Digital 'nudges' to increase childhood vaccination compliance: Evidence from Pakistan

Abstract: Pakistan has one of the lowest rates of routine childhood immunization worldwide, with only two-thirds of infants 2 years or younger being fully immunized (Pakistan Demographic and Health Survey 2019). Government-led, routine information campaigns have been disrupted over the last few years due to the on-going COVID-19 pandemic. We use data from a mobile-based campaign that involved sending out short audio dramas emphasizing the importance of vaccines and parental responsibilities in Quetta, Pakistan. Five out of eleven areas designated by the provincial government were randomly selected to receive the audio calls with a lag of 3 months and form the comparison group in our analysis. We conduct a difference-in-difference analysis on data collected by the provincial Department of Health in the 3-month study and find a significant 30% increase over the comparison mean in the number of fully vaccinated children in campaign areas on average. We find evidence that suggests vaccination increased in UCs where vaccination centers were within a short 30-minute travel distance, and that the campaign was successful in changing perceptions about vaccination and reliable sources of advice. Results highlight the need for careful design and targeting of similar soft behavioral change campaigns, catering to the constraints and abilities of the context.