A TSE analysis was conducted to articulate the public health value of measles (M) and measles-rubella (MR) 5-dose (5d) vials. This analysis attempts to quantify the programmatic, financial, and logistical trade-offs between 5-dose and 10-dose vials. The TSE analysis uses available data to incorporate assumptions on the impact of 5-dose vials on factors such as coverage, wastage, price, programmatic costs, cold chain requirements, and other qualitative considerations. Key Findings from the Total Systems Analysis include the following: - HCWs are more likely to open 5-dose vials, leading to increased coverage and more children vaccinated - Increased RI coverage may lead to reduced need for costly campaigns and improved demand predictability - Since 5-dose vials reduce wastage, countries can vaccinate more children with less TRS - 5-dose vials are associated with incremental non-vaccine costs such as cold chain, transport, outreach, HR, and wastage disposal compared to 10-dose vials - Incremental costs were mostly associated with HR costs in the Zambia study - Despite the higher cold chain per dose for 5-dose vials, the reduced TRS helps to offset the cold chain requirements - The Zambia study found that the difference in net cold chain per immunized child is marginal and 5-dose vials had minimal impact on the cold chain