Project Overview

What will we learn?

The essential components of a vaccine delivery system are well-established, but performance varies from country to country and from community to community.^1,2

This project examines three countries that have increased their immunization coverage in the last fifteen years. It asks:

• Why did these countries prioritize improving vaccine coverage? What motivated the changes we see in policy and practice?
• How did each Exemplar country drive change in achieving and sustaining high vaccine coverage?
• What were the effective and sustainable solutions (interventions and long-term system changes)?

These case studies will build on existing knowledge, generating concrete recommendations for other countries seeking to improve immunization coverage in their own systems.

Where are we working?

Research is underway in Nepal, Senegal, and Zambia.

Partners from Gates Ventures, the Bill & Melinda Gates Foundation, and Emory University selected these countries in a two-step process. First, they used filtering criteria to identify low-income countries that increased immunization coverage since 2000. From these candidates, they selected three countries with diverse locations, cultures, and health system attributes for deeper examination, with a fourth country pending selection.

Learning how and why these countries have improved immunization coverage over time will help other countries similarly improve coverage and increase equity and scale. 

How are we conducting this research?

A multidisciplinary team of researchers is using mixed methods to learn why and how these countries improved immunization coverage.

After first identifying a framework of vaccine systems, the team reviewed literature and data to learn which interventions each country has implemented and how their performance has evolved over time. The team is now conducting interviews and focus group discussions at central, regional, district, and local levels to understand why and how these interventions were made, and to learn why they succeeded. They will corroborate interview findings through document review and quantitative analysis as much as possible.

In addition, the team is analyzing global data to identify success factors that set the Exemplar countries apart from their peers—such as health financing, health systems, or health-related behaviors—to explain how these factors might drive or help drive improvements in immunization coverage. They will explore how these relate to immunization and what it might imply about the drivers of these countries’ success.

Who is involved?

Research team

Emory University

• Dr. Matthew Freeman, Principal Investigator
• Dr. Robert Bednarczyk, Co-principal Investigator

Principal Investigators in Exemplar countries

• Dr. Sameer Dixit, Center for Molecular Dynamics, Nepal
• William Kilembe, MD, Rwanda Zambia HIV Research Group, Zambia
• Dr. Moussa Sarr, Institut de Recherche en Sante de Surveillance Epidémiologique et de Formation, Senegal

Additional investigators with expertise in public health, political science, public policy and business, and systems science and engineering are contributing to this research.

Research Advisory Group (RAG)

Experts from a diverse range of organizations guide our Exemplars research in the vaccine delivery topic area.

• Bill & Melinda Gates Foundation, Global Delivery Program
• Gavi, the Vaccine Alliance, Department of Monitoring and Evaluation
• John Snow, Inc., Immunization Center
• United States Centers for Disease Control and Prevention, Global Immunization Division
• World Health Organization, Department of Immunization, Vaccines, and Biologicals, and Nepal, Senegal, and Zambia country offices
• UNICEF, Senegal and Zambia country offices

What’s next?

Research is underway now and results will be shared here soon.

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