The Zero-Dose Learning Agenda (ZDLA) is led by the Bill & Melinda Gates Foundation and focuses on identifying subnational programmatic actions to reduce zero-dose children by 50% by 2030 in six high-burden countries. ZDLA diagnoses the root causes of ZD children, develops tailored interventions, and captures insights on effective strategies. BMGF also has a operational learning workstream in order to understand the challenges and solutions to facilitate funding levers and implementation of the package of ZD interventions funded by Gavi.

Significant gaps exist in reaching zero-dose (ZD) children in high-burden countries such as India, Nigeria, and Ethiopia. A Rapid Assessment Survey (RAS) in 2021 in India revealed disparities in immunization coverage, with many ZD children and their caregivers lacking access to vital services like antenatal care and vaccinations. A second study used data from Demographic and Health Surveys from eight high ZD burden countries. Results show that ZD children and their families do often have contact with the health facility and recommend that better tracking of service delivery records across services, integration of services, and use of inter-operable digital systems could improve continuity of care and reduce the ZD burden.