: The cross-country study aimed to estimate vaccine wastage rates in Ghana, Mozambique, and Pakistan using retrospective and prospective analysis; understand the context and identity key drivers of vaccine wastage; and provide recommendations to improve wastage monitoring and data use. Open-vial wastage was highest across all 3 countries for the MR vaccine. Researchers found that there is evidence of the tradeoffs between meeting coverage versus wastage goals; hence vaccinators sometimes deviate from the national guidance of opening a multi-dose vial when only one child is present.