Transitioning to a 5-dose Measles and Measles-Rubella vaccine presentation for routine immunization

Healthcare workers (HCWs) can be hesitant to open Measles (M) and Measles-Rubella (MR) 10-dose vaccine vials due to fear of wastage or stockouts. This hesitancy results in missed opportunities to vaccinate children.​ Switching to a 5-dose M/MR vaccine vial for routine immunization (RI) can minimize HCW hesitancy to open a vial; more children are reached through smaller, more frequent sessions, leading to an increase in vaccination coverage.​

Why transition to M/MR 5-dose vials?

Switching to 5-dose vials offers a practical solution to address missed opportunities for measles vaccination during routine immunization. Using a smaller dose vial can improve M/MR coverage, reduce wastage, and lower vaccine procurement costs. Research by JSI and the Zambian health ministry showed that 5-dose vials increased MCV1 vaccination coverage by 4.9% and reduced wastage by 47%. The impact on cold chain storage was minimal and the cost difference was marginal; some facilities  had lower procurement costs due to reduced wastage.

The African and Southeast Asian RITAGs have both endorsed switching to MCV 5-dose vials for routine immunization, recommending that countries shift away from ordering 10-dose vials based on the above evidence .

Note that the M/MR vaccine is identical in 5-dose and 10-dose vials—the same formulation, reconstitution, storage and handling, delivery, waste management, and WHO prequalification (PQ) status. The only difference is the presentation.

When and how to transition?

Signs that this transition might be beneficial include low frequency of vaccination sessions and HCWs expressing hesitancy to open 10-dose MCV vials due to fears of wastage, , reluctance to vaccinate on unscheduled days, and directing parents to larger health facilities to avoid wastage.

Countries procuring vaccines through UNICEF can access 5-dose vials directly. Countries can submit a switch request form at any time of the year to Gavi’s Secretariat. Gavi may also offer a “switch grant” to help cover the one-time costs associated with transitioning such as additional cold storage capacity and health worker training.

Before planning a transition to 5-dose vials, consult with your Gavi Senior Country Manager (SCM) for guidance, and evaluate the impact on cold chain logistics, funding, and vaccine delivery via the assessment tool (see below).

MCV 5-dose resources (EN, FR)

Evidence and research

Switch guidance (EN, FR)

RITAG recommendations

Country experiences (EN, FR)