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Will GiveWell fund SMS reminders for immunization by 1st January 2027?

Main Draft
23rd Oct
Josh Hart
Josh Hart 13:50

GiveWell has recommended grants to over 10 charities over the years. They are currently investigating 12 charity areas with other areas of research in the pipeline including SMS reminders for immunization.

The following sections are quoted from GiveWell’s explanation of the topic.

“Child vaccination prevents illness, disability, and death from vaccine-preventable diseases including diphtheria, hepatitis B, measles, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhea, rubella, mumps, and tetanus. However, vaccination rates in many settings fall short of full coverage.1 Among children who are vaccinated, some may be vaccinated later than recommended (delayed vaccination), leaving the child susceptible to disease for a longer period of time.

Short Message Service (SMS) reminders for vaccination are a demand-creation and behavior-change intervention aiming to increase uptake and timeliness of vaccination. Caregivers of young children who enroll in an SMS reminder program receive SMS messages soon before the child is due for a vaccination visit. Caregivers may enroll with a personal cellular phone or a shared cellular phone. The timing and number of messages may vary by program. The program may also include other health messaging delivered via SMS.

We are aware of six randomized controlled trials (RCTs) of SMS reminders for vaccination, five in sub-Saharan Africa and one in Guatemala. See Characteristics of SMS for vaccination studies, which draws on Charity Science Health's notes on evidence for SMS reminders for vaccination.

There is some limited evidence that SMS messages can notably increase vaccination rates in some sub-Saharan populations that already access vaccination services or clinic delivery2 and have moderate baseline vaccination rates. Of two studies with high baseline vaccination rates, both in Kenya, one found a notable effect on vaccination rates and the other found no effect. The four RCTs that found an effect of SMS reminders on vaccination rates (8.7 - 20 percentage point increase in third visit at age 14-16 weeks) measured effects only on early infant vaccination, and not on measles vaccination at nine months.

The pilot RCT in Guatemala did not find statistically significant effects of SMS reminders on vaccination rates.

Based on a cost-effectiveness model of Charity Science Health we put together in May 2017 and updated with our most recent moral weights as of February 2021, we estimate that sending SMS reminders for immunization is within the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021).20 However, there are several key factors about which we need more information. Cost-effectiveness of such programs is likely to be highly dependent on context-specific factors, such as baseline vaccination rates, disease incidence and mortality, reasons for non-vaccination, and a population's responsiveness to SMS reminders.

We are highly uncertain about the magnitude of effect on vaccination rates to expect in the population targeted by Charity Science Health. We are also highly uncertain about the baseline vaccination rate in this population, and disease incidence and mortality rates in this population. We are somewhat uncertain about the costs of implementing SMS reminders for vaccination program.”