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New Approaches for Improving Timeliness of Routine Immunizations in Low-Resource Settings (Round 19)


The Opportunity

Vaccinations have greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better in reducing the burden of infectious disease. To reduce mortality from vaccine-preventable diseases, vaccine coverage rates, or the percent of people who have recieved a specific vaccine, must go up. Despite the importance of vaccination, in many low-resource settings, vaccine coverage rates remain unacceptably low, sometimes even in the single digits. Reducing missed opportunities for vaccinations will likely increase immunization coverage simply by making better use of existing vaccination sites (at health centres, hospitals, outreach/mobile services etc.). However, many vaccinations require a series of health center interactions, and improving coverage goes beyond ensuring high coverage of the first dose.

Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed, or not as recommended. To achieve maximum protection against vaccine-preventable diseases, a child should receive all immunizations within the recommend intervals. Even if coverage improves with time, postponed vaccination adds to the pool of unprotected children in the population. This can be particularly problematic during the introduction of new vaccines. However, there are few validated, evidence-based approaches available to improve timeliness of routine immunizations.

The Challenge

We are soliciting innovative ideas for improving timeliness of routine immunizations. We’re specifically seeking applications proposing innovative approaches that successfully improve timeliness while reducing missed opportunities for vaccination, respect gender and equity inequalities, and target hard to reach populations, such as nomadic or remote. Successful proposals will include details on the design and pilot testing of the approach in their application. The effectiveness of the proposed approach on timeliness should be evaluated in Phase I, and a clear plan for the the impact of the approach on vaccine timeliness, completeness and coverage rates should be evaluated in Phase 2 if subsequent funding is awarded.

What we are looking for:

Successful proposals will include:

  • A clear hypothesis underlying the proposed approach to improve timeliness as well as documentation of timeliness (e.g. by a woman/child’s card, by health facility register that can track individual names of women/children vaccinated);
  • Plan for evaluating the effectiveness of the approach in improving timeliness using established metrics;
  • Outline of the design of the proposed approach to improve timeliness; and,
  • A plan for evaluation of the impact of the approach on completeness and coverage rates, should Phase II funding be granted.

Additionally, we will consider proposals identifying and testing approaches for improving timeliness of vaccines in low and middle income countries that support:

  • Mothers and families seeking to overcome barriers regarding timeliness and completeness of routine immunization;
  • Innovations that involve building on, disrupting, or adapting existing systems. Successful proposals will describe how their approach would work within existing health systems or what change would need to occur within health systems for their approach to be effective; and,
  • Projects which constitute transformative rather than incremental improvements to improving timeliness that would be deliverable and scaleable in low-income countries.

We will not consider funding for:

  • Innovative ideas without a clearly-articulated and testable approach;
  • Approaches not directly relevant to low-income settings;
  • Approaches for which proof of concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);
  • Secondary analysis of existing studies or systematic reviews of approaches for vaccine timeliness, completeness or coverage;
  • Proof of concept studies that do not clearly consider the current context of available financial systems and infrastructure for resource poor health settings. For example, ideas that are tested using expensive devices or require government-issued IDs in a country where few people have them;
  • Approaches that circumvent the public sector completely;
  • Approaches that present significant data safety risks (for mobile solutions, these risk must not be greater than the relative risk inherent in developed world mobile payment systems);
  • Approaches which would require a donor’s long-term financial support to sustain; or,
  • Innovative ideas that repeat conventional approaches without novel application

Great ideas come from everywhere.

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The Bill & Melinda Gates Foundation is part of the Grand Challenges partnership network. Visit www.grandchallenges.org to view the map of awarded grants across this network and grant opportunities from partners.