A Project Launch: Implementation Research to Reduce Immunization Dropouts at the 9-month Touchpoint in Ethiopia

Dr. Mariamawit Asfaw, Lead Executive Officer for Maternal, Child and Adolescence Health Services at Ethiopia’s Ministry of Health. 

Though childhood immunization coverage has risen across the country over the last decade, Ethiopia has seen inconsistencies across its vast populations with marked disparities in vaccine access in some communities. Further, reports indicate a high dropout rate between the Penta3 vaccine, given at early infancy, and the measles vaccine, administered at 9 months of age. Nationally, about 7.2 percent of the children who receive penta3 at 14 weeks of age do not receive measles vaccination at 9 months.

With funding from the Gates Foundation, JSI, in collaboration with Ethiopia’s Ministry of Health (MOH), launched an implementation research project with the aim to reduce immunization dropout at the 9-month touchpoint. The 18-month project, launched on April 4, 2025, is a collaborative endeavor between JSI and the University of Gondar’s Center of Digital Health and Implementation Science. This research will explore drivers of dropout that occur across vaccine types from the primary infant series through to the measles vaccination at 9 months, examining both and supply-related factors.

With the goal of identifying specific, relevant, and effective initiatives that drive change in vaccine access, the research will be conducted in districts with varying contexts, including agrarian, pastoralist, and conflict affected settings, with marked differences in sociocultural beliefs and health behaviors

Dr. Mariamawit Asfaw, Lead Executive Officer for Maternal, Child and Adolescence Health Services at MOH and an honorary guest at the launch, highlighted the significant dropout observed from Penta3 vaccination to measles. She pointed out that the findings and recommendations from the Dr. Mariamawit Asfaw, Lead Executive Officer for Maternal, Child and Adolescence Health Services at MOH implementation research will have consequential national implications, as the MOH plans to expand best practices.

Dr. Binyam Desta, JSI’s Ethiopia Country Director, further emphasized that the project will not only equip policymakers and partners with crucial evidence, enabling informed decisions, but also provide actionable and replicable implementation strategies. Liya Wondossen, a representative from the Gates Foundation, reaffirmed the Foundation’s strong support for the initiative, noting that this research will generate valuable insights to improve vaccine coverage.

Through this project, Ethiopia will identify approaches to address service experience, and supply-related barriers to increase immunization retention; test and evaluate possible interventions to reduce missed communities, dropouts, and improve measles vaccination rate at the 9-month touchpoint; and complement MOH activities to reach zero-dose and under-immunized communities.

Dr. Tewodros Alemayehu, JSI’s Immunization Project Director, who provided an overview of the project, explained “The project will develop and test effectiveness of co-created interventions to reduce immunization dropout and improve coverage.” Over the last three decades, JSI has supported Ethiopia in strengthening health systems, improving service delivery, optimizing supply chains, implementing digital health tools, and transforming health care access for millions. Due to its years of experience and successful partnership, JSI is widely regarded as a trusted and reliable collaborator in Ethiopia’s public health initiatives.