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Geneva, 13 April 2023

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Gavi, the Vaccine Alliance (Gavi) has launched the Zero-Dose Learning Hub (ZDLH), a new mechanism to improve how data and evidence are leveraged to successfully identify and reach the millions of children who have not yet received a single routine vaccine shot – “zero-dose” children – and the missed communities in which they live. The goal of the ZDLH collaboration is to supplement existing and ongoing monitoring efforts by building deeper understanding and sharing learning on the complex array of factors that impact efforts to reach zero-dose children, particularly in lower-income Gavi implementing countries.

Funded and coordinated by Gavi, ZDLH is composed of Country Learning Hubs in Bangladesh, Mali, Nigeria and Uganda, as well as a global hub led by JSI Research and Training Institute, Inc. (JSI), with support from the Indian Institute of Health Management Research (IIHMR) and The Geneva Learning Foundation (TGLF). The global hub will provide technical and operational support to countries; and disseminate learning across immunisation stakeholders at the community, national, regional and global levels.

“Zero-dose children face significant and complex systemic barriers that impact their ability to access basic services, including immunisation,” said Thabani Maphosa, Managing Director of Country Programmes Delivery at Gavi. “Since the inception of our Alliance, Gavi has taken a data-driven approach to address immunisation challenges. This new investment will help inform and improve immunisation programmes to reach the most vulnerable children in urban slums, rural and hard-to-reach areas, and fragile and conflict settings – using tailored approaches and addressing gender-related barriers. Today’s new partnership is another important step in our mission to ensure no child misses out on life-saving vaccines, no matter where they live.”

While incredible progress has been made in immunisation coverage, particularly in lower-income countries in the last few decades, it is clear that a percentage of children consistently miss out, with the pandemic hampering progress. The number of zero-dose children in Gavi implementing countries reduced by 14% from 2015 to 2019. However, this number increased during the pandemic; and in 2021, there were 12.5 million zero-dose children in the 57 lower-income countries supported by Gavi.

As a result, during the 2021–2025 strategic period, Gavi and Alliance partners are focused on reaching zero-dose children and missed communities, aiming to leverage the power of innovation and new partnerships to reduce the number of zero-dose children in Gavi-eligible countries by 25% by 2025. Today’s ZLDH launch represents the latest initiative in this effort, alongside Gavi’s Zero-Dose Immunization Programme (ZIP), an innovative initiative that is providing two consortia of partners with up to US$ 100 million to identify and reach zero-dose children living in displaced communities and fragile and conflict settings.

“JSI is uniquely positioned to lead the ZDLH and address the complex socio-cultural, political, geographic and economic root causes of under-immunisation. Our team will draw on years of successful implementation of innovative and finely tailored approaches to immunisation equity,” said Kate Onyejekwe, Director of JSI’s International Division. “We have convened a dynamic roster of partners to implement the ZDLH’s charge.”

GENERATING KNOWLEDGE AT THE COUNTRY AND COMMUNITY LEVELS

A country-driven and community-driven approach to evidence generation will be vital. The Country Learning Hubs – led by in-country partners and supported by Gavi, JSI and IIHMR – will first engage with government and other key stakeholders to identify country learning priorities. Once priorities are aligned, the hubs will begin work on strengthening routine information systems, and implementing research studies – with regular reporting of progress and results shared across the Alliance at the country and global levels. A Learning Innovation Unit will leverage digital peer networks to help accelerate at scale how national and subnational immunisation staff share, learn and apply evidence-based practices within and across Country Learning Hub countries, and at the regional and global levels.

A populous country, Nigeria has one of the biggest zero-dose burdens globally, with more than 2.2 million children missing out on routine vaccines in 2021. However, there is increasing momentum and engagement at both the national and subnational levels to address this challenge. Bangladesh, Mali and Uganda made progress through 2020–2021, with the number of zero-dose children in all three countries declining, but obstacles remain: over 157,000 children were unprotected in Mali; nearly 50,000 in Uganda; and close to 30,000 children in Bangladesh.

The four Country Learning Hubs – in Bangladesh, Mali, Nigeria and Uganda – will be led by a variety of organisations with specific in-country knowledge: