Closing immunity gaps in Armenia – local evidence driving action to strengthe

Armenia is taking decisive steps to close immunity gaps and prevent future outbreaks of vaccine‑preventable diseases. Although the country has maintained overall high immunization coverage for more than 2 decades, measles outbreaks in 2023 and 2024 revealed pockets of un- and under‑vaccination – often hidden within otherwise high national coverage.

To better understand and address these immunity gaps, the Ministry of Health and National Centre for Disease Control and Prevention conducted an in‑depth assessment across 3 regions (marzes) – Armavir, Gegharquniq and Yerevan –  with technical support from WHO and funding from Gavi, the Vaccine Alliance. The findings were discussed with national and local health authorities, health workers and academia on 29 April 2026 to guide development of an Immunization Equity Improvement Plan.

“As the country has progressed from identifying immunization gaps and the factors contributing to them to designing and implementing targeted interventions, the action plan to address immunization inequities will guide concrete activities at the facility, marz and national levels – ensuring that every child, in every community, is protected,” says Zaruhi Grigoryan, Deputy Director General of the National Centre for Disease Control and Prevention in Armenia.

Taking a closer look: finding the reasons for under-vaccinated children

Using an approach developed by WHO to address inequities in immunization programmes, Armenia mapped the geographic location in the targeted marzes of the children who have missed their vaccination doses, followed by triangulation of facility‑level measles/mumps/rubella vaccine (MMR) coverage and measles surveillance data from 2023 and 2024. Eight health facilities were prioritized for site visits to review immunization records, and behavioural insights research was carried out with caregivers of fully vaccinated, partially vaccinated and unvaccinated children in the catchment areas of these identified health facilities.

Why are children falling behind with their routine vaccinations? Insights from health workers and caregivers

The findings show that Armenia’s immunization programme is robust: vaccination is available free-of-cost 5 days a week, waiting times are short, stockouts are rare and health workers are committed.

But the investigation uncovered several factors contributing to under‑vaccination in the reviewed areas.

• Missed opportunities. Some paediatricians reported requesting pre‑vaccination tests, which are not part of the approved protocol, and many reported being more cautious than what the national contraindication guidelines suggest; for example, postponing vaccination if a child presented with a mild cold, thereby creating missed opportunities to vaccinate on time.
• Communication. Health workers reported that they felt well‑prepared to speak with caregivers but relied on one‑size‑fits‑all communication strategies. Although they noted that autism and vaccine safety, especially around MMR, are frequently raised concerns, they did not have specific strategies to address these topics directly with caregivers.
• “Drop out” risk. Most under‑vaccinated children had received some of their routine vaccine doses at the health facility but had dropped out prior to receiving the first dose of MMR at 1 year of age, suggesting insufficient follow-up or potentially negative experiences with vaccination or the health facility.
• Documentation gaps. For many children classified as under‑vaccinated, no reason for missing a vaccine dose was recorded in facility journals, preventing targeted outreach.

From evidence to action

These findings will drive efforts to address vaccination gaps in Armenia. Health authorities, experts and partners came together to translate this evidence into actions as part of an Immunization Equity Improvement Plan, with the aim to reach every child with all recommended vaccine doses. Planned actions include:

• standardizing the documentation of reasons for missed or delayed doses;
• introducing structured reminder and recall systems, including text messages and follow‑up calls;
• reducing missed vaccination opportunities around unwarranted contraindications through targeted paediatrician training;
• strengthening the communication skills of health professionals to better address common concerns and rumours; and
• enhancing data quality and use within Armenia’s electronic immunization system.

A model for the WHO European Region

Armenia’s commitment to equity‑focused, data‑driven improvement reflects the goals of the European Immunization Agenda 2030, which calls for tailored local action to reach under‑served groups.

“By combining facility assessment, behavioural insights research and surveillance data, Armenia is setting an example for other countries working to restore or sustain high vaccination uptake in all communities,” says Dr Siddhartha Datta, WHO Representative in Armenia and Head of Country Office.