Decreasing zero-dose children threefold amidst pandemic and political unrest in Myanmar

Reducing zero-dose children

In 2021, Myanmar faced dual crises: the COVID-19 pandemic and political instability. These crises led to a sharp decline in primary health care services, including routine immunization for children, categorizing Myanmar among the top 20 countries with the highest number of zero-dose children.[1][2] Myanmar had as many as 1.2 million zero-dose (DTP1) and under-immunized (DTP3) children under the age of five, putting them at risk of childhood infectious diseases.[3][4] Despite the challenges, including being in a state of protracted emergency (Grade 2), Myanmar took key decisive actions to improve immunization. Employing data-driven strategies, the country rolled out a multi-modal vaccination drive across the country. By 2022, the Penta 3 vaccine coverage had surged from 37 percent to 71 percent nationwide, through the vaccination of an additional 170 000 children.[5] This achievement represented a remarkable threefold decline in the number of zero-dose children, significantly reducing the country’s vulnerability to outbreaks and childhood infectious diseases. This accomplishment aligns with WHO Myanmar’s Country Cooperation Strategy, Myanmar's Comprehensive Multi-Year Plan (cMYP) for 2017-2021, and the Immunization Agenda 2030 (IA2030) in line with South-East Asia Regional Vaccine Implementation Plan 2022–2026 aiming to leave no one behind.[6][7][8] The development of Myanmar's National Immunization Strategy for 2024-2028 is underway.

How did Myanmar, with the support of WHO, achieve this?

Recognizing the immediate need for action, the national Essential Programme on Immunization (EPI), with high quality technical assistance from WHO Myanmar, implemented a precise, risk-prioritized data triangulation strategy. This sophisticated approach enabled health authorities across the country to pinpoint vulnerable populations down to the township level, serving as a roadmap for customized immunization initiatives.

A diverse array of delivery mechanisms—fixed sites, outreach programs, mobile units, and focused immunization drives—were deployed to maximize reach to the communities. Rigorous documentation, both physical and digital, facilitated ongoing data validation and real-time updates to the District Health Information System 2 (DHIS2) dashboard by the national EPI programme.

WHO support was instrumental in training more than 10 000 basic health staff (BHS) in immunization in 2020, just before the pandemic. WHO supported the drafting of adverse event following immunization (AEFI) guidelines, training in immunization practices, microplanning training modules, and Standard Operating Procedures (SOPs), and provided necessary logistic and financial assistance for these trainings. The collaborative efforts of WHO’s technical support, United Nations Children’s Fund’s (UNICEF's) vaccine procurement, and Gavi, the Vaccine Alliance’s funding further strengthened the drive to bolster Penta 3 vaccine coverage for un/under immunized children.

Revised microplanning, based on risk prioritization, culminated in a multifaceted strategy that achieved striking success: more than 186,000 zero dose children were vaccinated with the Penta 1 vaccine nationwide in 2022 compared to 2021, boosting the coverage rate. These advancements were made despite the significant challenges of political unrest and a fragile health system. They serve as a testament to the achievements possible through focused, well-coordinated efforts, even under challenging circumstances.

Through the technical assistance of WHO and other United Nations partners like UNICEF, Myanmar not only reversed a critical public health decline but also established itself as a reference point for effective immunization strategies under difficult conditions. These gains meaningfully contribute to Sustainable Development Goal (SDG) target 3.4 and exemplify the resilience and dedication of Myanmar’s healthcare community, which continued to flourish under WHO’s steadfast support.

Efforts do not stop here. Plans are already underway to further extend vaccine coverage and enhance health data systems, aiming for sustainability and further improvements. The objective remains clear: to ensure equitable access to vaccination across Myanmar and to ensure that no child is left behind.

1. O’Brien, Immunization, Vaccines and Biologicals, World Health Organization. Global Immunization Update: Opportunities from Crisis. World Health Organization's South-East Asia Regional Immunization Technical Advisory Group (SEAR-ITAG) August 2022, New Delhi, India [presentation].
2. United Nations Children’s Fund. Regional Brief: Eastern and Southern Africa. The state of the world’s children 2023. For Every Child, Vaccination [report]. The State of the World’s Children 2023: ESARO Brief, accessed 26 February 2024.
3. EPI Evaluation annual review meeting, Myanmar 2023 [evaluation meeting].
4. World Health Organization. Immunization data (eJRF data). WHO Immunization Data (eJRF), accessed 26 February 2024.
5. Myanmar Ministry of Health and Sports, Department of Public Health. Expanded Program on Immunization. Multi Year Plan 2017-2021. Myanmar EPI Multi Year Plan 2017-2021, accessed 26 February 2024.
6. World Health Organization. Immunization Agenda 2030: A Global Strategy to Leave No One Behind [report]. Immunization Agenda 2030, accessed 26 February 2024.
7. Myanmar Ministry of Health. The Immunization Catch-Up Plan. Leaving No One Behind in Myanmar – in line with immunization agenda 2030 – reducing zero dose and under vaccinated children [report].