pilot study form

LunaVax MAP Pilot Study Portal

Help reimagine vaccine delivery in Nigeria. Join our MAP pilot exploring microneedle patches, mobile vans, and biometric tracking to expand vaccine access for all. Fill out the form to get involved.

Whether you’re a health facility, mobile unit, outreach provider, or immunization lead, we’d love to hear from you.

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Name *

First

Last

Email *

Phone

Facility or Organization Name *

Where is your site based? (City/State) *

Role *e.g., Clinic Admin, Pharmacist, Program ManagerClinic AdminPharmacistNurseOutreach LeadProgram ManagerProgram CoordinatorOther (please specify)

Does your site currently offer measles vaccinations? *

• Yes
• No

What types of vaccines do you currently deliver? *

• Measles
• Polio
• Hepatitis B
• Other

Do you have experience with immunization programs? *

• Yes
• No
• Other

Are you interested in piloting microneedle vaccine patches at your site? *

• Yes
• No

Upload Are offer

Are you open to joining a training or feedback session? *

• Yes
• No

Briefly tell us why you’re interested in joining this pilot *

Upload any relevant license or facility document (optional)

Click or drag a file to this area to upload.

Submit

Learn more about the MAP pilot and how health facilities can get involved →