Many governments understandably prioritise reducing vaccine wastage, in order to save limited resources. But a focus on prioritising vaccination coverage is essential to saving more lives from measles.
Measles vaccines are estimated to have averted around 57 million deaths globally between 2000 and 2022. However, there is still work to be done, with 136,000 lives being taken by the virus in 2022. One core component to broadening measles vaccination coverage is to bring about a fundamental mindset shift away from saving resources, towards saving lives.
Introduce five-dose vials
Across many countries, vaccinators prioritise wastage over coverage. They often do this as a result of wastage being a performance criterion for them.
Ordinarily, measles vaccine vials contain 10 doses, meaning vaccinators often refuse to vaccinate children, if only two or three children attend a vaccination session. With a vial able to vaccinate up to 10 children, vaccinators do not want to waste the other unused doses. This is a particular challenge with measles, as vials cannot be reused for more than a few hours after they are opened.
As an alternative, countries should introduce five-dose vials. This means that even when only a few children attend vaccination sessions, fewer doses will be wasted per vial. This enables vaccinators to feel more comfortable opening vials, without the worry of excessive wastage. Countries that have already switched to five-dose vials have seen significant wastage reductions. For example, Zambia has seen a 47% waste reduction, while Bangladesh has seen a 25% reduction in waste.
Increase measles vaccination days
In order to further reduce wastage, some health facilities often only host one or two measles vaccination days per week. This presents a problem for caregivers, as children may not be able attend facilities on these days. For example, some children may be unwell or caregivers might need to attend work on these days.
Adding to the limited number of vaccination days is the small number of hours that vaccination sessions often take place for. Half-day sessions or even 10am-2pm are common, which presents further challenges for caregivers and children, who may not be able to attend during these hours. However, 8pm closures are being trailed in various Pakistan districts, which is leading to improvements in vaccine coverage.
Reducing vials to five doses enables an increase in the number of vaccination days that health facilities can host, due to the reduction in wastage. Ultimately though, it is essential that mindsets shift from prioritising wastage to prioritising vaccination coverage. This is what will enable more lives to be saved from measles.
Improve screening
Improper screening procedures cause hundreds of thousands of children to miss out on vaccines in various low- and middle-income countries (LMICs). In some countries, almost half the caregivers who enter vaccine sites are not asked about their child's vaccination status. This means some children are receiving vaccinations when they do not need them, while others are missing out on vaccines when they have none.
To improve screening, standardised screening protocols should be implemented at health facilities during all visits. This ensures that vaccines are effectively deployed, while children receive the right number of vaccines.
Switching to five-dose vials, increasing the number of vaccination days, and improving vaccine screening, are all ways to raise vaccine coverage for children. While these actions can reduce wastage, a fundamental mindset shift from prioritising wastage to saving lives must also take place.
