Bringing health to every home – door-to-door immunization campaign in North Macedonia

In a joint effort to improve immunization coverage and provide equitable access to vaccines, the Ministry of Health and the Institute of Public Health of the Republic of North Macedonia, in collaboration with WHO and with support from the European Union, carried out a nationwide door-to-door vaccination campaign in the spring of 2025.

Over the course of the 5-week campaign, health-care teams were mobilized across 15 towns and 174 villages in 19 municipalities, reaching a wide range of communities - from densely populated neighbourhoods to more isolated rural areas, all with vaccination coverage below the national average. A total of 3394 households were visited. Each visit enabled the health-care team to engage with families, share accurate health information and offer onsite vaccination services. This allowed children to catch up on any due or missed vaccinations in line with the national immunization schedule, including the measles/mumps/rubella (MMR) vaccine and human papillomavirus (HPV) vaccine.

"The campaign is a testament to what we can achieve when institutions, international partners and communities work together," said Jovica Andovski, Deputy Minister of Health. "With WHO's support, we brought health care to people's doorsteps - and in doing so, we built trust, boosted coverage and protected the next generation."

Reaching out

The campaign aimed not only to address logistical barriers to immunization, but also to strengthen public confidence in routine vaccinations and the health system through face-to-face communication. Health-care workers went from house to house, often in challenging conditions, engaging directly with parents and caregivers. This personal engagement enabled them to counter misinformation and respond to questions in real time, thereby also helping to build trust. This targeted campaign recorded an estimated vaccination refusal rate of 10%, reflecting encouraging levels of community interest and openness to dialogue.

"I met a mother who had been uncertain about vaccines for a long time," shared Dr Marija Dimovska, a local health-care worker from the Bitola Public Health Centre. "After we spoke and she saw how many of her neighbours had already participated, she decided to vaccinate both of her children. Experiences like these highlight the value of personal outreach."

Professor Dr Marija Andonovska, Director of the Institute of Public Health, noted that this was more than a logistical undertaking, adding, "it was an opportunity to reconnect with communities and support informed health choices. Our teams listened, explained and supported families in making decisions that protect their health and the health of their children."

Immediate and long-term impact

The campaign resulted in the administration of:

• 540 doses of MMR vaccine
• 380 doses of HPV vaccine
• 1403 doses of other essential childhood vaccines.

In addition to delivering vaccination services, the teams distributed more than 7300 informational leaflets, helping families to make informed decisions based on verified health data. The campaign also involved over 35 group education sessions in schools and kindergartens, where medical professionals discussed the importance of MMR and HPV vaccination with parents, teachers and community leaders. These sessions reinforced the messages shared during home visits and created additional spaces for learning and discussion.

This activity illustrated how bringing health care directly to people's homes and communities can help to overcome both practical and emotional barriers to vaccination. It offered a model of community-based service delivery that prioritizes access, understanding and respectful communication.

Although the door-to-door phase has ended, its impact continues by way of vaccinated children, strengthened community trust and renewed momentum for improving immunization services across North Macedonia.

The outreach campaign was part of a European Union-funded project aimed at strengthening health systems' resilience and immunization services in the Western Balkans. The project is being implemented in Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia and Kosovo^*.

*All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).