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Time to Vaccinate

By Joe Sugarman
Noor Sabah Rakhshani
Noor Sabah Rakhshani received a grant to develop a vaccination band that she conceived of as a doctoral student in public health.

It’s April 2012 and Noor Sabah Rakhshani is having a dream. In it, she sees herself fastening a band around a baby’s ankle as a mother looks on. When she awakens, Rakhshani, then a doctoral student at the Johns Hopkins Bloomberg School of Public Health, thinks her vision could be the answer to solving a problem that has vexed her for months: In her native Pakistan, where preventable diseases like polio, pneumonia, measles, whooping cough, and meningitis claim more than 100,000 lives annually, how can you ensure children complete their vaccinations?

After months of design challenges and frustrations involving bureaucratic red tape and arcane banking laws, Rakhshani’s dream is that much closer to reality. In September 2015, she and her team wrapped up an 11-month study involving 346 Pakistani children who received what Rakhshani dubbed the vaccine indicator reminder band, a soft strip of plastic designed to be worn around an infant’s ankle and used to remind family members when inoculations are due. The study was funded with a $100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation, which called the VIR band a “bold idea.”

The band employs something called a timestrip, a time-sensitive smart label often used in the food and pharmaceutical industries to indicate product shelf life, explains Rakhshani. After pinching an ink blister, a vegetable-based dye flows via capillary action along a membrane timed to signal when six, 10, and 14 weeks have passed—the intervals between an infant’s immunizations. (That design beat out another employing a blinking LED light, which anxious parents believed could target them for drone attacks.)

Traditionally, Pakistani mothers receive a vaccine record card after their baby’s first immunizations, but from her own experiences as a practicing physician before graduate school, Rakhshani knew that many women misplace the card. “Analysis of the Pakistan Demographic and Health Survey 2006–2007 data showed that only 13 percent of mothers were able to show the card to survey teams and that just 40 percent completed their children’s vaccine cycles,” she says. “I just keep thinking, ‘How can we get families to remember?’”

It was a long journey for Rakhshani and members ofher partner organization, Trust for Vaccines & Immunizations, a nongovernmental organization based in Karachi. She and her team had to overcome numerous barriers, including banking regulations that prohibited the transfer of money outside Pakistan; a fragmented, bureaucratic health care system that threatened to stop the study in the middle even after it was approved by the National Bioethics Board and the Expanded Program on Immunization; and the possibility of field workers being harassed or even killed by the Taliban, which has targeted polio vaccination teams after the CIA covertly used such organizations as a front to gather genetic information in the hunt for family members of Osama bin Laden.

“Mothers have said to us, ‘We don’t understand the card, give us the band, it works for us.’ That has been a big encouragement.”

And though Rakhshani is still crunching the data, she says initial reaction from mothers has been overwhelming. “Mothers have said to us, ‘We don’t understand the card, give us the band, it works for us.’ That has been a big encouragement.”

Rakhshani has already been awarded a follow-up grant to expand the study to communities in rural Pakistan and additional funds to launch a “community acceptance study” in Nigeria. She says that while the VIR could help with immunization programs in other countries, researchers will first need to consider potential cultural differences. “We know enough from previous public health programs that an intervention that works in one place may or may not work in another place,” she says, noting that some cultures may not accept the practice of strapping an anklet on an infant. “It has to take in the local context.”

For now, Rakhshani has a new dream: “[I want] to create awareness in communities that vaccination should be seen as a fundamental child’s right and a parent’s responsibility. We need to build up societal accountability for childhood vaccinations. Twenty-five percent of infant mortality in Pakistan is attributable to vaccine-preventable illnesses. If we can reduce that 25 percent, that’s a huge achievement.”

Illustration of a baby with an ankle band that reminds parents to inoculate them.
Image above by Livia Cives; Portrait by Caroline Andrieu

Noor Sabah Rakhshani’s vaccine reminder band uses a time-sensitive strip to signal when six, 10, and 14 weeks have passed, the intervals between an infant’s immunizations.

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