By early 2024, Niger’s Expanded Programme on Immunization (EPI) was beginning to experience strain in meeting the evolving needs of its population. Zero-dose and under-immunised children were common in several regions, particularly Dosso, Tahoua and Tillabéri1 (Fig. 1). Although staff at regional and district levels were making consistent efforts, many reported feeling insufficiently supported. Coordination meetings were irregular, available data seldom informed decision-making, and the fragile security environment further limited supervision and the planning of outreach activities.
