ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKAL
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Conditional cash transfers to increase infant vaccination in Nigeria - New IncentivesAbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguFCTGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfara
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Increase in vaccination rates due to New Incentives
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Aggregate baseline vaccination coverage (i.e. vaccination rates in the absence of New Incentives' program)86%71%82%78%46%75%75%49%90%77%98%87%93%96%90%58%91%53%61%50%45%43%78%63%90%67%55%61%69%87%69%76%87%23%66%71%43%
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Percent of infants who would be unvaccinated in the absence of New Incentives' program14%29%18%22%54%25%25%51%10%23%2%13%7%4%10%42%9%47%39%50%55%57%22%37%10%33%45%39%31%13%31%24%13%77%34%29%57%
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Estimated reduction in the percent of unvaccinated infants as a result of New Incentives' program33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%33%
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Increase in vaccination rates due to New Incentives (in percentage points)5%10%6%7%18%8%8%17%3%8%1%4%2%1%3%14%3%16%13%17%18%19%7%12%3%11%15%13%10%4%10%8%4%26%11%10%19%
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Number of vaccinations supported with a hypothetical donation
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Cost of the program per enrolled infant, New Incentives$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27$21.27
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Government cost per additional (counterfactual) full immunization$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29$34.29
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Gavi cost per additional (counterfactual) full immunization$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64$28.64
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Donation to New Incentives (arbitrary size)$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000
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Percent of infants who would have been vaccinated without New Incentives86%71%82%78%46%75%75%49%90%77%98%87%93%96%90%58%91%53%61%50%45%43%78%63%90%67%55%61%69%87%69%76%87%23%66%71%43%
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Percent of those vaccinated in treatment catchment areas who were enrolled in New Incentives' RCT95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%95%
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Size of cohort of infants (based on size of donation to New Incentives)5,4766,1605,6445,7987,7705,9425,9477,5025,3075,8645,0125,4025,1885,1015,2846,8695,2547,2156,7187,4387,8568,0245,7946,5545,3096,3307,0866,7146,2455,4376,2635,8935,43010,2206,3976,1407,984
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Number of vaccinations in cohort paid for by New Incentives4,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,7004,700
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Number of infants in cohort counterfactually vaccinated2636043474231,4064954981,27217945732226120761689571531,1298821,2401,4481,5324218001806891,0658806462446554712402,6267225941,513
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Total government spending on counterfactual vaccinations$9,020$20,699$11,881$14,513$48,199$16,986$17,063$43,621$6,128$15,653$1,097$7,749$4,106$2,614$5,746$32,817$5,231$38,725$30,237$42,527$49,658$52,530$14,444$27,426$6,170$23,610$36,513$30,159$22,149$8,353$22,459$16,149$8,238$90,045$24,745$20,361$51,859
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Total spending by Gavi on counterfactual vaccinations$7,534$17,289$9,924$12,122$40,259$14,188$14,252$36,435$5,119$13,074$916$6,473$3,430$2,183$4,799$27,411$4,369$32,346$25,256$35,521$41,478$43,877$12,065$22,908$5,154$19,720$30,498$25,191$18,500$6,977$18,759$13,488$6,881$75,212$20,669$17,007$43,316
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Total amount spent on hypothetical program by all contributors$116,554$137,989$121,806$126,636$188,458$131,174$131,315$180,056$111,247$128,727$102,013$114,222$107,536$104,797$110,545$160,228$109,600$171,071$155,493$178,048$191,135$196,407$126,509$150,334$111,324$143,330$167,011$155,350$140,650$115,331$141,218$129,637$115,120$265,256$145,413$137,368$195,175
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Effect of vaccination on disease incidence
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Percent of all under 5 vaccine-preventable deaths from diseases targeted by:
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PCV vaccine (three doses)46%46%48%52%38%39%42%32%48%48%49%53%48%47%49%44%51%37%46%44%35%36%41%42%45%46%45%46%52%46%48%45%49%35%47%36%31%
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DTP vaccine (three doses)7%8%12%15%10%14%10%15%12%10%10%9%8%13%10%11%10%10%12%9%11%13%26%14%10%12%11%12%9%11%17%10%9%11%9%13%12%
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HiB vaccine (three doses)4%4%4%5%3%3%4%3%5%4%5%6%5%5%5%3%5%3%3%3%2%3%3%3%5%3%3%4%4%4%4%4%5%2%3%3%2%
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Measles vaccine (one dose)2%3%4%3%5%5%3%6%5%3%3%4%5%4%3%4%3%5%5%3%7%7%6%8%4%4%4%4%4%5%5%4%4%5%3%7%6%
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BCG vaccine (one dose)11%14%10%10%18%8%11%13%13%11%15%15%15%14%14%14%15%20%12%12%17%17%10%9%11%12%12%10%11%14%9%15%12%17%12%17%21%
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Rotavirus vaccine (two doses)30%25%20%15%26%31%30%31%17%23%18%13%18%16%19%24%17%26%22%29%28%24%14%23%25%22%25%24%19%19%17%22%22%29%26%25%28%
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Vaccine efficacy
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PCV vaccine (three doses)0.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.580.58
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DTP vaccine (three doses)0.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.840.84
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HiB vaccine (three doses)0.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.82
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Measles vaccine (one dose)0.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.85
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BCG vaccine (one dose)0.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.850.85
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Rotavirus vaccine (two doses)0.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.460.46
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Ratio of the reduction in vaccine-preventable disease mortality to the reduction in vaccine-preventable disease100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%
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Overall unadjusted vaccine efficacy for vaccine-preventable disease from meta-analyses0.610.630.640.650.640.620.620.640.650.630.640.660.650.660.640.640.640.650.640.620.650.660.680.650.630.640.630.630.630.650.650.640.630.640.620.650.66
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Overall unadjusted relative risk for the incidence of vaccine-preventable diseases from meta-analyses0.390.370.360.350.360.380.380.360.350.370.360.340.350.340.360.360.360.350.360.380.350.340.320.350.370.360.370.370.370.350.350.360.370.360.380.350.34
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Adjustment for coverage in trials0.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.950.95
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Adjustment for lower vaccine efficacy in Nigeria
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Probability that low agreement between biomarkers results and caregiver reports in operational pilots were driven by:
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Issues unlikely to lead to vaccine efficacy concerns in New Incentives' program30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%
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Issues likely to lead to vaccine efficacy concerns in New Incentives' program70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%70%
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Implied adjustment factors for explanation for biomarkers results:
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Issues unlikely to lead to vaccine efficacy concerns in New Incentives' program1.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.01.0
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Issues likely to lead to vaccine efficacy concerns in New Incentives' program0.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.30.3
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Weighted average adjustment to vaccine efficacy based on biomarkers results0.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.51
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Adjustment factors for additional sources of evidence:
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Meta-analysis we use for main effect of measles vaccine1.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.001.00
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Nigerian seroconversion study (Fowotade et al. 2015)0.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.81
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Meta-analysis with Africa-specific effect (Uzicanin and Zimmerman 2011)0.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.860.86
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Weight applied to each source of evidence:
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Biomarkers operational pilots30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%
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Meta-analysis we use for main effect of measles vaccine in CEA10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%10%
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Nigerian seroconversion study (Fowotade et al. 2015)30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%
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Meta-analysis with Africa-specific effect (Uzicanin and Zimmerman 2011)30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%
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Weighted average adjustment factor0.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.75
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Application to other vaccines besides measles:
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Contribution of measles to CEA2%3%4%3%5%5%3%6%5%3%3%4%5%4%3%4%3%5%5%3%7%7%6%8%4%4%4%4%4%5%5%4%4%5%3%7%6%
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Contribution of other vaccines to CEA98%97%96%97%95%95%97%94%95%97%97%96%95%96%97%96%97%95%95%97%93%93%94%92%96%96%96%96%96%95%95%96%96%95%97%93%94%
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Percent of adjustment that applies to non-measles vaccines75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%75%
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Measles adjustment0.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.750.75
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Non-measles adjustment0.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.820.82
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Overall adjustment for lower vaccine efficacy in Nigeria0.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.810.81
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Adjustment for all-cause mortality effect
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Probability of death from vaccine-preventable diseases among vaccinated and unvaccinated children under 51.04%1.64%0.53%0.55%2.50%0.94%0.82%0.69%0.53%0.74%0.84%0.60%0.58%0.33%0.63%1.77%0.42%2.92%1.45%1.74%2.05%2.02%0.56%0.41%0.32%0.85%0.99%0.46%0.55%0.26%0.34%0.63%0.72%3.21%1.78%1.33%3.22%
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Percent vaccinated during time of IHME data62.02%51.30%66.47%71.46%29.15%49.71%52.55%43.94%75.03%60.87%73.26%78.92%75.49%79.48%72.13%36.83%76.13%30.78%45.78%29.73%28.62%32.86%60.99%52.94%72.57%49.58%35.16%51.71%61.06%68.52%57.73%58.86%67.55%12.62%37.96%35.12%23.14%
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Indirect deaths averted per direct death averted from vaccination0.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.5
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Relative risk for the incidence of vaccine-preventable diseases, with adjustments for coverage and lower vaccine efficacy in Nigeria
0.480.460.450.450.450.470.470.450.440.460.450.440.450.440.450.460.450.440.460.470.450.440.420.450.460.450.460.460.460.450.440.450.460.450.470.440.44
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Adjustment for all-cause mortality effect (goal-seek based on indirect deaths averted per direct death averted estimate)
1.291.321.271.251.391.331.321.341.241.291.251.231.241.231.251.361.241.381.331.391.391.371.271.311.251.321.371.321.291.261.291.291.271.451.361.371.41
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Relative risk for the incidence of vaccine-preventable diseases, with adjustment for all-cause mortality effect0.330.290.310.310.240.300.300.270.310.310.310.310.310.310.310.260.320.230.270.270.230.230.260.280.320.280.260.290.300.300.280.290.320.210.280.240.21
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Probability of death from vaccine-preventable diseases among unvaccinated children under 5 (direct only)1.5%2.3%0.8%0.9%3.0%1.3%1.1%0.9%0.9%1.1%1.4%1.1%1.0%0.6%1.0%2.2%0.7%3.5%1.9%2.1%2.4%2.5%0.9%0.6%0.5%1.2%1.2%0.6%0.8%0.4%0.5%0.9%1.1%3.4%2.2%1.7%3.7%
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Probability of death from vaccine-preventable diseases among unvaccinated children under 5 (direct and indirect)1.8%2.6%1.0%1.1%3.2%1.4%1.3%1.0%1.1%1.3%1.7%1.3%1.2%0.7%1.2%2.4%0.9%3.8%2.2%2.2%2.6%2.7%1.0%0.7%0.6%1.3%1.3%0.7%1.0%0.5%0.6%1.1%1.3%3.6%2.5%1.8%3.9%
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Deaths directly averted per person vaccinated0.010.010.000.010.020.010.010.000.010.010.010.010.010.000.010.010.000.020.010.010.010.010.010.000.000.010.010.000.000.000.000.010.010.020.010.010.02
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Total deaths averted per person vaccinated0.010.020.010.010.020.010.010.010.010.010.010.010.010.000.010.020.010.030.020.020.020.020.010.000.000.010.010.010.010.000.000.010.010.030.020.010.03
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Indirect deaths averted per person vaccinated0.000.010.000.000.010.000.000.000.000.000.000.000.000.000.000.010.000.010.010.010.010.010.000.000.000.000.000.000.000.000.000.000.000.010.010.000.01
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Indirect deaths averted per direct death averted from vaccination (calculated)0.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.50.5
90
Check on indirect deaths averted estimateTRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUETRUE
91
Adjustment for reductions in mortality from causes other than vaccine-preventable diseases1.291.321.271.251.391.331.321.341.241.291.251.231.241.231.251.361.241.381.331.391.391.371.271.311.251.321.371.321.291.261.291.291.271.451.361.371.41
92
Vaccine efficacy for vaccine-preventable disease from meta-analysis, adjusted0.670.710.690.690.760.700.700.730.690.690.690.690.690.690.690.740.680.770.730.730.770.770.740.720.680.720.740.710.700.700.720.710.680.790.720.760.79
93
Relative risk for the incidence of vaccine-preventable disease from meta-analyses, adjusted0.330.290.310.310.240.300.300.270.310.310.310.310.310.310.310.260.320.230.270.270.230.230.260.280.320.280.260.290.300.300.280.290.320.210.280.240.21
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Mortality reduction for children under 5
96
97
Probability of death from vaccine-preventable diseases for unvaccinated children under 51.8%2.6%1.0%1.1%3.2%1.4%1.3%1.0%1.1%1.3%1.7%1.3%1.2%0.7%1.2%2.4%0.9%3.8%2.2%2.2%2.6%2.7%1.0%0.7%0.6%1.3%1.3%0.7%1.0%0.5%0.6%1.1%1.3%3.6%2.5%1.8%3.9%
98
Ratio of the reduction in vaccine-preventable disease mortality to the reduction in vaccine-preventable disease100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%100%
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Number of deaths of children under five averted in cohort31123355410140210117133142029323417115413427413847
100
Value assigned to averting the death of an individual under 5 from vaccine-preventable diseases116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116116