Zero-Dose Learning Week Webinar - Presentations and Video Recordings

"This event sought to provide valuable insights to inform future immunisation efforts and enhance equity in global health."

As part of Gavi, the Vaccine Alliance's Zero-Dose Learning Week, which took place in September 2024, a full-day webinar was held to share emerging evidence on reaching zero-dose (ZD) children. Global learning consortia leads and selected experts presented key findings and recommendations to shape Gavi's strategy, policies, and programming for the years ahead. In particular, the webinar sought to better understand the emerging evidence on ZD children and to learn more about identifying and reaching ZD children and the key enablers and barriers across different settings and countries.

In preparation for the Zero-Dose Learning Week and in an effort to consolidate evidence, Gavi put out a call for abstracts on ZD programmatic evidence from emerging or completed learning activities (e.g., implementation research, case studies, assessments, etc.). About 200 abstract contributions were received from 140 different groups of authors from more than 100 different organisations. Expert reviewers scored and ranked the submitted abstracts, of which 181 were accepted. This webinar is an opportunity to share the findings outlined in the abstracts more widely. Findings from all abstracts were collated and synthesised for the event, and for more in-depth knowledge exchange, the authors of some of the top-rated abstracts were invited to present and discuss their work and lessons learned in a series of short (15-minute) presentations.

The webinar was intended for policymakers, partners, programme implementers and practitioners, researchers, students, and new professionals at all levels working to improve equity in the immunisation space.

The proceedings of the webinar are made available through video recordings and downloadable slide presentations. The following are the presentations with implications for social and behaviour change (SBC) (click on the title for the presentation slides accompanying each session):  

The Immunization Agenda 2030 Strategy to Reach Zero-Dose Children in Low-and Middle-Income Countries: A Living Scoping Review [PDF]
 

• Authors: Audrey Beaulieu, Joelle Ducharme, Celine Thibeault, Bangaman Christian Akani, Daniela Ziegler, Dan Hogan, Gustavo Caetano Correa, Heidi Reynolds, Mira Johri
• Organisations: Université de Montréal et du monde, Gavi, ERG
• Summary: This scoping review of peer-reviewed, quantitative studies on ZD children presents results from 82 articles on barriers to vaccination and deprivations faced by ZD children. No articles were found on interventions specific to ZD children. The findings underscore the need for evidence and for catalytic approaches to address multiple deprivations.

Synthesis of Findings and Recommendations from ZD Learning Week Call for Abstracts [PDF]
 

• Author: Sunitha Chandrasekhar
• Organisation: Sabin Vaccine Institute
• Summary: This presentation summarises the key findings from the 181 abstracts submitted as part the call for abstracts on evidence on ZD programming. It underscores the significant barriers to reaching ZD and under-immunised children in low- and middle-income countries (LMICs). Challenges such as delivery outside the health system, limited healthcare access, and health workforce gaps are highlighted. The synthesis also provides recommendations for integrating primary health care, addressing gender considerations, and leveraging the role of the community to improve vaccine equity and ensure broader immunisation coverage. 
   

Zero-Dose Learning Hub: Key Learnings and Recommendations [PDF]
 

• Authors: Heidi Reynolds, Erin Broekhuysen, Nancy Vollmer
• Organisations: Gavi, JSI
• Summary: The Zero-Dose Learning Hub (ZDLH) is composed of learning hubs in Bangladesh, Mali, Nigeria, and Uganda, and at the global level. Country learning hubs generate and use data to identify and address barriers to immunisation for ZD children, understand what interventions work to ensure timely immunisation and reach ZD children, and improve monitoring and measurement. This presentation offers a number of recommendations across the Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework underlying Gavi's work on ZD and contains links to additional resources.

Successes and Opportunities from the Nigeria Zero-Dose Learning Hub Project [PDF]
 

• Author: Yahaya Mohammed
• Organisations: African Field Epidemiology Network (AFENET); African Health Budget Network (AHBN)
• Summary: The Nigeria ZDLH aims to enhance immunisation equity by generating evidence and insights to guide policy and programme improvements. Funded by Gavi and implemented by AFENET and AHBN, the Learning Hub addresses barriers such as low vaccine confidence, gender inequality, and economic challenges. This presentation shares findings on regional variation in barriers to immunisation, the decentralised immunisation monitoring approach for timely monitoring and programmatic course correction, implementation research activities to assess the effectiveness and costs of the identify, enumerate, and vaccinate (IEV) strategy, capacity building, and advocacy and engagement.

Sustainable Solutions to Root Causes of Zero-Dose and Under-Immunized Children [PDF]
 

• Author: Grace Chee
• Organisation: JSI
• Summary: The MOMENTUM Routine Immunization Transformation and Equity (M-RITE) project seeks to sustainably address the root causes of ZD and under-immunised children through strategies that engage communities, strengthen health systems, and foster partnerships. By improving vaccine delivery, supply chain management, and community outreach, M-RITE supports immunisation programmes across multiple countries. Key efforts include enhancing data quality, addressing gender-related barriers, and mobilising private sector resources to expand vaccination access. This presentation also covers strategies for identifying, reaching, and monitoring ZD and under-immunised children in Mozambique, the Democratic Republic of Congo, and Nigeria.

Gates Foundation Zero-Dose Learning Agenda [PDF]
 

• Authors: Tove Ryman, Mike Brison
• Organisation: Bill & Melinda Gates Foundation (BMGF)
• Summary: The Zero-Dose Learning Agenda (ZDLA) is led by the BMGF and focuses on identifying subnational programmatic actions to reduce ZD children by 50% by 2030 in six high-burden countries. ZDLA diagnoses the root causes of ZD children, develops tailored interventions, and captures insights on effective strategies. BMGF also has an operational learning workstream in order to understand the challenges and solutions to facilitate funding levers and implementation of the package of ZD interventions funded by Gavi.

Missed Community or a Missed Opportunity? [PDF]
 

• Authors: Deep Thacker, Krishna Kumar Choudhary, Ravi Prakash, John Anthony
• Organisations: Indian Health Action Trust (IHAT), Uttar Pradesh Technical Support Unit (UP-TSU); University of Manitoba
• Summary: Significant gaps exist in reaching ZD children in high-burden countries such as India, Nigeria, and Ethiopia. A Rapid Assessment Survey (RAS) in 2021 in India revealed disparities in immunisation coverage, with many ZD children and their caregivers lacking access to vital services like antenatal care and vaccinations. A second study used data from Demographic and Health Surveys from eight high ZD burden countries. Results show that ZD children and their families often have contact with the health facility and recommend that better tracking of service delivery records across services, integration of services, and use of interoperable digital systems could improve continuity of care and reduce the ZD burden.

ZIP, Gavi's 5.0 Humanitarian Partnerships, Has Moved > 1 Million Children along the Path to Full Immunisation [PDF]
 

• Author: Amy Ratcliffe
• Organisation: Gavi
• Summary: The Zero-Dose Immunization Program (ZIP) is a Gavi initiative designed to reach children in humanitarian settings where government health services are inaccessible. Active in countries such as South Sudan, Ethiopia, and Chad, ZIP delivers life-saving vaccines to children in conflict zones, displaced populations, and nomadic communities. By working beyond government reach, ZIP ensures full immunisation coverage through agile programming, local partnerships, and neutral humanitarian access, addressing the unique challenges of children living in vulnerable and high-risk environments.

Routine Immunization Strengthening Programme (RISP): Learning Consortium [PDF]
 

• Author: Katie Stahley
• Organisation: BMGF
• Summary: The Routine Immunization Strengthening Program (RISP), supported by the BMGF, focuses on improving immunisation coverage and reducing ZD children in subnational geographies across ten countries with low Penta3 coverage and high risk of polio transmission. By partnering with governments and leveraging local partnerships, RISP aims to double diphtheria, tetanus toxoid, and pertussis (DTP3) coverage while strengthening health systems for long-term sustainability. The programme tailors its approach to each context, combining rigorous monitoring, integrated service delivery, and community engagement to ensure that vulnerable populations receive lifesaving vaccines.

Recent Findings from the Evaluation of Gavi's Contribution to Reaching Zero-Dose and Missed Communities [PDF]
 

• Authors: Jessica Baxendale, Louisiana Lush
• Organisation: Ipsos
• Summary: Ipsos presented emerging findings from an evaluation of Gavi's contribution to reach ZD and missed communities through its 5.0/5.1 strategy period (through 2025). The current phase of the evaluation has five focus priority topics, and the presentation focused on two areas: the integration of immunisation initiatives with primary health care (PHC) systems and the role of advocacy in driving political commitment to the ZD agenda. Methods are mixed (review of secondary data and documents and stakeholder interviews). Findings highlight both the successes and challenges with PHC integration and how it relates to health systems or ZD outcomes. There is no common definition of advocacy or its approaches, making it difficult to identify best practices in this area.

Accompanying documents: 
 

• Zero-Dose Learning Day Agenda & Overview - This recording provides an introduction to the proceeding, discussing the agenda and providing a brief overview of the presentations that will be featured during the full-day webinar.
• ZD Learning Day Agenda (11 September 2024) [PDF]
• ZD Learning Week List of Abstracts [Excel] - A list of the 181 abstracts that were accepted following the call for abstracts on ZD programmatic evidence.
• ZD Learning Week Abstract Posters [PDF] - From the call for abstracts, the authors of the 40 top-scoring abstracts with results were invited to submit posters, which are available for download.
• ZD Learning Day Q&A [PDF] - A list of questions and their answers submitted during the ZD Learning Day.