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A Vaccine Photo Safari

December 11, 2012

Vaccines are powerful tools for improving the lives of children and communities. They reach nearly all children at least once in the first year of life, and four out of five children multiple times. But we don’t reach everyone, and some children receive their shots late, leaving them unnecessarily vulnerable to disease. 

At the Gates Foundation, we believe that we can improve our immunization systems by empowering health workers with timely, accurate data. The importance of improved data was evident to me on a recent trip to the field in western Kenya. Here I’ll use a sort of ‘photo safari’ to illustrate the challenges to capturing, reporting, analyzing, and using accurate, timely data to guide vaccination programs in developing countries.

Here’s an example of a small government-run dispensary in a rural part of Africa.


In this case, the dispensary is staffed by an organized, motivated nurse named Ben.

When the vaccine arrives, it goes into a refrigerator like this one, where the vaccine needs to be kept between 2-8 degrees, even if the power goes out.

The way we currently monitor the vaccine refrigerator temperatures is to record each day, and then the observed temperature of the vaccine gets recorded on a notebook like this one. This data is useful for supervisory visits because it is an indication that efforts are being taken to maintain the cold chain temperatures, but it doesn’t monitor the temperature of the fridge on a regular basis. To do that, Ben leaves a light on in his house. The fridge and his light bulb share the same power grid so if it goes out he knows he needs to get the vaccine into a cold box with a freezer pack.

He is diligent and accurate in tracking his vaccine stocks. He knows when he got vaccines in from the district vaccine store and he has an accurate record of what’s in his refrigerator. The daily logs indicate how many shipments took to the clinic to deliver and how many were returned to the fridge later, a figure he then reconciles with the figures from the start of the day.


But the current “system” doesn’t provide real-time data back to the central levels. At this time, the system relies on Ben to send a text message (often from his own personal phone and at a cost to himself) every Friday. You can see Ben’s hand-written message on top of the refrigerator here.


Next, how does Ben know where to look for the children in his community? In an era when satellite maps live on virtually every smartphone, Ben depends on a hand-drawn cartoon map like this one (and local knowledge, of course).


Finally, when Ben has successfully vaccinated a child, he records it twice. Once on the child’s immunization and health card, and also on a logbook register like this one. 


But the reporting back to his supervisors, a figure that becomes the basis for most national estimates of vaccine coverage, is based on a simple tally sheet like this and gets rolled up on a weekly or monthly basis.

It’s a credit to Ben and all the frontline health workers like him that they’ve succeeded in reaching so many children with these simple information systems. But in an era when our systems are expanding rapidly to give even more vaccines, to reach additional age groups, and to do so with increasing efficiency, we will rapidly find the limits of these systems and leave too many people unnecessarily vulnerable to vaccine-preventable disease. I’m optimistic that during the Decade of Vaccines we’ll successfully transform these systems using cell phones, new software, and innovative equipment to bring the power of vaccines to ever more communities, and for a lower cost.

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