How to pull off a mass vaccination campaign

Protecting as many people as possible under the most challenging circumstances

An MSF health worker prepares to vaccinate a child against pneumonia

Greece 2019 © Anna Pantelia/MSF

Over 50 years of responding to crises, Doctors Without Borders/Médecins Sans Frontières (MSF) has seen time and again that vaccines are one of the most important tools we have. That’s because immunizing people with a simple shot or oral dose is always easier and safer than treating them for a potentially deadly disease. By carrying out preventive vaccination campaigns, even amid other emergencies such as COVID-19, MSF has saved countless lives. MSF also carries out outbreak response vaccinations, often in settings where children and adults have not been covered by routine immunization programs.


Spring 2021: Vaccines work

On the Greek island of Samos, where thousands of refugees are still stranded, MSF teams providing mental health and sexual and reproductive health services moved quickly last spring to pick up vaccination activities suspended by the ministry of health due to COVID-19. “Our team decided we could not leave the children unvaccinated,” said MSF medical activity manager Mirjam Molenaar. So they started a catch-up vaccination campaign to reach children under five. “That was done once a week on a soccer field in front of this camp, with all the measures in place for COVID.” To keep patients safe, MSF teams vaccinated about 150 children at a time, making sure they kept six feet apart. “It went smoothly because of all these parts having been put into place. We set up hand sanitizers, water, soap, and masks that people had to [throw away] themselves at the end.” 

Man speaks in a microphone and directs children to get their vaccines
South Sudan 2015 © Karin Ekholm/MSF

The team had to account for a wide diversity of backgrounds and vaccination histories to make sure everyone got the shots they needed to protect themselves and others. For example, some children who came from countries like Iraq and Syria—whose once robust immunization programs were disrupted by war—might be partially vaccinated. But children born after their families fled home might not have received any vaccines at all. In September 2020, when COVID-19 rates began to rise in Greece, the camps went on partial lockdown and the vaccination campaign temporarily paused. MSF teams resumed as quickly as possible, hoping not to miss the opportunity to immunize people who would be transferred out of the camps.

An MSF health worker vaccinates a child
Pakistan 2005 © Ton Koene/MSF

Plans were complicated once again in October, when an earthquake struck the island. By then, because people living in the camp had become familiar with the routines, MSF was able to keep vaccinations going. “Continuing our operations through the emergency brought calm to an already awful camp situation where people are in upheaval all the time,” said Molenaar. “Anything that can remain consistent, that shows that we are still here, is helpful.” Though the mass vaccination campaign ended in November, MSF continues to vaccinate new children arriving at the camp.

MSF medical mobile team member vaccinates a patient in northern Lebanese city of Tripoli.
Lebanon 2021 © Mohamad Cheblak/MSF

A team effort

[Mass vaccination campaigns] are quite challenging to execute, but beautiful to see. It's like a ballet, where a team works in unison to accomplish something incredible.


Northan Hurtado, MSF deputy medical advisor

The goal of a mass vaccination campaign is straightforward: vaccinate thousands of people over a relatively short period to prevent or respond to a disease outbreak. But just as no two emergencies are alike, there is no onesize-fits-all way to organize a mass vaccination campaign. Instead, each response must be carefully planned and tailored to reach the most people possible with lifesaving vaccines, sometimes in the most challenging settings imaginable—often amid a slew of complicating variables. 

“[Mass vaccination campaigns] are quite challenging to execute, but beautiful to see,” said Dr. Northan Hurtado, MSF deputy medical advisor. “It’s like a ballet, where a team works in unison to accomplish something incredible.” In addition to thorough pre-planning, substantial human, material, and financial resources are required. Medics, logisticians, community health promoters, human resources managers, and more must collaborate closely, combining their respective skills to make it happen.

An MSF team prepares to admit patients at a measles vaccination clinic
Central African Republic 2020 © James Oatway/MSF

First, teams investigate an outbreak to identify priority communities and age groups in need of protection. Then, while coordinators secure permissions from local health authorities, medical, logistics, and human resources teams carry out a series of critical calculations that provide a framework for the campaign. Priority age groups and areas are used to estimate the total number of people to be vaccinated. Then, the team calculates how many different vaccination sites must be set up in order to reach those people, and how many health workers are required to staff them.

An MSF team packs vaccination supplies in insulated boxes
Guinea 2017 © Markel Redondo/ MSF

With locations identified, health promoters begin circulating information to surrounding communities, ensuring that families know when and where they can receive free immunization. Health promoters rely on different communication methods depending on the context. In remote places, for instance, teams travel in advance to homes and meet with local leaders for support in informing rural communities. In urban areas, MSF publicizes vaccination campaigns through local radio announcements, text message alerts, or simply by driving through a city with megaphones to broadcast information far and wide.

Every vaccination site operates like an assembly line, with each team member managing one specific responsibility in order to improve efficiency and maintain proper protocol.


As colleagues spread the word, human resources managers assess how many new staff members must be recruited. Every vaccination site operates like an assembly line, with each team member managing one specific responsibility in order to improve efficiency and maintain proper protocol. New hires are assigned clearly defined roles and trained in MSF guidelines for vaccine preparation and administration, aseptic measures, waste management, crowd control, and emergency procedures, like managing accidental exposure to blood. 

MSF measles vaccination team crossing river
Democratic Republic of Congo 2019. © Narcisse Mukembe Muzabula/MSF

Logistics experts also play a critical role. Because many vaccines must be stored at specific low temperatures to remain viable, each vial must be kept cold from the time it leaves an MSF storage facility in Europe to the moment a patient is vaccinated thousands of miles away. This requires a “cold chain,” a system of refrigeration, portable cooling, and temperature monitoring. In some places, weak local infrastructure combined with a warm climate make maintaining the cold chain a major challenge. 

 MSF team members unload insulated containers of measles vaccine
Democratic Republic of Congo 2013 © Franck Ngonga/MSF

Tackling an outbreak

The logistical challenges are immense in Democratic Republic of Congo (DRC), where a deadly measles outbreak declared in June 2019 has infected more than 460,000 people and killed nearly 8,000 children. Although the government declared an end to the outbreak in August 2020, the epidemic rages on. MSF teams have provided patient care, surveillance to track the epidemic, and mass vaccination campaigns, immunizing millions of children.

A health worker prepares a dose of vaccine
Guinea 2017 © Markel Redondo/MSF

In this vast country communities are often separated by great distances and unpaved, poorly maintained roads. MSF teams must travel for hours or even days over rugged terrain by car and motorbike, or navigate rivers by boat. Vaccine vials are packed securely in portable coolers, using ice packs and insulating materials to keep the doses cold without freezing them.

Women vaccinating men in a dense forest in Indonesia.
Indonesia 2006 © Jean-Pierre Amigo/MSF

MSF has long experience carrying out such campaigns in DRC and other places. “I’ll never forget working on measles vaccinations in DRC in 2010,” said Dr. Hurtado. “The sheer number of freezers we had to keep running, and the dozens of coolers we had to pack and carry six hours away, without the vaccines getting too warm or too cold, made me understand how complicated this work is.” 

Two women register their children for measles vaccinations
Democratic Republic of Congo 2020 © Caroline Thirion/MSF

MSF team members typically wake well before dawn to pack their supplies and travel—sometimes for hours—to the vaccination sites. Upon arrival they set up fencing to direct lines of people and set up stations for patient registration, the vaccinations themselves, and supplementary services as needed.

An MSF nurse vaccinates a child against measles
Democratic Republic of Congo 2019 © Pablo Garrigos/MSF

During the latest measles vaccination campaign in DRC, triage staff worked the entrance, checking the ages of children in line and managing crowd control. Children and their guardians filed through registration, where they received a stamped vaccination card. At the following station, children were given vitamin A, which can become depleted by measles infection. Next was the vaccination station, where a team member loaded syringes before handing them to a vaccinator, who administered the shots. Nearby, another staff member was responsible for tallying each vaccination performed.

An MSF team member prepares a dose of polio vaccine
South Sudan 2015 © Karin Ekholm/MSF

Each night, team members met to report on vaccination figures for the day before finally going to bed—only to wake up before dawn to do it all again. “It’s a very long day and they’re exhausted, but teams return at night feeling energized,” said Dr. Hurtado. “They’re excited to know they’ve reached thousands of people with lifesaving protection.”