A new study by researchers at Makerere University School of Public Health has uncovered alarmingly high levels of vaccine wastage in Uganda's health facilities--posing serious risks to the efficiency and sustainability of the country's immunization programme.
The peer-reviewed research, published in Global Public Health, was conducted across health facilities in Mukono and Kalungu districts.
It examined the use of six key childhood vaccines: Bacillus Calmette-Guérin (BCG) for tuberculosis, Oral Polio Vaccine (OPV), Injectable Polio Vaccine (IPV), Pneumococcal Conjugate Vaccine (PCV), Measles-Rubella (MR), and the combined DPT-HepB-Hib vaccine.
Findings revealed that vaccine wastage rates in both rural and urban facilities far exceeded national and World Health Organization (WHO) recommended thresholds.
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BCG recorded the highest wastage at 70%, followed by MR at 58%, IPV at 31%, OPV at 28%, and PCV at 17%.
For context, the WHO recommends a maximum wastage of 50% for BCG, 25% for reconstituted measles vaccines, 10% for OPV, 15% for multi-dose vials, and just 5% for single- or two-dose vaccines like PCV.
"These levels are deeply concerning, especially in a low-resource setting where every dose counts," said Dr Simon Kasasa, a senior lecturer at the Department of Epidemiology and Biostatistics and lead author of the study.
The researchers collected data from 22 health facilities and conducted interviews with 57 health workers, in addition to key informant discussions, to explore the underlying causes of the wastage.
Contributing factors included the use of large multi-dose vials, poor community turnout during outreach programs, cold chain breakdowns, gaps in documentation, and inadequate staff training.
While Uganda's Ministry of Health reports strong national vaccine coverage--exceeding 80% for most vaccines and 90% for DPT, BCG, and PCV3--Dr Kasasa warned that high coverage alone is not enough.
"Without minimizing wastage, we risk losing valuable resources and compromising the impact of our immunization efforts," he said.
To address the problem, the researchers recommend several urgent interventions, including:
- Predictive planning tools to match vaccine supply with actual demand
- Use of reduced-volume vaccine vials to minimize leftovers
- Expansion of decentralized immunization delivery
- Refresher training for health workers on vaccine handling and recordkeeping
"Effective immunization is not just about access; it's also about accountability and efficiency," Dr. Kasasa emphasized.
Uganda's national immunization schedule starts at birth with BCG and OPV, followed by OPV, IPV, Rotavirus, DTP-HepB-Hib, and PCV at 6, 10, and 14 weeks, and culminates with MR vaccines at 9 and 18 months.
Given the scope of the program, efficient vaccine management is crucial.
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As Uganda works to strengthen its healthcare systems and prevent avoidable childhood deaths, the study serves as a sobering call to action for policymakers, donors, and health sector leaders to address gaps in vaccine delivery and protect hard-won public health gains.
