New Incentives

The problem

Vaccinations are a global success story and save millions of lives every year. The World Health Organization (WHO) describes them as one of the best health investments money can buy.^[1] However, despite enormous progress, vaccination rates worldwide have not improved in recent years. The COVID-19 pandemic placed a heavy burden on health systems in 2020 and 2021, even leading to dramatic setbacks in some cases. Although there are signs of recovery, 14.5 million children worldwide did not receive a single vaccination in 2024.^[2]

In Nigeria, 33% of all children will not have received all recommended vaccinations by 2024.^[3] With 115 deaths per 1,000 live births, Nigeria had the second-highest mortality rate in the world for children under five in 2024. (By comparison, the rate in Germany is less than four.) In absolute terms, Nigeria actually has the highest number of deaths among children under five. The country is home to about 3% of the world’s population, but accounts for about 16% of all deaths worldwide among children under five.^[4] Low vaccination rates are a major reason for this—an estimated 38% of deaths among children under five are due to vaccine-preventable diseases.^[5]

Poor people living in remote rural areas often have little access to healthcare. In Nigeria, routine vaccinations for children are offered free of charge in state clinics. However, parents often cannot afford the trip to the clinic—which can take half a day or longer—due to transportation costs and potential loss of income. And to complete the full routine vaccination schedule, this round trip to the clinic must be made six times within the first year of a baby’s life.

The solution

In collaboration with government clinics and in conjunction with existing programs in Nigeria, New Incentives offers parents small cash rewards, known as “conditional cash transfers”, when it is confirmed that their child has received the latest vaccinations. New Incentives focuses on the regions with the lowest immunization rates in northern Nigeria. There, fewer than one in three children receive all the recommended vaccinations. A quarter of children are not vaccinated at all.^[5]

The cash rewards, which are paid out during six visits to the clinic in the child’s first year of life, amount to 1,000 naira each, totaling around €3.60 or CHF 3.33. This small amount is sufficient to cover transportation, medication, food, and lost income for the families. In addition, New Incentives pays parents 5,000 naira when their children have completed the entire routine vaccination schedule, bringing the total incentive to 11,000 naira (≈€6.60 / CHF 6.10).

The impact

New Incentives developed its program based on a series of studies that show, among other things, that conditional cash transfers can improve health behavior^[7] and that small incentives can significantly increase vaccination rates.^[8] Taken together, the research suggests that small cash incentives can be a highly cost-effective way to increase immunization rates in areas with low rates.

Since the specific model used by New Incentives and the local context in northern Nigeria had not yet been evaluated, the organization had its model thoroughly tested in a randomized controlled trial. The study found clear evidence that the program significantly increases vaccination rates.^[9]

Based on the findings that vaccine-preventable diseases are a major cause of child mortality in northwestern Nigeria and that vaccines effectively prevent disease, the GiveWell research initiative is convinced that the New Incentives program can contribute to a significant reduction in child mortality in northwestern Nigeria. GiveWell estimates that with every donation of USD 4,500 (≈€3,900 / CHF 3,600), New Incentives saves the life of one child—that is, ensures that a child remains alive who, statistically speaking, would otherwise have died from an infectious disease without vaccination.^[10]

The organization

New Incentives was founded in 2011 by Svetha Janumpalli in the USA. Svetha founded New Incentives to familiarize the nonprofit sector with conditional cash transfers, which are among the most researched, evidence-based instruments of development cooperation. For her work, Svetha was named one of Forbes’ “30 Under 30” social entrepreneurs in 2012 and was the winner of the Women Deliver Social Enterprise Challenge in 2013.

Her organization, New Incentives, has impressively scaled up its work to support vaccination campaigns in Nigeria in recent years. The team now consists of over 3,100 employees, more than 2,700 of whom work in Nigeria. In 2022, New Incentives reached its millionth child. Since its formation, New Incentives has enrolled over 6 million young children, disbursed approximately 26 million cash transfers, and encouraged over 90 million vaccinations. They regularly publish new figures on their website.

GiveWell has supported New Incentives since 2014 and has listed the organization as a “top charity” since November 2020.