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New Incentives is committed to using data and evidence to design our program and guide our work, with a laser focus on staying true to our mission of saving lives in a manner that does the most good per dollar. Here, we summarize the global evidence that has guided us to make this our focus, and we address some common questions and misconceptions about using financial incentives to improve health behavior.

Why Vaccinations?

Childhood vaccines are one of the most cost-effective child health interventions in the world.

“Immunization currently prevents 3.5-5 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles."
"When looking only at costs associated with illness, such as treatment costs and productivity losses, the return was $16 for every dollar spent on vaccines. In a separate analysis taking into account the broader economic impact of illness, vaccinations save $44 for every dollar spent."
“There is arguably no single preventive health intervention more cost-effective than immunization.”

Despite the effectiveness of vaccines, every year millions of children—most of them in very poor, rural areas of low-income countries—don’t receive routine vaccinations against preventable, yet deadly diseases like measles, tuberculosis, and tetanus. Policymakers, practitioners, and funders seek cost-effective ways to close the coverage gap.

Why Cash Incentives for Childhood Vaccination?

Conditional cash transfer (CCT) programs and small incentives have been effective at boosting vaccination rates in countries around the world.

“CCT beneficiaries… are more likely to have visited health providers for preventive checkups, to have had their children weighed and measured, and to have completed a schedule of immunizations.”
“Conditional cash transfer programmes have been the subject of some well-designed evaluations, which strongly suggest that they could be an effective approach to improving access to preventive services.”
“...[the CCT program] significantly increases child vaccination rates for all basic vaccine types by up to 30% compared to the control group means. There is also evidence that PKH is equity enhancing… All this underscores the ability of cash transfers to reach poor children for whom health systems supply-side-oriented strategies have been less successful.”

New Incentives’ program was rigorously tested and proven to double vaccination rates in northern Nigeria. Other research on incentives for immunization in Nigeria has also indicated significant increases in uptake.

New Incentives’ program “caused substantial additional increases in coverage of routine childhood immunizations in Katsina, Zamfara, and Jigawa States. These findings suggest that CCTs could have a profound impact on ensuring that children in North West Nigeria access life-saving immunizations and could be an important complement to other ongoing programs.”
“Cash incentives significantly increased the uptake of tetanus toxoid vaccine among women in Adamawa state, Nigeria. We also found that cash incentives relaxed budget constraints among women who needed to pay for the transportation costs to visit the health clinic for vaccination.” 

Many researchers—including Nobel Prize winners—have concluded that small incentives should be used in resource-poor settings to improve immunization and health. 

“[S]mall incentives have large positive impacts on the uptake of immunization services in resource-poor areas and are more cost-effective than purely improving supply.”
“From a policy perspective, programs should explore strategies to introduce small mCCTs [mobile conditional cash transfers] for health, or make part of existing cash transfers in LMICs conditional on immunization, as an effective policy tool to improve immunization and overall health outcomes for children.”

Does Cash Reduce Internal Motivation?

Contrary to concerns that financial incentives can reduce caregivers' internal or intrinsic motivation to get their children vaccinated, rigorous research has not found evidence of negative effects and instead finds positive long-term benefits of incentives. 

“We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety.”
“…for health-related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors.”
“Intrinsic motivation for ART [anti-retroviral therapy] adherence increased significantly both overall and within the food and cash incentive arms, even after the incentive period was over…These results suggest that incentive interventions for treatment adherence should not be withheld due to concerns of crowding out intrinsic motivation.”
“There is also evidence of sustained impact beyond the end of the funding suggesting that short-term programmes can lead to a long-term change in patterns of health-seeking behavior."

In summary, childhood vaccination is one of the most cost-effective public health interventions in the world, preventing disease before it starts. Small incentives are proven to significantly boost vaccination rates in various contexts around the world, helping to close the global vaccination equity gap. New Incentives continuously monitors new research for insights that may inform our work.