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Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.

Monovalent Hepatitis B vaccine (HepB) is heat stable, making it suitable for storage outside cold chain (OCC) at 37 °C for 1 month. We conducted an OCC project in the Solomon Islands to determine the feasibility of and barriers to national implementation and to evaluate impact on coverage. Healthcare workers at 13 facilities maintained monovalent HepB birth dose (HepB-BD) OCC for up to 28 days over 7 months. Vaccination data were recorded for children born during the project and those born during 7 months before the project. Timely HepB-BD coverage among facility and home births increased from 30% to 68% and from 4% to 24%, respectively. Temperature excursions above 37 °C were rare, but vaccine wastage was high and shortages common. Storing HepB OCC can increase HepB-BD coverage in countries with insufficient cold chain capacity or numerous home births. High vaccine wastage and unreliable vaccine supply must be addressed for successful implementation.