Reconstruction of immunisation during conflict: A mixed-methods cohort evaluation of programme delivery and outcomes in Myanmar

This preprint presents a mixed-methods observational cohort evaluation of a nurse-led, community-based immunization programme implemented in conflict-affected Karenni State, Myanmar. The study assessed delivery, outcomes, and costs of restoring routine childhood immunization among zero-dose and incompletely immunized children between November 2023 and December 2025, using programme records, mixed-effects regression, cost analysis, and qualitative review of implementation documents and nurse questionnaires. 

Key findings

• Among 13,263 enrolled children, 2,684 were zero-dose children in the analytic cohort. Of these, 17% were fully immunized at 12 months and 50% at 18 months after enrolment.
• Among children who were incompletely immunized at enrolment, 70% achieved full immunization at 12 months and 78% at 18 months.
• Greater vaccination opportunity and use of an accelerated vaccination schedule were strongly associated with earlier full immunization among zero-dose children.
• Retention was a major determinant of completion: children who did not return for vaccination within 12 months were highly unlikely to achieve full immunization by 18 months.
• The cost per fully immunized zero-dose child was US$147, largely driven by vaccine costs, while sensitivity analysis using UNICEF/Gavi-equivalent prices reduced the estimated cost substantially.

Thumbnail image credit: Gavi