Routine childhood immunizations, provided on a set schedule over a child’s first two years of life, are very effective at reducing some of the major causes of death in young children. We estimate that in the provinces where we’ve supported programs in the Democratic Republic of the Congo (DRC), about one in 13 unvaccinated children dies from vaccine-preventable diseases before the age of five, yet only about half of children there receive the vaccinations they need.

Much of our Vaccination research subteam’s work focuses on finding ways to make it easier for caregivers to have their children vaccinated, such as bringing vaccines closer to where parents and infants live. This is especially important in places like DRC, where coverage is low and disease burden is high. Following a request for proposals and a request for information seeking targeted vaccination outreach programs, we funded 11 additional programs, run by distinct organizations—six of which will be implemented in DRC. This portfolio builds on years of investment in our research team, which allowed us to evaluate more than 100 proposals and fund several programs side by side to learn which approaches work best.

In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Senior Program Officer Natalie Crispin, who leads GiveWell’s vaccination grantmaking, about the programs we funded in DRC. They discuss barriers preventing many children in DRC from getting vaccinated, how the programs we’re funding aim to reach them, and what we hope to learn.

Elie and Natalie discuss:

• Identifying barriers to full vaccination in DRC: Based on the evidence we’ve reviewed, our past experience funding vaccination programs, and the experts we’ve consulted, we think reliable access to opportunities for children to be vaccinated is a major barrier to coverage. The typical immunization schedule requires eight or nine visits to a health facility over a child’s first 18 months. In DRC, families living within about three miles of a health facility are generally expected to travel there. This can mean walking several miles to the nearest health facility while carrying a small child, with no guarantee that the needed supplies or staff will be available to vaccinate their child when they arrive. Mobile vaccinators travel to reach families living further than three miles from a facility, but there are often insufficient resources to ensure these outreach sessions take place on the needed schedule and in the hardest-to-reach communities.
• Funding different strategies for reaching under-vaccinated children: Each of the six outreach programs we are funding in DRC includes two core components: (1) a method for identifying the communities that need additional support and (2) a strategy for reaching those communities, often by increasing how often vaccination teams travel from health facilities to underserved villages. In many of the programs, a small vaccination team travels by motorbike with a cooler of vaccines, sets up in a central spot that community health workers often announce in advance, and gives each child the vaccines they need. The details of the programs vary. For example, one organization is implementing an app that helps health teams log their work, allowing supervisors to track activity and make changes in an effort to increase coverage rates.
• Learning which approaches work best: In order to compare the cost-effectiveness of various approaches and organization types, we’ve chosen a diverse grant portfolio of programs and organizations (including large international NGOs, organizations focused on data and technology, and nonprofits with deep experience with the DRC health system). To assess the results, we’re funding independent coverage surveys before program implementation and every year afterward, using comparison groups wherever we can to assess whether changes in coverage were caused by the program. We’re also drawing on programs’ own monitoring data and talking with government officials, other funders, and implementers in the same areas. Over time, we plan to scale up those that increase coverage most cost-effectively to help people in need as much as we can.

We expect efforts to increase coverage of routine childhood immunization to make up at least half of our vaccination grantmaking, as these vaccines have the greatest potential to save lives. The team is also assessing the cost-effectiveness of filling funding gaps for purchasing vaccines, starting with malaria vaccines, and researching other vaccines that aren’t fully funded. With a larger, more experienced team, we can now research vaccines in more depth and fund multiple vaccination outreach programs to assess which are most cost-effective. We’re bringing that approach to all of our work, so we can do the most good we can with donors’ funds.

For more on how our vaccination grantmaking has evolved, see our earlier podcast episode with Natalie. Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on October 27, 2026, and represents our best understanding at that time.