“No One is Safe, Unless Everyone is Safe”—Reaching Zero-Dose Children with Reveal

By Anabelle Nuelle on April 28, 2021 in COVID-19, GIS, News

Maximal coverage defines the effectiveness of vaccination campaigns. Over one year after the start of the devastating COVID-19 pandemic, countries around the globe are vaccinating those ages 16 and older, while vaccine-producing companies are conducting vaccine trials for children. Positivity and hope infuse vaccine distribution efforts, but as these initiatives ensue, attention is being drawn to the challenges of vaccine distribution, namely, those left behind. 

Mass vaccination campaigns are critical to the introduction of new vaccines, to providing doses to those who may have missed routine doses, and to giving a second opportunity to those who may not have developed immunity. In each instance, with greater coverage comes stronger, more resilient communities. However, zero-dose children, or children who have not received any routine vaccinations, are often missed by these campaigns. With every child left unvaccinated, communities’ vulnerability to vaccine-preventable diseases escalates. Fortunately, in bracing for future vaccination efforts, we can look to previous initiatives to guide our efforts. In particular, the potential of geospatial data and technology to ensure all, including zero-dose children, are included. 

From June through to December 2020, Akros, in partnership with Johns Hopkins University, Macha Research Trust, and the Zambia Ministry of Health, utilized spatial intelligence and the Reveal platform to identify and vaccinate zero-dose children following a nationwide Zambian vaccination campaign for measles and rubella. 

To first identify zero-dose children, the team applied enumeration methods to satellite imagery, establishing structure counts for ten health facility catchment areas in Southern Province’s Choma District. Once structure counts were complete, community health workers were able to navigate to and register children at the household level by utilizing Reveal. Reveal is an open-source platform designed to support decision makers and intervention managers by guiding and precisely tracking delivery of in-field activities. Using smart maps and technology appropriate for low-resource settings, Reveal monitors intervention coverage in real time. 

Following the initial mass vaccination campaign, nurses and community health teams together visited the households of the identified zero-dose children. At each and every household, they verified whether or not each household’s children had been vaccinated during the initial campaign. Those who had not received a vaccine then received one from the nurses. 

By the conclusion of their efforts, these teams found and registered 13,497 children in total—791 of whom were zero-dose. Of these nearly 800 children, 64% were confirmed to have been vaccinated during the mass vaccination campaign, while 33% were initially missed. However, by the conclusion of the initiative, the majority of these missed, zero-dose children were successfully vaccinated. 

The efficacy of this campaign to identify and vaccinate zero-dose children holds immense promise for global COVID-19 vaccination efforts to come. As described by WHO, Gavi, CEPI, and UNICEF through their COVAX initiative, “with a fast-moving pandemic, no one is safe, unless everyone is safe”. At the time of writing, over 3 million people have died from COVID-19, and less than 3% of the world’s population is fully vaccinated. The health and outcome of our global community hinges on equitable access to COVID-19 vaccines. Every child, in every country, must be included. As the vaccination work of the Choma-based team demonstrates, geospatial data and technology like Reveal will help us get there.