Challenges to Vaccinating Every Child

Vaccines are one of the most cost-effective public health interventions ever developed, and receiving vaccines on time is a key part of ensuring children can grow up to live a healthy life, without disability or death from a vaccine-preventable disease. Worldwide more children are being immunized today than ever before, and this is a tremendous achievement for the global health community and the many dedicated health workers who tirelessly work every day to protect us all. 


Yet while global immunization rates are high, vaccines are still not reaching what is often called the "fifth child", 1 in 5 children worldwide who are not vaccinated and who often live in rural, remote, or hard-to-reach areas. It is estimated that between 18 and 22 million children are immunized late and, sadly, over 80% of deaths of vaccine-preventable diseases occur in low- and middle-income countries. These children get left behind for a variety of reasons which are complex, interrelated, and not fully understood, including long distances to clinics, lengthy wait times, inability to take time off work, and financial barriers. Children born to parents of lower education levels and lower income levels are at a higher risk of being immunized late and dying of vaccine-preventable diseases. 

Preventing Parents' Forgetfulness

We aim to solve a specific problem - parents forgetting their children's immunization dates. Not providing a vaccine reminder and parents' forgetfulness have been recognized as key reasons why children are immunized late (Patel & Pandit, 2011)(Wakadha et al., 2013)(Wilson, 2000)(Quaiyum et al., 2011). Uncertainty about the vaccination dates is part of a larger problem around appropriate communication with parents about vaccines and parents' health literacy. 

We saw that parents forgetting vaccination dates caused three unsettling effects: 

  • Children are immunized late, putting them at risk of contracting or dying of vaccine-preventable diseases
  • Health workers must spend hours away from seeing patients in crowded clinics to look for parents at home to remind them
  • Governments waste millions of dollars to repurchase vaccines which have expired from non-use and must be thrown out

Now that the Millennium Development Goals ended this year, the Sustainable Development Goals have been developed to replace them, and ensuring vaccines reach every child remains a key indicator of success. Creating appropriate tools to support health workers' communication with parents about vaccines are now at a premium. Simplifying the graphical information on the government issued child health card has been recommended to help improve parents' understanding of the vaccine schedule. 

Where Our Story Began 

Our founder, Lauren Braun, saw the effects of late immunization firsthand during a college internship in 2009 in Cusco, Peru. As part of her internship at a Ministry of Health clinic, Lauren accompanied nurses who spent up to four hours a day looking for mothers in mountainous villages to remind them of their children’s vaccination appointments. The mothers at this clinics were low-income, spoke native Quechua rather than Spanish, had little education, and were mostly indigenous. Mothers were handed a small piece of paper with the next appointment date, but they quickly lost it because they didn't have a purse or pocket to stow the paper reminder in. As a result, mothers frequently missed the appointment. Consequently, vaccines expired and had to be thrown out. Yet, once reminded at home by nurses, mothers immediately returned to the clinic for their appointments. 

When Lauren showed the nurses the initial bracelet design that summer, the nurses were ecstatic about using the bracelet.  Every day the nurses asked Lauren how the project was coming along, offered suggestions about how to improve the design, and asked when it would be ready for them to use. They asked her to promise them she would bring the bracelets back to them to use to help save children's lives and make their jobs less burdensome. In the long term, the bracelets would also result in cost savings in disease treatment costs avoided and fewer expired vaccines.