Fewer doses, less waste: what three counties revealed about the 5-dose MR vaccine switch

Over three days in Kiambu, Vihiga and Homa Bay, a NIERA monitoring team followed the endline phase of Kenya’s Measles–Rubella vaccine-vial study—and watched wastage fall at every intervention facility they visited.

A three-day monitoring visit rarely makes headlines, but it is where evidence quietly earns its credibility. In late May 2026, the Network of Impact Evaluation Researchers in Africa (NIERA) sent a team across Kiambu, Vihiga and Homa Bay to see, first-hand, how a deceptively simple change was playing out in clinics: swapping the standard 10-dose Measles–Rubella (MR) vaccine vial for a smaller 5-dose presentation.

The visit was routine oversight during the study’s endline phase, but its questions were anything but routine. Does a smaller vial actually reduce the vaccine that gets thrown away? Do health workers find it easier to use? And is the endline data being collected cleanly enough to stand behind? The team visited both intervention facilities using the 5-dose vial and control facilities still on the 10-dose vial, spanning public, private and faith-based settings.

What the team set out to learn

1. Assess implementation fidelity of the 5-dose vial — utilization, wastage trends, challenges and best practices.
2. Monitor the progress and quality of endline data collection, verifying records and source documents.
3. Gather feedback from health workers on the acceptability and feasibility of the smaller vial.
4. Document lessons to inform future policy on adopting and scaling up 5-dose MR vials in Kenya.

Methods were purposive and practical: reviews of immunization and study records (including Ministry of Health (MOH) 710 registers and wastage-monitoring tools), observation of cold-chain equipment and service delivery, key-informant discussions with facility in-charges, Expanded Programme on Immunization (EPI) coordinators and Maternal and Child Health (MCH) nurses, and cross-checking of study records against primary source documents.

Reduction in vial wastage

1. Kiambu County

The visit begun in Kiambu on 25 May. It is the largest sample in the study — 246 facilities split evenly between arms — and contribute the most private facilities, 109 of them. Serving urban and peri-urban populations across twelve sub-counties, the county has reliable electricity, well-maintained cold chain and relatively adequate staffing.

At Curepark Medical Center, a private control facility still on the 10-dose vial, records showed wastage easing from 56% to 48% as the monthly target population climbed from 16 to 26 children. Staff credited better scheduling, community mobilization and tracking of eligible children — but noted the 10-dose vial still forces a hard choice when turnout is low: vaccinate promptly or hold back to avoid waste.

Dr. Edna Nyange’chi (Research Team Member) and Derick Oluoch (Program Officer, NIERA) verify facility records against enumerator submissions at AIC Kijabe Mission Hospital, Kiambu County.

At AIC Kijabe Mission Hospital, a faith-based intervention facility, wastage fell from 86% to 66%. Levels remained high, but the steady decline pointed to better utilization since the smaller vial arrived. Health workers said the 5-dose presentation gave them more flexibility during quiet periods, easing the pressure to gather several children before opening a vial — and cutting missed opportunities.

2. Vihiga County

On 26 May the team reached Vihiga, with 59 interventions and 10 control facilities in the study. Many of its Level II and III facilities serve small under-five populations — precisely the setting where a smaller vial should reduce waste most.

At Vihiga County Referral Hospital, the county’s highest-level facility, wastage fell sharply from 79% to 49% even as the monthly target population rose from 72 to 80 children. Because targets are set annually and held until coverage performance prompts revision, wastage declining against a growing target was a strong signal of improved utilization.

Nurses brief the NIERA monitoring team at Vihiga County Referral Hospital, Vihiga County.

At Esaaba Dispensary, a small lower-level facility serving 10–13 children a month, wastage dropped from 82% to 65%. The nurse in charge was an outspoken supporter of the 5-dose vial: with only a few children presenting on any given day, the smaller presentation eased the anxiety of opening a multi-dose vial and made timely vaccination the easy choice. Some of the earliest 5-dose batches were still in storage.

“Before the smaller vial, we would postpone vaccination or set aside specific days to avoid wasting a 10-dose vial. Now children can be vaccinated the moment they arrive.”

— EPI Coordinator, Kabondo Kasipul Sub-County Hospital

3. Homa Bay County

The final day, 27 May, offered a useful contrast between a large referral hospital and a busy sub-county facility. Homa Bay County Teaching and Referral Hospital, a control facility on the 10-dose vial, draws patients from Kisii, Nyamira and parts of Migori; its MCH unit was busy all day. With a monthly target of 124 children, average wastage sat around 20% already low thanks to high volumes — and there had been no significant MR stock-outs in two years. The Chief Nursing Officer welcomed the study and expected wastage could fall further still under the 5-dose presentation.

The NIERA monitoring team at Homa Bay County Teaching and Referral Hospital. From left: Derick Oluoch, Jennifer Nyakinya (Director of Programs), Caren Oyugi, Elizabeth Okoth and Edwin.

At Kabondo Kasipul Sub-County Hospital, a Level IV intervention facility on the Homa Bay–Kisumu highway, wastage fell from 54% to 43%. The EPI Coordinator strongly endorsed the 5-dose vial for low-volume settings, noting that the old habit of postponing sessions to avoid waste had largely disappeared. At this center, the team noted the heavy workloads against under staffing where one employee would at times cover both immunization and records for the whole MCH unit. The group appreciated the need for stronger human-resource capacity and that routine data-quality checks matter most at lower-level facilities.

Key takeaway

The monitoring visit found the 5-dose MR vaccine vial intervention progressing well. Intervention facilities consistently reported positive experiences and declining wastage — with the biggest gains in low-volume settings, where staff had previously delayed sessions to avoid opening a 10-dose vial. The result was more flexibility in service delivery and fewer missed opportunities to vaccinate. These findings support the operational feasibility and acceptability of the 5-dose MR vaccine vial — and underline why the final endline analysis will matter so much for decisions on a potential national scale-up.

Written by Programs Officer, NIERA