Improving Timeliness and Completeness of Routine Immunizations in Low-Resource Settings Will Save Lives

While the international community has set a goal to end preventable newborn and child deaths by 2030, 47 countries will struggle to meet the global targets if they continue their current trends in reducing child mortality. A large portion of the child deaths occurring in low-income countries could be prevented with high, complete, and timely coverage of already existing vaccines. Near 1.5 million of the deaths among children under 5 years is due to diseases that could be prevented by routine immunization. This is almost 17% of the global total mortality in children under 5 years of age!

Although child survival is dependent on several factors including high vaccine coverage, high vaccination coverage rates for individual vaccines do not necessarily mean timely vaccination or population immunity. Parents of young children have a long list of vaccines they must ensure their child get, which in and of itself can seem daunting. However, many vaccines are also given as part of series, meaning a child needs multiple doses before they are considered "fully vaccinated." For series vaccines, often protection is not just about getting all the doses in the series but also about WHEN those doses are given. Delays in receiving doses can compromise the child's protection against the disease.

To show you how children can quickly become undervaccinated, let us introduce you to Halima and her infant son Musa. Over the next two years, Musa will need more than 10 vaccines given at 5 sessions. Halima lives in Northern Nigeria where vaccines are given monthly in outreach sessions. Her son recieved his first dose of Penta vaccine when he was just a 6 weeks old which can protect him against 5 potentially deadly diseases (diphtheria, whooping cough, tetanus, haemophilus influenzae type B, hepatitis B). At this outreach session, Halima received an immunization card for Musa which outlined that she should bring him back in 4 weeks, however, Halima is not literate and the health care worker vaccinating Musa failed to explain the vaccine card and the need for Musa to return in 4 weeks. Halima knows she needs to return with Musa but the importance of returning in exactly 4 weeks was not conveyed. Halima has a lot of responsibilities around the home, including caring for 5 other children who all have their own vaccines schedules. She also works in the garden, cooks, cleans, does laundry, and makes sure the kids get to school. With everything going on, she does not remember to look at Musa's vaccine card tucked away in a drawer, and when it is time for the next vaccine outreach session, the town announcer fails to alert mothers about in the village. When Musa turns 10 weeks Halima misses the outreach session at the local health center and Musa's second Penta dose. The next month when she hears there is an outreach session going on at the nearby health center, she knowns she should go but Musa appears healthy, there is so much to do at home, and with the cost and time associated with transport and waiting at the clinic, she decides she can't do it this time. As time goes by and Musa gets older, the idea of taking him for infant vaccines becomes less of a priority. One day he is playing around the home and contracts tetanus, a life threatening disease that requires hospitalization.

With the Grand Challenges Explorations New Approaches for Improving Timeliness of Routine Immunizations in Low-Resource Settings call, we are seeking applications proposing innovative approaches that build on, disrupt, or adapting existing systems to improve timeliness of routine immunizations and that can be realistically implemented at scale by a government in a developing setting.

Special consideration will be given to projects that successfully improve timeliness while reducing missed opportunities, respect gender and equity inequalities, incorporate improved vaccine card availability, and target hard to reach populations. Approaches should focus on simple methods, using routinely available data (preferably free/open-access), and be sustainable in the developing world context by being feasible to be easily taken to scale nationally.

We are especially interested in applicants and solutions that come from diverse sectors, even those outside of health.