health...
Talking about Vaccines: How Communities in Mozambique are Boosting Child Immunization
In the quiet village of Mudine, Mozambique, Jolita, a 27-year-old mother of two, knows the challenges of raising healthy children all too well. When her 2½-year-old son, Alceu, needed his vaccinations, she struggled to keep track of his schedule without a health card. That...
New Technical Paper on Participatory Immunization Research Aims to Empower Communities
VillageReach and the Sabin Vaccine Institute have released a new technical paper to help organizations plan and prepare for participatory research and design within global immunization health initiatives. The paper highlights the value of participatory approaches and offers insights into the key principles and...
Community Collaboration and Co-Creation with Bate-Papo Vacina! - An Interview with Gaspar Come
A community comprises many parts—community leaders, community health workers, caregivers, and more. To truly address the needs and concerns of the hardest-to-reach people and communities, their voices must be heard. The Bate-Papo Vacina! Project (Let’s Talk About Vaccines) did just that, bringing radical collaboration...
Bate-Papo Vacina! Pilot Project in Mozambique Exceeds Targets and Shows Promise for Long-Term Sustainability
We are thrilled to announce the successful completion of the pilot phase of the Bate-Papo Vacina! (Let’s Talk About Vaccines!) Project in Zambezia Province, Mozambique. This five-year initiative, funded by Wellcome, focuses on understanding and addressing barriers to full vaccination coverage for children under...Background
Many children complete their infant series of vaccinations at 14 weeks of age and do not return for vaccines due at 9 months of age, leaving communities at risk of vaccine-preventable diseases, including measles. VillageReach, Impetus Advisory Group, Solina Centre for International Development and Research (SCIDaR) and Scope Impact conducted a mixed-methods participatory study to explore the drivers of dropout and delay at the 9-month touchpoint and identify potential solutions to improve coverage. This study was conducted in Democratic Republic of Congo, Malawi, Nigeria and Pakistan, where a total of more than 5 million children have never been immunized against measles.
Late Infancy Immunization in the DRC (Director: Carlo Lechea)
How It Works
Data was collected through interviews with 457 caregivers, heads of household, health care workers, community influencers and EPI officials, complemented by human-centered design workshops. We found that caregiver intent to vaccinate in early infancy gradually declines as system support weakens over time.
Key drivers of delayed or missed vaccination at 9 months:
- Reduced reminders after early infancy
- Lower perceived urgency as children age
- Accumulating practical and social barriers
- Service delivery challenges such as restrictive vial opening practices and stockouts
Communities co-created solutions, tailored to each context:
- Stronger, multi-channel reminder systems
- Better engagement of families (including broader household involvement)
- Clearer, more accessible information on 9-month vaccines and catch-up
- More reliable and accessible service delivery
Overall, findings indicate that improving 9-month coverage requires interventions that both restore follow-up and urgency in later infancy and ensure that when families present, children are vaccinated without delay.
Resources
Closing the 9-Month Immunization Gap: Cross-Country Findings
Stakeholder Perspectives on Shifting Measles Vaccination (MCV1) to 6 Months
Closing the 9-Month Immunization Gap: Nigeria
Closing the 9-Month Immunization Gap: Pakistan
Closing the 9-Month Immunization Gap: Malawi
Closing the 9-Month Immunization Gap: DRC
Gender Analysis – Late Infancy Immunization Study
Program Findings
We have completed the research project, with findings pointing to practical, community-designed solutions that can help close one of immunization’s most persistent gaps. Read the findings here.
Our Briefs
- Cross-Country Findings
- Nigeria barriers and solutions report
- Malawi barriers and solutions report
- The DRC barriers and solutions report
- Pakistan barriers and solutions report
- Moving Measles vaccine to 6 months policy brief
Research across four countries found that while most caregivers intend to fully vaccinate their children, fading reminders, declining urgency, mounting social and logistical barriers, and unreliable services steadily increase the risk of missed or delayed 9-month vaccines.
In Nigeria, community-driven solutions highlight the need for better reminders, stronger local engagement, clearer communication and more responsive health services.
Malawi communities emphasized that stronger outreach, improved information and broader family involvement are key to reducing later-stage vaccine dropout.
Solving 9-month immunization challenges in the DRC will require coordinated action to improve vaccine availability, reduce service barriers and rebuild caregiver confidence.
Pakistan families called for more flexible, reliable vaccination systems that reduce repeated burdens and make it easier to vaccinate children on time.
Could moving the first measles vaccine dose to 6 months help? The evidence suggests earlier scheduling may help some families, but stronger systems are still essential to ensuring children complete their full immunization journey.
Stakeholder Perspectives on Shifting Measles Vaccination (MCV1) to 6 Months
Partners
Government
- National Expanded Programme on Immunization (EPI) in DRC, and provincial EPI in Haut-Katanga and Kasai Oriental
- National EPI in Malawi and Chikwawa and Zomba District EPI
- National Primary Health Care Development Agency in Nigeria, and Kaduna and Enugu State Primary Health Care Boards
- Federal Directorate of Immunization, and EPI Sindh and Punjab
Technical Partners
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Impetus Advisory Group – Pakistan
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Solina Centre for International Development and Research (SCIDaR) – Nigeria
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Scope Impact – Global
Donors
- Gates Foundation
Related Global Impact
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