VIR Band+ Intervention:
Vaccine Indicator and Reminder (VIR) system for increased immunization coverage, timeliness and completion
VIR band, evaluated in Nigeria and Pakistan, provides active visual cue to action to parents for timely completion of immunization schedule.
Design ideation process: every aspect of the vaccination considered.
During VIR band ideation, we reviewed immunization programs in LMIC countries, vaccines in the routine immunization (RI) schedule, biological mechanism of vaccines providing immunity, dosage, and timing of vaccines. The societal value of vaccines and security issues surrounding the immunization program staff were also taken into account. The alpha prototypes were tested in house worn by the innovator and her infant son.
Human-centered design process: grandmother preferring a smooth flat material for the band which can be cleaned easily.
The form, material, and characteristics of a reminder method for timely completion of the routine immunization schedule were developed with feedback from the end users. Interviews were conducted with a representative sample of mothers, grandmothers, fathers, and routine immunization center staff and asked to choose from range of materials and different time indicator mechanisms
Mothers suggesting that the band should be worn by the infant since they have to perform household chores like cooking on an open fire and doing laundry which can damage the time indicator.
During the design phase, the fathers/grandfather and vaccinators suggested that the mother should wear the band but the mothers thought otherwise. The VIR band team decided to listen to mothers and design a band for infants keeping in mind safety and comfort in every element of the form and function.
Father of newborn supporting the idea of a reminder method for timely immunization.
The VIR band team asked study participants if they felt a need for a reminder method for completing the vaccination routine in a timely manner and if they would agree to use it for their children.
First-generation VIR band: Form and function study.
The VIR band was tested for form and function by enrolling 376 newborn infants in peri-urban settlements. The study assessed comfort and VIR band compatibility with day to day activities of infants. During this phase parental compliance and societal acceptance was also evaluated. The VIR band was very well received by mothers and caregivers especially among participants with no formal schooling.
Second-generation VIR band: redesign and testing in lab, office, and community.
Prior to the Formative Evaluation study, several rounds of testing in the community were carried out. Infants were identified by the community health workers and the study team contacted parents at their homes. The infants were provided the VIR band irrespective of their age and vaccination status and visited on a weekly basis to monitor the performance of the timestrip, parental compliance, and family feedback.
Third-generation VIR band: a product of almost two years of design and testing carried out during Jan-2013-April 2014 and modified during February 2016-April 2017.
Yellow VIR band is activated and issued on administering BCG vaccine (first immunization visit), purple band on administering the Penta 1 vaccine (second visit), Aqua band after administering Penta 2 (third visit) and when the child receives Penta 3 (fourth visit) parents are provided with the digital immunization record number.
Community engagement and communication prior to rolling out the VIR band intervention. Community feedback was actively sought and incorporated into the intervention design to ensure ownership: VIR band Formative Evaluation, Karachi, Pakistan January 2016-December 2018
VIR band Formative Evaluation, Karachi, Pakistan. Parents/caregivers engaged to enroll infants into the VIR band study.
Enrolling eligible infants into the pilot study and entering their health and immunization records online in real time. Children were enrolled at close birth (less or equal to two weeks of age) and after receiving the first dose of vaccine. Each infant was followed for up to 18 weeks and their records update at each of the subsequent visits at 6, 10 and 14 weeks. At the completion of RI schedule or if dropping out, exit interview was conducted. Parents were asked if they would recommend VIR
Describe what you intend to do and how you'll do it in one to two sentences (required 350 Characters)
VIR band+ intervention is multipronged: i) use community health workers to reach infant close at birth for vaccination initiation, ii) provide VIR band to serve as active visual cue to action for parents of vaccination due dates, and iii) utilize public private partnerships for zero missed opportunities for timely completion of routine immunization
Explain the innovation (2,500 characters)
Despite improvements in vaccine coverage over the past decade, globally 18.7 million children, one in every five, remain unvaccinated and over 2 million children die from vaccine-preventable diseases annually. Similarly, Pakistan is no exception, and immunization rates reflect abysmal rates of coverage, with only 43% of children complete vaccinations up to the first dose of measles.
The VIR band intervention will benefit under the age of two children by reaching every child and providing parents/caregivers visual cues to action for timely and complete immunizations to reduce mortality and morbidity caused by infectious diseases. The intervention will enhance immunization program efficiency by maximizing utilization. It will benefit families and health care system by saving costs from healthcare seeking expenditure and prevent loss of national GDP due to disability and failure of the new generation to reach cognitive potential.
The VIR band is an innovative device that has been undergone rigorous testing for safety, performance, accuracy and parental compliance. It is tied to child's ankle after they receive their vaccines and serves to provides a persistent visual cue for caregivers to vaccinate their children in a timely and complete manner.
The VIR band is a silicon anklet consisting of three main parts; 1) silicon band, 2) encased “Timestrip” indicator and 3) one-time locking button. The silicone band is FDA approved and has an embossed unique identification number that is used to connect the child to his/her digital records stored in a computer and cloud database. VIR is equipped with 'Timestrip', which when activated changes color by red ink moving along a white membrane at a time-controlled rate thus showing time elapse since last vaccine received. The red ink is a natural dye in vegetable oil and safe for humans even if ingested. The VIR band has been evaluated in Nigeria (rural areas) and Pakistan (urban slums) and has demonstrated very high parental acceptance and compliance. The innovation is also well received by health policymakers in both countries and by international development organizations for scale-up.
The VIR band intervention will target urban slums and internally displace populations living in Karachi who live under the radar out of reach of healthcare system. The limited education and resources available in these communities put them at risk of not seeking healthcare which the intervention will address by reaching out.
Which part(s) of the world does this innovation target?
VIR band evaluation in two continents and presented globally at research and policy forums support the introduction of innovative intervention for early adoption and scale up within all countries with dismal immunization coverage and timeliness indicators especially the LMICs of Africa and Asia.
Who will work alongside your organization in the project idea? (1,000 characters)
During the VIR band proof of concept and formative evaluation study, we partnered with national and provincial health departments and Expanded Program on Immunization (EPI). In the upcoming phase of early adoption, we will leverage our relations with entities mentioned above to deliver the intervention through outreach system of various cadres of community health workers, birth attendants (trained and traditional), EPI fixed and outreach staff and private healthcare providers active in the communities. To have a sustained impact, we will engage civil society organizations, faith-based, social welfare and educational institutions. Influencers, youth and women from the community will also be engaged to strengthen the delivery of our programmatic messages, promote uptake of the VIR band and dispel misinformation and mistrust regarding vaccine and related programs. Through our waste network, we will be able to access and serve hard to reach, marginalized and mobile populations.
How is your idea unique? (750 characters)
VIR band leverages low cost tech which has the ability to gives active and timely visual cue to caregivers of the vaccine due time. SMS vaccination reminders depend on mobile phone ownership thus by default excludes parents who don’t have access to a device. In LMIC most cell phone accounts are pre-paid, and parents on average for 3-4 months don’t have funds to keep their accounts active. Low connectivity/coverage and interrupted electricity further reduce effectiveness of SMS. Other wearable reminder bands use symbols and beads which don't provide active visuals to caregivers where as VIR band has built in time indicator. VIR band has are no electronic components thus acceptable to mobile populations who fear being tracked by authorities.
What is the name of your organization
Precision Health Consultants (PHC) Global
Explain your organization (250 characters)
A group of like-minded professionals founded PHC Global with the intent of creating a space enabling innovations for improving lives by transforming healthcare. VIR band draws from our core values to introduce low-cost, high impact tech to save lives
Type of Submitter
We are a For-Profit Startup or Startup Social Enterprise
Women’s health/rights focused organization
Displaced person / refugee-led organization
Community-led organization (CBO)
Gender and Diversity (500 characters)
PHC Global is a female-led gender sensitive organization and is an equal opportunity employer. Beneficiaries of our development programs and research studies are mostly women and young girls. We have worked towards empowering women by equipping them with knowledge and skills to seek health care, education and achieve economic empowerment. We particularly encourage female applicants to compete for vacant positions and have devised a gender-sensitive scoring system for selection.
Organization Location (less than 250 Characters)
PHC Global is headquartered in Karachi, Pakistan with extensive reach throughout the country through partnerships with local NGOs/public sector. We are registered with Security Exchange Commission (SECP) and Federal Board of Revenue (FBR) of Pakistan
Size of organization (number of employees):
Scale of organizational work
National (expansive reach within one country)
Tell us more about you
The VIR band team consists of trained researchers, operational experts and supportive field staff of energetic and dedicated young men and women. The team leadership has well-known track record of working for almost two decades in immunization programs in Pakistan and globally. The VIR band team has built strong connections with program stakeholders and are a household name in the communities it has served. The organization will be the focal point in intervention implementation and advocacy.
Dr. Noor Sabah Rakhshani, DrPH, MPH, MBBS
VIR band innovator
Principal Investigator (PI) VIR band Proof of Concept Study
Principal Investigator (PI)VIR band Formative Evaluation, Nigeria and Pakistan
Applying to Gavi INFUSE
Received an Email