Vaccination reaches zero-dose children

14 March 2025, Siem Reap – 36-year-old mother-of-five Dong Chhuon used to get regular visits from a village health volunteer at her home on the Tonle Sap Lake, where she lives with her children in a floating house that’s only accessible by boat. Torn Samnang would come to remind her how important it is for her baby boy, Thona—now 17 months old—to receive his core vaccinations. 

“He came many times trying to convince me that if I did not take my child to get vaccinated, he might get a disease that would affect his health,” she says. 

There was always a reason why she would miss her appointments at the health centre—with no transportation of her own, going far always meant having to borrow a motorbike, and it was hard to take time away from her work harvesting snails, which gives her much-needed income to take care of her family.  

But there was also another, more troubling reason that kept her away. 

“I was afraid of taking him to get vaccinated,” she says. “I heard from others that when you vaccinate your child, it might affect their nerves and make their limbs go numb. Whatever people said, I believed it.” 

A misplaced trust in stories and rumours among her neighbours about vaccines causing more harm than good left her baby unprotected. It was only after the persistent advocacy from Samnang, the village health support group (VHSG) volunteer whose crucial role is to provide a link between the community and health workers, that she was finally convinced that vaccines are safe and essential to protect children from illness.  

Baby Thona was 9 months old when he received his first-ever vaccination.  

“I tried to ask them to look at the other children who have been vaccinated—they are healthy and strong,” says Samnang of the UNICEF-supported approach that finally drove the message home. “But your children, who are not vaccinated, are sick all the time. They are not strong like the other children.” 

While tremendous progress has been achieved in ensuring children are protected from vaccine-preventable diseases, with national estimates of DTP-1¹ coverage reaching 94 per cent and 92 per cent in 2014 and 2021 respectively, the percentage of zero-dose children increased from 6 to 8 percent in this same period.² This number shoots up in remote provinces like Ratanakiri, where 54 per cent of children aged 12–23 months are missing out on their core vaccinations, as well as other vulnerable communities such as rural and urban poor, ethnic minorities and migrant populations. 

To address the complex and varied barriers to vaccination among zero-dose and under-immunised children, UNICEF has been supporting the Ministry of Health and partners, including Provincial Health Departments (PHDs) and civil society organisations (CSOs) such as the Reproductive and Child Health Alliance (RACHA), to roll-out the “HCD-TIP” (“human-centred design for tailoring immunisation programmes”) approach. Designed by UNICEF and WHO, HCD-TIP aims to increase the demand for health services and address service delivery barriers by tailoring solutions according to challenges in specific areas.  

In Cambodia, this involves bringing together all stakeholders, including health workers, VHSGs, focal points from the Commune Council for Women and Children (CCWC) and PHD, CSOs as well as caregivers themselves to collect data, identify the challenges and then brainstorm creative solutions together. With funding from GAVI CDS III, 83 per cent of the 1,127 children aged 0–23 months who were identified as zero-dose across five provinces were successfully reached with their first vaccination. 

“During these meetings we will gather together and try to find the root cause of the problem, to find what really is the reason that families don't take their children to get vaccinated,” says Dr Choeng Meta, chief of Pohmeanchey Health Centre, which serves eight villages around where Chhuon lives. “One of the main reasons is their negative thinking about vaccination.” 

Through the sessions they identified challenges like the difficulty of accessing health services because of distance, lack of transport and income, but also lack of awareness, education and trust in healthcare workers. When health staff came directly to the village to provide immunisation outreach, Samnang says some families thought that their children were guinea pigs for vaccination testing. 

For both health staff and health volunteers, persistent education has been the key to their efforts to change mindsets and behaviour.  

“This approach really works,” says Samnang of HCD-TIP. “I was happy to see that my efforts did not go to waste. The families realise that this is not just something I do for myself, but for them and the whole community.” 

Chhuon says she’s noticed that her baby boy is less sickly than before, allaying her fears even more. She knows where to go to get advice and information she can trust and promises herself that she’ll always prioritize her children’s health.  

“Now, I will go straight to the health centre,” she says. “Now, I put my children first. No matter how busy I am, I will take my child to get vaccinated.” 

¹ DTP-1 refers to the first dose of the Diphtheria, Tetanus, and Pertussis (DTP) vaccine, a combination vaccine that protects against three infectious diseases, diphtheria, tetanus and whooping cough (pertussis). Children who have not received the DTP-1 vaccine are considered zero-dose. 

² Cambodia Demographic Health Survey (CDHS), 2021–2022