NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Tuesday, November 24, 2015

In her dream, she fastens a band around a baby’s ankle as his mother stands watching.

Noor Sabah Rakhshani wakes. For months, she has been living and breathing her doctoral thesis. Even in her sleep, data from the Pakistan Demographic and Health Survey swirls around her. While commuting to the Bloomberg School, and while preparing meals for her husband Imran and their daughters Lailée and Nida, Noor ponders the variables that influence the use of health services in her homeland.

Only 40 percent of children in Pakistan complete their vaccinations. As a result, preventable diseases like pneumonia, meningitis, whooping cough and measles claim more than 100,000 lives there each year. Yet intriguing factors keep surfacing for Noor: Among children who never received a standard paper card with their immunization history, only half completed the DTP3 vaccine’s 3-shot regimen. However, among children who received all the recommended vaccinations, 90 percent had a paper immunization card.

That last finding has whispered to Noor day and night, relentlessly begging the question: How to design a vaccine reminder—one that wouldn’t get lost or damaged like the standard paper cards so often do—that would bring all children into that 90 percent?

Having worked as a primary care physician in Pakistan, she knows the reminder would need to be both durable and culturally acceptable. Ideally, mothers who can’t read would understand it. Mobile phone-based solutions wouldn’t be helpful because so many of impoverished mothers don’t own one.

In this predawn hour, she recognizes the dream as a Eureka moment. Her gauzy idea of a wearable immunization reminder propels her out of bed and onto the computer in her tiny Baltimore apartment. The first phrase she Googles—time-dependent, temperature-independent indicator—is in deference to her former advisor, Orin Levine, PhD ’94. Before he left the Bloomberg School to head up the Vaccine Delivery program for the Gates Foundation, he had insisted, time and again, that as critical as immunization completion is, timely completion is key. Delays can be risky, even deadly, in the event of outbreaks.