Missed Opportunities for Vaccination (MOV)

Laura Nic Lochlainn

A missed opportunity for vaccination (MOV) refers to any contact with health services by a child or adult who is eligible for vaccination, which does not result in the person receiving one or more of the vaccine doses for which he or she is eligible. When countries observe that their vaccination coverage is decreasing or stagnating, they seek alternative strategies to explore the reasons and design tailored strategies to address them. The MOV strategy, which includes the 1) Planning Guide to Reduce Missed Opportunities for Vaccination, 2) Methodology for the Assessment of Missed Opportunities for Vaccination and 3) Intervention guidebook for implementing and monitoring activities to reduce Missed Opportunities for Vaccination, was designed to help decision-makers and national or subnational programme managers reduce MOV. The MOV strategy aims to increase immunization coverage by simply making better use of existing vaccination sites and promoting synergy between different maternal and child health programmes. The MOV strategy answers three important questions:

  • How many opportunities were missed?
  • Why are these opportunities being missed?
  • What can be adjusted or done differently?

Once these questions have been addressed, the MOV strategy aims to link and translate the MOV findings into actionable solutions and interventions to reduce MOV, especially at the facility level where vaccination services are provided.

This page was created and is maintained by the WHO Expanded Programme on Immunization (EPI) and provides a list of resources related to MOV.

MOV publications

This collection contains technical and methodological publications on MOV

TitleAuthorYearTypeLanguage
A systematic literature review of missed opportunities for immunization in low- and middle-income countriesAnais Colombini, Bradford D. Gessner, Elise Guillermet, Nadira Maleq, Shruti Sridhar2014Journal articleEnglish
Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverageBertrand Meda, Colin Sanderson, Edouard Betsem, Ikechukwu Udo OGBUANU, Isaie Médah, Lassané Kaboré, Laura Nic Lochlainn, Mâ Ouattara, Stephanie Shendale, William M.F. Kaboré2020Journal articleEnglish
Assessment of missed opportunities for vaccination in Kenyan health facilities, 2016Anyie J. Li, Colin Sanderson, Collins TABU, Iheoma U. Onuekwusi, Ikechukwu Udo OGBUANU, Isaac K. Mugoya, Kibet Sergon, Peter O. Okoth, Stephanie Shendale, Zorodzai Machekanyanga2020Journal articleEnglish
Can vaccination coverage be improved by reducing missed opportunities for vaccination? Findings from assessments in Chad and Malawi using the new WHO methodologyAnyie J. Li, Blanche-philomene Melanga Anya, Colin Sanderson, Dah Cheikh, Geoffrey Chirwa, Ikechukwu Udo OGBUANU, Joseph Okeibunor, Kwame W. Chiwaya, Mbaihol Tamadji, Mohamed El-Hafiz Djalal, Richard Mihigo, Zorodzai Machekanyanga2019Journal articleEnglish
Increasing routine immunization coverage by reducing missed opportunities for vaccinationWorld Health Organization (WHO)2017GuidanceEnglish, French
Intervention guidebook for implementing and monitoring activities to reduce Missed Opportunities for VaccinationWorld Health Organization (WHO)2019GuidanceEnglish
Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019Akinola Ayoola Fatiregun, Elvis Isere, Fiona Braka, Francis Adegoke Akanbiemu, Itse Olaoye, Kofi Boateng, Lassané Kaboré, Laura Nic Lochlainn, Modupeola Dosumu, Richard Banda, Rosemary Onyibe, Yetunde Olagbuji2021Journal articleEnglish
Opportunities to improve vaccination coverage in a country with a fledgling health system: Findings from an assessment of missed opportunities for vaccination among health center attendees—Timor Leste, 2016Anyie J. Li, Colin Sanderson, Ikechukwu Udo OGBUANU, Laura Nic Lochlainn, Manuel Mausiry, Rosye Bela Joana Benevides Monizda Silva, Thelge Sudath Rohana Peiris2019Journal articleEnglish
Planning Guide to Reduce Missed Opportunities for VaccinationWorld Health Organization (WHO)2017GuidanceEnglish, French, Portuguese
Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilitiesAnyie J. Li, Collins TABU, Ephantus Maree, Iheoma U. Onuekwusi, Ikechukwu Udo OGBUANU, Isaac K. Mugoya, Kibet Sergon, Peter O. Okoth, Stephanie Shendale, Zorodzai Machekanyanga2020Journal articleEnglish
Reducing missed opportunities for vaccination in Mozambique: findings from a cross-sectional assessment conducted in 2017Bvudzai Priscilla Magadzire, Gabriel Joao, Graça Matsinhe, Ikechukwu Udo OGBUANU, Laura Nic Lochlainn, Ruth Bechtel2021Journal articleEnglish
Reducing missed opportunities for vaccination in selected provinces of Mozambique: A study protocolIkechukwu Udo OGBUANU, Stephanie Shendale, Gabriel Joao, Bvudzai Priscilla MagadzireJournal articleEnglish
Studies of missed opportunities for immunization in developing and industrialized countriesH.A.F.M. Jansen, P. Evans, R.J. Kim-Farley, S.E. Robertson, S.S. Hutchins1993Journal articleEnglish

MOV training material

This collection contains tools and resources for training on MOV.

TitleAuthorYearTypeLanguage
Identifying Interventions to Reduce MOV: CaregiversImmunization Academy, World Health Organization (WHO)2020TrainingEnglish
Identifying Interventions to Reduce MOV: Health Worker IssuesImmunization Academy, World Health Organization (WHO)2020TrainingEnglish
Interventions to Reduce MOV: Health System IssuesImmunization Academy, World Health Organization (WHO)2020TrainingEnglish
Missed Opportunities for Vaccination (MOV) and Their Impact on Immunization CoverageImmunization Academy, World Health Organization (WHO)2020TrainingEnglish
Recognizing Common Reasons for Missed Opportunities for VaccinationImmunization Academy, World Health Organization (WHO)2020TrainingEnglish
Training slides and sample agendaWorld Health Organization (WHO)2017TrainingEnglish

Interventions to reduce MOV by addressing health worker knowledge, attitudes and practice

Country examples and/or resources to address health worker knowledge, attitudes and practice.

TitleAuthorYearTypeLanguage
Assessment of vaccine wastage rates, missed opportunities, and related KAPs during introduction of a second dose of measles-containing vaccine into Cambodia’s national immunization programAaron S. Wallace, Danni Daniels, Eleanor Burnett, John Hustedt, Kong Krey, Margaret L. Watkins, Narin Choun, Richard Duncan, Sann Chan Soeung2018Journal articleEnglish
Australian Measles vaccination catch-up guideNational Centre for Immunisation Research and Surveillance2019GuidanceEnglish
Flow chart for integrated maternal and child health from KenyaUNICEFToolEnglish
Ministry of Health and Child Care Vaccination CalendarZimbabwe Ministry of Health and Child Care and partners2017ToolEnglish
Tool for catch-up vaccination from MalawiMalawi Ministry of Health2017ToolEnglish
Vaccination calendar from ThailandThailand Ministry of HealthToolThai
Vaccination calendar from Thailand, including accelerated scheduleThailand Ministry of Public Health2017ReportThai
Working together: An integration resource guide for planning and strengthening immunization services throughout the life courseWorld Health Organization (WHO)2018Case studyEnglish, French

Interventions to reduce MOV by addressing health systems issues

Country examples and/or resources to address health systems issues.

TitleAuthorYearTypeLanguage
Annex 4: Illustrative example of job aid on screening for vaccine eligibility (2YL Guidance)World Health Organization (WHO)2018TrainingEnglish
Data Quality Review (DQR) ToolkitWorld Health Organization (WHO)RepositoryEnglish
Immunization flip-chart from GhanaCenters for Disease Control and Prevention (CDC), Ghana Health Service, UNICEFGuidanceEnglish
Providing opportunistic immunisations for at-risk inpatients in a tertiary paediatric hospitalFiona Newall, Kirsten Perrett, Sonja Elia2017Journal articleEnglish
Vaccination Programs: Standing OrdersThe Community Guide2015RepositoryEnglish
Working together: An integration resource guide for planning and strengthening immunization services throughout the life courseWorld Health Organization (WHO)2018Case studyEnglish, French

Interventions to reduce MOV by addressing the demand-side (caregiver behaviours)

Country examples and/or resources to address demand-side (caregiver behaviours).

TitleAuthorYearTypeLanguage
A picture speaks a thousand words: evaluation of a pictorial post-vaccination care resource in AustraliaHammad Ali, Holly Seale, Kirsten Ward, Nicholas Zwar2010Journal articleEnglish
Lao PDR vaccination stickerLao PDR Ministry of Health, World Health Organization (WHO), Gavi, the Vaccine Alliance, UNICEFToolLao