Dose Per Container: Understanding the Effects of Multidose Vaccine Presentations

Kelly McDonald

The widespread use of multi-dose vaccine containers in low- and middle-income countries’ immunization programs is assumed to offer benefits and efficiencies for health systems, such as reducing the purchase price per vaccine dose and easing cold chain requirements. Yet the broader impacts on immunization coverage, costs, and safety are not well understood. It is also unclear what processes governments typically go through to determine their choices about dose per container (DPC), and what information decision-makers have or use when determining DPC. To add to the limited evidence base on this topic, the JSI-led Dose Per Container Partnership (DPCP), funded by the Bill & Melinda Gates Foundation, with partners Clinton Health Access Initiative (CHAI), the HERMES modeling team and the International Vaccine Access Center (IVAC) through Johns Hopkins University, Bloomberg School of Public Health, and PATH, undertook a series of activities to explore current decision-making on DPC options and better understand the relationship between DPC and immunization systems, including operational costs, timely coverage, safety, product costs/wastage, and policy/correct use.

Watch our video, explore the resources below and share your thoughts with us on DPC. 

  • Case studies - A series of case studies on DPCP's implemented country-level research, decision making on DPC options, computer simulation modeling, and a review of tools on DPC.
  • Decision support resources - Resources that provide decision makers with evidence that can be generalized to help make effective DPC decisions based on country context. Country- and global-level stakeholders — such as Expanded Program on Immunization (EPI) managers, logisticians, Ministries of Health (MOHs), Ministries of Finance (MOFs), donors, procurement agencies, manufacturers, global partners, and other stakeholders — can use these resources to better understand the potential trade-offs of various DPC choices and to select the best vaccine presentations for their program. 


 Case studies

Ghana: Understanding Changes in Vaccine PresentationDose Per Container Partnership2018Case studyEnglish
Immunization Tools to Help the Dose Per Container DecisionDose Per Container Partnership2018Case studyEnglish
Information Gaps in Decision-Making on Vaccine Presentation in 3 Francophone CountriesDose Per Container Partnership2017Case studyEnglish
Introducing 5-dose Measles-Rubella Vaccine Vials in Zambia: Research FindingsDose Per Container Partnership2019Case studyEnglish
Measles Vaccination in Zambia: Balancing Coverage & WastageDose Per Container Partnership2018Case studyEnglish
Modeling to Support Decision-Making for 5-dose Measles-Rubella Routine Vaccination in ZambiaDose Per Container Partnership2018Case studyEnglish
Senegal: Weighing the Costs and Benefits of Changing DPCDose Per Container Partnership2018Case studyEnglish
The Effects of Dose Per Container Change in ZambiaDose Per Container Partnership2019Case studyEnglish
Vaccination in Zambia - Healthworker Experiences Using 5-dose MR VaccineDose Per Container Partnership2018Case studyEnglish
Vietnam: Effects of Changing Dose per Container on the Immunization SystemDose Per Container Partnership2018Case studyEnglish


Decision support resources