The Zero-Dose Learning Agenda (ZDLA) was a 2-year learning initiative by the Gates Foundation to better understand how to accelerate progress toward the IA2030 goal of achieving a 50% reduction in ZD. Through ZDLA, partners applied learn-by-doing (LxD) techniques and practices in high-ZD settings.
This page provides a variety of resources for immunization decision-makers, implementers, and funders interested in exploring, integrating, and scaling evidence-based interventions that reach unvaccinated children using innovative LxD approaches.
- Overview Materials
- Learn-by-doing Approaches (LxD) and Lessons Learned
- Costing
- Drivers of Zero-Dose
- Gender
- Democratic Republic of the Congo (DRC)
- Ethiopia
- India
- Kenya
- Nigeria
- Pakistan
This two-year initiative (2023–2025) operated across select subnational areas in Democratic Republic of the Congo (DRC), Ethiopia, India, Kenya, Nigeria, and Pakistan where partners:
- Diagnosed drivers of ZD and understand their root causes;
- Worked collaboratively with end-users, including caregivers, community leaders, healthcare workers, and government officials, to co-design, implement, and iteratively adapt interventions;
- Reflected gender-related barriers and responsiveness; and,
- Captured costing information.
Overview materials
Resources that provide an overview of the ZDLA initiative and learnings.
Title Author Year Type Language Zero-Dose Learning Agenda: Overview Gates Foundation 2026 Datasheet English
Learn-by-doing Approaches (LxD) and Lessons Learned
Resources that explore LxD approaches, lessons, and learnings from ZDLA, including case studies, as well as practical ways to apply LxD techniques in new or existing work.
Title Author Year Type Language Investing in Learn-by-doing (LxD): Insights from the immunization Zero-Dose Learning Agenda 2023-2025 Gates Foundation 2026 Presentation English Learning-by-doing lite toolkit Datharm 2026 Presentation English Lean learning-by-doing approach (guide with toolkit) Clinton Health Access Initiative (CHAI) 2025 Presentation English
Costing
Resources on the financial and economic costs of ZDLA interventions and LxD processes, including cost-per-zero-dose-child estimates and implications for scaling.
Resources not available.
Drivers of Zero-Dose
Resources examining drivers and root causes of zero-dose status across ZDLA sites.
Resources not available.
Gender
Resources on gender-intentional design and implementation within ZDLA, including LxD approaches used.
Resources not available.
Democratic Republic of the Congo (DRC)
Country-specific resources from ZDLA implementation in Tshopo province, including lessons and learnings from high-ZD-prevalence rural and urban settings.
Title Author Year Type Language “We are learning, and we are changing”: Health workers in Kisangani embrace human-centered design Tara Newton, Olivier Lokangaka, PATH 2025 Report English Advancing safe and reliable vaccination in the DRC Osee Lleke, Tara Newton, PATH 2025 Report English
Ethiopia
Country-specific resources from ZDLA implementation in three different settings: an urban slum in Addis Ababa, pastoralist communities in Afar, and agrarian areas in Oromia.
Resources not available.
India
Country-specific resources from ZDLA implementation in Uttar Pradesh and Bihar states, covering frontline worker capacity building, product-based tools, and fathers' group approaches across rural and urban settings.
Title Author Year Type Language Zero Dose Children: Exploring the context & drivers of missed vaccination of children in Uttar Pradesh using a gender lens IHAT, Uttar Pradesh Technical Support Unit (UP TSU), University of Manitoba 2025 Report English Why children were missing out on routine vaccines, and how listening helped to close the gap Ram Ratan, Gavi, the Vaccine Alliance 2026 Journal article English
Kenya
Country-specific resources from ZDLA implementation in Homa Bay and Turkana counties, including lessons on community-based outreach and father's groups.
Title Author Year Type Language How simple outreach transformed immunization in Turkana Shamim Omar, Tara Newton, PATH 2025 Report English Human-centered design in action: Q&A with a community health leader in Kenya Tara Newton, PATH 2025 Report English
Nigeria
Country-specific resources from ZDLA implementation in Kano state, including driver findings, intervention learnings, and examples of LxD tools being integrated into routine EPI processes.
Resources not available.
Pakistan
Country-specific resources from ZDLA implementation in Karachi, covering interventions in urban high-ZD settings and lessons learned about working with non-traditional service delivery partners to improve connections to routine immunization.
Title Author Year Type Language When the 'Unrecognized' Became Essential: How Informal Health Practitioners Helped Vaccinate 58 Zero-Dose Children in Karachi Meerub Amir, Impetus 2026 Report English