National trends and operational drivers of vaccine wastage in Uganda, 2020–2025: a descriptive analysis of four tracer antigens

Background

Vaccine wastage reduces immunisation efficiency, increases costs, and complicates supply forecasting. Uganda routinely monitors vaccine use, but national evidence comparing observed wastage with World Health Organization (WHO) and Uganda-specific planning thresholds has been limited. We described national and sub-national trends for four tracer antigens to inform supply-chain planning and forecasting.

Methods

We conducted a retrospective descriptive analysis of routinely reported immunisation data from Uganda’s District Health Information Software 2, 2020–2025. We analysed Bacille Calmette–Guérin (BCG), measles–rubella (MR), oral polio vaccine (OPV), and diphtheria–tetanus–pertussis-containing vaccine (DPT). Vaccine wastage was calculated as the proportion of issued doses not administered. Annual wastage rates were summarised using medians, and temporal trends were assessed using the Mann–Kendall test. Observed wastage was compared with WHO thresholds: BCG≤50%, MR≤25%, OPV≤10%, DPT≤15%, and Uganda’s planning thresholds: BCG≤70%, MR≤40%, OPV≤15%, DPT≤10%. Effective Vaccine Management reports were reviewed to summarise reported reasons for wastage.

Results

During 2020–2025, median national wastage was 40.6% for BCG, 25.9% for MR, 10.0% for OPV, and 9.2% for DPT. OPV wastage declined from 12.8% in 2020 to 8.0% in 2025, with a significant downward trend (τ _b =−1.00; p=0.008). OPV and DPT wastage remained largely within their respective Uganda in-country thresholds (≤15% and ≤10%) for most of the study period, while BCG generally remained below the WHO threshold (≤50%) and MR frequently exceeded the WHO threshold (≤25%) but remained within Uganda’s planning threshold (≤40%) in most years. The proportion of districts exceeding both WHO and Uganda thresholds declined for OPV from 36.3% to 5.5% (p=0.024) and for DPT from 22.6% to 1.4% (p=0.013). Wastage was consistently higher in lower-level (Health Centre II and III) facilities, compared to hospitals. Among 50 service delivery points, reported reasons included low session attendance (66%), multi-dose vial policy non-compliance (28%), and vaccine expiry (12%).

Conclusion

Uganda achieved reductions in OPV wastage and district-level improvements in DPT wastage, while BCG and MR remained more variable and frequently had higher wastage. Strengthening adherence to the multi-dose vial policy and improving session planning at lower-level facilities could strengthen vaccine utilisation and forecasting.

What is already known on this topic

• Vaccine wastage is a key indicator of immunisation programme efficiency and supply-chain performance.

• Lyophilised multi-dose vaccines usually have higher wastage than liquid vaccines because opened vials must be discarded soon after reconstitution.

• National evidence on vaccine wastage trends in Uganda has been limited.

What this study adds

• Using national data from 2020 to 2025, this study describes vaccine wastage trends for four tracer antigens across all districts in Uganda.

• OPV wastage improved significantly, and district-level threshold exceedance declined for OPV and DPT.

• BCG and measles-rubella wastage remained more variable and higher in lower-level facilities.

How this study might affect research, practice or policy

• The findings support stronger multi-dose vial policy implementation, better session planning, and improved routine wastage monitoring.

• They also suggest a need to review service-delivery approaches for lyophilised vaccines in low-volume settings.

• This evidence can help inform vaccine forecasting and supply-chain planning in Uganda and similar settings.