Social Incentives for Childhood Immunization

Vaccines can save an estimated two to three million children from deadly diseases each year and are globally recognized as one of the most cost-effective health and welfare interventions in low- and middle-income countries (LMICs), yet approximately 25 million children still do not receive life-saving immunization. Nearly 60 percent of deaths each year are related to vaccine-preventable diseases. There are sharp inequalities in full and timely childhood immunization, with the poorest quintile of children in LMICs 13 percent less likely to be fully vaccinated than in the wealthiest quintile. In Sierra Leone, where fewer than 60 percent of children complete their first year immunizations, a research team incentivized timely immunization by having government healthcare workers provide different colored bracelets to children after their first and fifth vaccines to publicly indicate their progress through the recommended series of vaccines. A randomized controlled trial (RCT) of this innovative social signaling approach found that it increased timely and complete vaccination by 14.4 percentage points from approximately 56 to 71 percent of children receiving their final first-year vaccine on time at an approximate cost of $2.30 per child. With support from the DIV Fund and the WAM Foundation, and in close partnership with Sierra Leone's Ministry of Health and Sanitation (MoHS) and partners, Innovations for Poverty Action (IPA) will adapt the bracelet program for government-led implementation and scale to children in hundreds clinics within Sierra Leone. IPA will also work with communities in Sierra Leone to better understand the enabling conditions that appear in a real-world setting where the intervention has successfully increased vaccination rates, as well as conduct scoping activities to assess the potential to expand the program to other countries.