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How We Encourage All Routine Childhood Vaccines

March 8, 2023

Our goal at New Incentives is to increase childhood vaccination rates for all vaccines covered under Nigeria’s routine immunization schedule to protect children against deadly, yet preventable diseases and save lives. In this post, we explain how our incentive structure works and why we’ve designed it this way.

We incentivize each vaccination visit. 

Children in Nigeria need six rounds of vaccinations to complete their routine immunization schedule. The six visits are supposed to take place at birth or shortly after, at six weeks, at 10 weeks, at 14 weeks, at nine months, and at 15 months.

When we first piloted our program, we identified a need to select the minimum vaccines required during each visit to be eligible for a cash incentive. The main reason for this is that stockouts of vaccines sometimes occur in Nigeria which is why we monitor the supply of vaccines and help increase their availability by coordinating with local actors at every level of the government. But we cannot prevent all stockouts. For this reason, we do not require that infants receive every recommended vaccine. Instead, infants need to receive the minimally required vaccines in order for the caregiver to be eligible for the cash incentive. 

We directly incentivize the most cost-effective vaccines.

The directly incentivized vaccines were selected because they provide the largest health benefits and reduction in mortality per dollar spent. They are:

  • BCG (tuberculosis)
  • Penta (diphtheria, pertussis, tetanus, hepatitis B, and HIB)
  • PCV (pneumococcal)
  • MCV (measles)

The other vaccines in the schedule are indirectly incentivized. They are:

  • IPV and OPV (polio)
  • Hep B (hepatitis B)
  • YF (yellow fever)
  • Men A (meningitis)
  • Rota (rotavirus: added in 2022)

By incentivizing certain vaccines, we can increase the uptake of ALL routine vaccinations.

Our own monitoring data and findings from the independent randomized controlled trial (RCT) of our program suggest incentivizing select vaccines is an effective model for increasing take-up of all vaccines. In the RCT, the program increased the proportion of children who were fully vaccinated—defined in Nigeria as having received BCG, three doses of Penta, and one dose of MCV (measles)—by 27 percentage points. These are all directly incentivized vaccines. In addition, the RCT showed that children in program areas were also more likely than those in control areas to receive three vaccines offered at the same time as the directly incentivized vaccines: the proportion of children vaccinated against Hep B increased by 16 percentage points, vaccination against polio (IPV vaccine) increased by 18 percentage points, and vaccination against yellow fever also increased by 18 percentage points. 

Our monitoring data also shows that enrolled infants receive indirectly incentivized vaccines at a very high rate. For instance, more than 91 percent of babies who get the 9-month measles vaccine also receive the yellow fever vaccine, and more than 86 percent also receive the meningitis vaccine. Our data certainly indicates a correlation between lower vaccination rates of indirectly incentivized vaccines and higher stockouts, but when these vaccines are available, infants in our program typically receive them in addition to the ones that are minimally required for our cash incentives. 

In short, we designed our program to encourage caregivers to bring their babies to the clinic but to not unfairly penalize them by refusing them a cash incentive if any stockout occurs. This is in line with other data suggesting that getting to the clinic is the biggest hurdle––once caregivers are there, they are more likely to have their babies vaccinated for all routine vaccinations, whether there is a financial incentive or not.

As always, we welcome your feedback and questions at info@newincentives.org

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