The waves of immigration flooding Europe in recent years and raising weighty questions of identity and morality also brought forth a less frequently-discussed problem – European doctors found themselves treating symptoms and illnesses that hadn’t been seen in their clinics for many years. Diseases studied in the West as part of the history of medicine were suddenly resurrected in the daily struggles of the immigrants, forcing doctors to return to mid-19th-century medical literature. One of the reasons for this is that one of the most outstanding achievements of modern medicine is preventative treatment – discovering and developing the principles of vaccination at the start of the 19th century.
Vaccines are even considered exemplars of efficient and cost-effective public policies, as a relatively minor investment in vaccinating children who occasionally visit children’s health centers regardless, can almost entirely prevent future health complications which may incur significant market expenses in treating and losing manpower. Likewise, the transition to a critical mass of vaccinated people allows the entire population to be considered safe.
India, like many African countries, is still struggling in its attempt to vaccinate its enormous population. The estimates by official health organizations is that only about 44% of children ages one to two have received some form of vaccination, and in the rustic state of Rajasthan the official number is cut in half, down to a mere 22%.
Vaccines are even considered exemplars of efficient and cost-effective public policies, as a relatively minor investment in vaccinating children who occasionally visit children’s health centers regardless, can almost entirely prevent future health complications which may incur significant market expenses in treating and losing manpower. Likewise, the transition to a critical mass of vaccinated people allows the entire population to be considered safe.
India, like many African countries, is still struggling in its attempt to vaccinate its enormous population. The estimates by official health organizations is that only about 44% of children ages one to two have received some form of vaccination, and in the rustic state of Rajasthan the official number is cut in half, down to a mere 22%.
Impoverished families would often spend amounts of money equal to several hundred days’ worth of work in attempts to take care of children who contracted illnesses that could have easily been prevented if the child had been vaccinated.
But when you take into account that government estimates tend to be overly optimistic, and that a single vaccination is insufficient and five separate vaccinations are required to meet the standards of Western medicine, the situation becomes even grimmer. And indeed, when a group of researchers conducted a precise sampling of village children in the Udaipur region, it turned out that only 2% of the children were indeed vaccinated in accordance with the recommendations of the World Health Organization.
Public policy professionals and economists tended to blame the locals for the situation, as vaccinations are freely provided by the public health system six days out of the week, six hours a day. The approach to these centers also shouldn’t be a problem, as the service is given in community centers scattered in villages such that the average walking distance is approximately a mere three kilometers, not a trivial distance but the sort the locals are used to managing on foot.
And indeed, early efforts focused on educating the population on the usefulness of vaccinations, and attempts to mediate the economic logic of vaccination. Impoverished families would often spend amounts of money equal to several hundred days’ worth of work in attempts to take care of children who contracted illnesses that could have easily been prevented if the child had been vaccinated. The approach adopted by public education turned out to have utterly failed in terms of its results, and the numbers of vaccinated individuals remains as minimal as ever.
Public policy professionals and economists tended to blame the locals for the situation, as vaccinations are freely provided by the public health system six days out of the week, six hours a day. The approach to these centers also shouldn’t be a problem, as the service is given in community centers scattered in villages such that the average walking distance is approximately a mere three kilometers, not a trivial distance but the sort the locals are used to managing on foot.
And indeed, early efforts focused on educating the population on the usefulness of vaccinations, and attempts to mediate the economic logic of vaccination. Impoverished families would often spend amounts of money equal to several hundred days’ worth of work in attempts to take care of children who contracted illnesses that could have easily been prevented if the child had been vaccinated. The approach adopted by public education turned out to have utterly failed in terms of its results, and the numbers of vaccinated individuals remains as minimal as ever.
The rate of children in the population who have completed all vaccinations.
Loyal to their beliefs that key insights lay hidden in the field, Prof. Esther Duflo’s team sought to study what was going on in the villages up close. They conducted surprise visits in 100 community health centers throughout Udaipur. It quickly became clear that the health workers were predominantly absent from the cases at the centers, almost 60% of the centers were locked up, and after a quick investigation it turned out that only 12% of the absences were justified.
Either way, what this meant for the villagers was that any visit to the clinic was a gamble with especially low odds. Local mothers who needed to complete a series of five visits for each child to meet the necessary quota of vaccinations were met with locked doors in most cases, and after several failed attempts they internalized that chances were too low to miss out on more work days. In their difficult daily routine, there was no place to invest a great deal of time on largely fruitless actions.
In an attempt to restore trust and fill the void created by the failing public service, a local association began conducting centralized monthly vaccination days held on fixed days and dates, widely advertised among the villagers. Duflo persuaded the association to conduct an experiment in which parts of the village would be randomly allocated to a test group in which a program would carry out vaccination days that were slightly different than those of the association. In the test group, every vaccinated child earned their mother one kilogram of lentils – a basic food source for locals with low monetary value, slightly more than half a day’s work – and those who completed the full vaccination quota would receive a set of 2 aluminum plates.
Either way, what this meant for the villagers was that any visit to the clinic was a gamble with especially low odds. Local mothers who needed to complete a series of five visits for each child to meet the necessary quota of vaccinations were met with locked doors in most cases, and after several failed attempts they internalized that chances were too low to miss out on more work days. In their difficult daily routine, there was no place to invest a great deal of time on largely fruitless actions.
In an attempt to restore trust and fill the void created by the failing public service, a local association began conducting centralized monthly vaccination days held on fixed days and dates, widely advertised among the villagers. Duflo persuaded the association to conduct an experiment in which parts of the village would be randomly allocated to a test group in which a program would carry out vaccination days that were slightly different than those of the association. In the test group, every vaccinated child earned their mother one kilogram of lentils – a basic food source for locals with low monetary value, slightly more than half a day’s work – and those who completed the full vaccination quota would receive a set of 2 aluminum plates.
In the test group, every vaccinated child earned their mother one kilogram of lentils – a basic food source for locals with low monetary value, slightly more than half a day’s work
At first, the effort seemed to overwhelmingly pay off: 77% of the children from the 134 villages received at least one vaccination during the centralized vaccination days. But over time, the significant gap between the two experiment conditions became clear. Among the villages where centralized vaccination days were held, the full vaccination rate was 17%, a significant achievement in light of the 6.2% among the control group, but among those who also received additional small prizes, the full vaccination percentage leapt by almost seven times relative to the control group, to an unprecedented 38% of the population.
In other words, of those who received no encouragement beyond the promise of the stability of centralized vaccination days, eight out of every ten children remained improperly vaccinated. Furthermore, neighboring villages that participated in the program also had a significant gap in favor of those who received lentils, 20% versus 10%, and they seemed to return more thrilled as well as spread the word.
Prior to the success of the program, discussions on the problem of vaccinations focused on educating the locals regarding the projected benefit of the vaccination, but Duflo’s team understood that among learned mothers, the disappointment towards public clinics needed a different kind of motivation – even something as simple as a package of lentils – to tilt the scales towards the decision to invest a workday towards a single vaccination out of a series of five, and made this decision easier for them using a kilogram of lentils. In hindsight, the lentil program turned out to be more financially efficient, even after calculating the cost of the lentils and the plate set, as health workers who also received wages for centralized vaccination days took advantage of their time more efficiently and gave more vaccinations per every work day. The practical cost of a single vaccination was lower.
In other words, of those who received no encouragement beyond the promise of the stability of centralized vaccination days, eight out of every ten children remained improperly vaccinated. Furthermore, neighboring villages that participated in the program also had a significant gap in favor of those who received lentils, 20% versus 10%, and they seemed to return more thrilled as well as spread the word.
Prior to the success of the program, discussions on the problem of vaccinations focused on educating the locals regarding the projected benefit of the vaccination, but Duflo’s team understood that among learned mothers, the disappointment towards public clinics needed a different kind of motivation – even something as simple as a package of lentils – to tilt the scales towards the decision to invest a workday towards a single vaccination out of a series of five, and made this decision easier for them using a kilogram of lentils. In hindsight, the lentil program turned out to be more financially efficient, even after calculating the cost of the lentils and the plate set, as health workers who also received wages for centralized vaccination days took advantage of their time more efficiently and gave more vaccinations per every work day. The practical cost of a single vaccination was lower.
