Zambia School Vaccination Screening & Catch-up (SVS) Pilot

Challenge

Many countries rely on supplemental immunization activities (SIAs) to fill gaps in routine immunization coverage, though these efforts are resource-intensive and often fail to reach children who missed routine doses. One alternative catch-up strategy is school vaccination checks, which involve checking vaccination status at at enrollment or during childcare, pre-school, early child education, or primary school to identify students who are missing vaccine doses. These checks can be implemented with or without mandates that require proof of vaccination at school entry, serving as an opportunity to identify students missing doses and facilitate catch-up vaccination. We sought to examine how school vaccination checks could be implemented in Zambia, where first-dose coverage for measles-containing vaccines (MCV) is high but second-dose coverage lags behind, and where most children (97%) attend primary school.

Approach

In partnership with Zambia's National Health Research & Training Institute (NHRTI), Ministry of Health (MoH), and Ministry of Education (MoE), we conducted a pilot program to test school-based vaccination screening and catch-up approaches in 25 public schools in Lusaka, Ndola, and Masaiti Districts (2021–2025). The pilot compared different models of delivery by varying screening timing (enrollment, middle of the year), target grades, who conducted screening (teachers, nurses), and where catch-up doses were delivered. Following a process evaluation, we nested a serosurvey within the pilot program in five schools in Ndola district to estimate measles seroprevalence and validate reported measles-rubella (MR) vaccination status.

Findings

Our evaluation found that the pilot program had a high turnout for screening and catch-up, providing an opportunity to identify a large proportion of children misses routine vaccination doses. Caregivers and implementers both perceived school vaccination screening as beneficial, and schools were seen as a convenient location for immunization catch-up. Further, task shifting of vaccination screening responsibilities to teachers was found to be feasible and reduces workload for nurses.

A modeling analysis to evaluate the role of school vaccination checks across Zambia on coverage and disease found that this approach could increase the proportion of children by 9% compared to routine immunization alone over a 20-year period, and by 2% compared to routine immunization plus SIAs. In areas with high routine measles-rubella vaccination coverage, supplementing routine immunization with school vaccination screening could prevent measles outbreaks, though SIAs remain critical in areas with lower routine coverage. 

Resources

• Policy Brief – Implementing School Vaccination Checks & Catch-up: Actionable Insights from a Pilot Study in Zambia
• School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia
• Assessing the Effectiveness of School-Based Vaccination Checks to Identify and Reach Un- and Under-Vaccinated Students in Zambia (preprint)