In early 2025, major reductions to U.S. government global health funding created an urgent need to understand the effects on immunization programs in countries heavily reliant on donor support. This rapid assessment, funded by GiveWell and conducted by Results for Development, documents the “on the ground” impacts of these funding cuts in three countries with high burdens of vaccine-preventable disease and diverse health system delivery approaches: Democratic Republic of Congo (DRC), Madagascar, and Nigeria. The assessment aimed to generate actionable insights to expand the evidence base and inform grantmaking strategies, ensuring investments remain impactful even as aid flows shift.
Drawing on key informant interviews (KIIs) and focus group discussions (FGDs) with more than 200 vaccinators, health facility managers, subnational and national stakeholders, the report details how immunization service delivery functioned before the funding cuts, the disruptions that followed, and the consequences for coverage, equity, and system performance. Major impacts include significant reductions in the immunization workforce due to the loss of stipends; dramatic shifts in service delivery modalities, moving away from outreach and mobile strategies toward fixed-post sessions; delays and increased costs for last-mile vaccine transport and distribution, resulting in more frequent stockouts and session cancellations; and, incomplete, compromised and/or delayed data for tracking coverage and planning. In the countries assessed, there is already evidence of declining coverage rates and loss progress in reaching zero-dose children.
Findings are presented both across countries and in country-specific sections, illustrated with direct quotes from anonymized participants. The report concludes with a discussion on the most actionable findings for governments, donors and implementing partners seeking to rapidly recover coverage and prevent further losses.
