Zambia Evaluation & Research of 0-Dose (ZER0-D): Strategies to More Effectively Target Measles Zero-Dose Children


Although progress has been made toward measles elimination in Zambia through increased routine coverage with two doses of measles and rubella vaccine and supplemental mass vaccination campaigns, measles outbreaks continue to occur. In 2019 and 2020, six measles outbreaks were reported. To achieve measles elimination, the general goal is to reach and sustain at least 95% coverage with two doses of measles-containing vaccine (MCV); however only 65% of Zambian children receive two MCV doses. Unvaccinated and undervaccinated children can be difficult to identify and reach. Targeted and tailored vaccination strategies are needed to reach children not captured through routine immunization activities and non-selective, nationwide immunization campaigns.


This project consists of two workstreams to improve our ability to reach measles zero-dose children and close immunity gaps more effectively.

The first workstream on decision-making aims to:

  1. Identify what factors need to be considered by policy makers and EPI program managers to select appropriate supplementary vaccination strategies and identify where to use those strategies
  2. Determine if and how sub-national modeled or triangulated indicators of the risk of measles outbreaks can be used to improve the decision-making process for selecting supplementary vaccination strategies
  3. Evaluate if decision-making processes change over time as vaccination coverage and the epidemiology of measles change

The second workstream on school entry vaccination aims to:

  1. Use dynamic modeling to estimate the potential effectiveness of school entry as a point of contact for identifying and filling vaccination gaps among children
  2. Implement a pilot school entry vaccination program in selected rural and urban districts to determine the feasibility of using school entry checks to identify unvaccinated and undervaccinated school children, households, and communities