HYBRID EVENT: You can participate in person at Baltimore, Maryland, USA or Virtually from your home or work.
Gashaw Andargie Biks, Speaker at Vaccines Conferences
Project HOPE, Ethiopia
Title : In-depth reasons for the high proportion of zero-dose children in underserved populations of Ethiopia: Results from a qualitative study


Background: Increasing attention is being given to reach children who fail to receive routine vaccinations, commonly designated as zero-dose children. A comprehensive understanding of the supply- and demand-side barriers is essential to inform zero-dose strategies in high-burden countries and achieve global immunization goals.

Objectives: This qualitative study aimed to identify the barriers for reaching zero-dose and under-immunized children and what and explore gender affects access to vaccination services for children in Ethiopia. Data was collected between March-June 2022 using key informant interviews and focus group discussions with participants in underserved settings.

Results: The high proportion of zero-dose children was correlated with inadequate information being provided by health workers, irregularities in service provision, suboptimal staff motivation, high staff turnover, closure and inaccessibility of health facilities, lack of functional health posts, service provision limited to selected days or hours, and gender norms viewing females as responsible for childcare. Demand-side barriers included religious beliefs, cultural norms, fear of vaccine side effects, and lack of awareness and sustained interventions.

Conclusion: Recommendations to increase vaccination coverage include strengthening health systems such as services integration, human resources capacity building, increasing incentives for health staff, integrating vaccination services, bolstering the EPI budget especially from the government side, and supporting reliable outreach and static immunization services. Additionally, immunization policy should be revised to include gender considerations including male engagement strategies to improve uptake of immunization services.

Key Words: supply and demand barrier, gender norms, key informant interview, focus group discussion

Audience Takeaway:

  • By understanding the various factors health policymakers and practitioners can use this knowledge to develop comprehensive information campaigns that tackle the misconceptions and fears surrounding vaccines while providing accurate, accessible, and culturally sensitive information to caregivers.
  • Understanding the diverse range of barriers contributing to the high proportion of zero-dose children is crucial for professionals in their job. By addressing these barriers comprehensively, professionals can ultimately contribute to reducing vaccine-preventable diseases and safeguarding the health and well-being of children.
  • The findings highlight the importance of addressing issues such as inadequate information provision, irregularities in service provision, staff motivation, accessibility challenges, gender norms, and demand-side barriers. By incorporating these key findings into their own research or teaching, faculty members can contribute to the collective efforts aimed at improving vaccination coverage and reducing the prevalence of zero-dose children.
  • the high proportion of zero-dose children is influenced by both the supply and demand sides of immunization. Addressing this complex issue requires a comprehensive and integrated approach that strengthens the health system, promotes gender equality, and fosters community engagement. By adopting these multifaceted strategies, we can work towards ensuring every child receives the life-saving benefits of vaccination, simplifying the task of designers and making the process more efficient.
  • By recognizing and understanding these barriers, interventions can be designed to improve the accuracy of design, providing new information to assist in designing effective interventions. A multidimensional approach that targets health worker training, service provision, staff motivation, gender norms, and demand-side barriers is crucial for achieving comprehensive immunization coverage and ensuring that every child has access to life-saving vaccines.


Professor Gashaw is a Public health specialist in the field of public health, his expertise in implementation sciences has made him an invaluable asset to project HOPE. Joining the project two years ago as the Senior Implementation Sciences Advisor for the Zero Dose Children Project, Professor Gashaw has been instrumental in driving the research activities of the project. One of his primary responsibilities is the development of project protocols. Professor Gashaw ensures that the protocols are robust and effective in achieving the project goals. He also oversees the field research activities, providing guidance and support to the team. His hands-on approach ensures that the research is carried out meticulously, yielding accurate and reliable results.

Apart from his involvement in the field, Professor Gashaw writing manuscripts that are published in international peer-reviewed journals. As a professor, he imparts his wisdom in public health courses such as research methods, neonatal and child health, and health systems, economics, leadership, and management. He has been teaching these subjects for over 25 years, shaping the future of public health professionals. Professor Gashaw's passion for education is evident through his dedication to teaching and advising PhD and master's students. His desire to empower the next generation of public health professionals has motivated him to write teaching modules and lecture notes in the field. With over 120 publications in national and international peer-reviewed journals, Professor Gashaw has established himself as a prominent figure in public health research.