My first memory of vaccines takes me back to when I was about three years old. Because I was prone to tantrums (and quite good at them, I might add), my mother would bribe me if I promised not to cry during my “shots”. At the time, I valued vaccines because they were a way for me to collect more Barbie dolls or TY Beanie Babies. I decided that the pain they brought was worth the good they also seemed to bring.In sixth grade, I had to do a project in my science class, and I was assigned the topic of Edward Jenner. I learned that Jenner pioneered the first vaccination, which was for smallpox, by studying the cowpox virus. This led me to create a home video in which I was dressed up as Edward Jenner and my friend was dressed as a cow. The video was a hit with my class, and my research on the topic led me to begin viewing vaccines as magical—how else could they prevent people from getting sick?
As a first year medical student taking microbiology, I became more aware of the ways in which vaccines truly impact health, both on a personal and global scale. For example, smallpox has been eradicated, saving an estimated 5 million lives annually. An outbreak of polio has not been reported in some time, making it likely that this debilitating disease may also be a matter of history. If children and infants are immunized, many life-threatening illnesses can be avoided and maybe even annihilated. This is a powerful concept.
My respect for vaccines grew even more when a group of researchers from Mayo Clinic used a high-dose measles vaccine in a clinical trial for multiple myeloma, and one woman was cured. I am not claiming that all cancer, or even all of multiple myeloma, will be eradicated by measles vaccines. However, I do believe that vaccines and our understanding of them may open doors in many fields of research. In a way, I still feel like they are a bit magical. Yet, until I began my internship earlier this summer, I did not realize just how much I have always taken vaccines for granted. I have never stopped to consider what a difficult process it must be for healthcare professionals and mothers to keep track of infants’ immunizations. Luckily, most of this is done by electronic medical records in our country. However, I had never stopped to think about the countries without electronic medical records—the countries that still rely on paper immunization cards. While it may sound easy to keep up with an important paper document in the United States, mothers in many other countries may not have this luxury—especially if they travel miles on dirt paths, often on foot, through rough terrain to reach the clinic. It is also difficult, much of the time, for these mothers to make their journeys back to the clinic for their infants’ subsequent vaccinations. Thus, the infants do not often receive all the shots in a series that are sufficient for complete immunization.
As a result of the challenges faced by mothers who live in poverty, in very rural communities or with low education levels, many infants and children in developing nations do not receive full or timely vaccination. Take Peru, for example. Despite Peru’s relatively high vaccine coverage compared to other developing countries, the children in poverty often do not receive their immunizations. Perhaps as a result, a child under five years of age who is born in the poorest 20% of the Peruvian population is five times as likely to die as a child born in the wealthiest 20% of the population (World Health Organization). This situation is not unique to Peru.
Lauren Braun, a 2011 graduate of Cornell University, discovered this problem firsthand during a 2009 summer internship in a public health clinic in Cusco, Peru. Struck by what she saw as one of the major contributing factors to the low vaccination rates in Cusco—a lack of communication and follow up with mothers in rural areas, Lauren came up with an idea. She found a way to remind the mothers of exactly when their infants were due for vaccines (and which vaccines they were due for), so that even if they lost the paper or were unreachable via phone or mail (which was often the case), the mothers would still be able to look out for their children’s best interests by getting them vaccinated on time. Her idea came in the form of a simple silicon bracelet. Lauren founded an organization to create and promote the use of the bracelets and called it Alma Sana (which translates in Spanish to “healthy soul”). She received a Gates Foundation grant through their Grand Challenges Explorations initiative in November of 2012 and began a Phase I study of her vaccine reminder bracelet in both Cusco, Peru and in Tena, Ecuador.
The results were astounding:
- 91% of mothers said the bracelets helped remind them of their children’s vaccination visits.
- 90% of mothers said they would like to continue using the bracelets as reminders in the future.
- 87% of mothers said they would recommend the bracelets to other parents to use.
Due to the success of the bracelets, Alma Sana is in the process of planning a Phase II study—a randomized controlled trial and impact evaluation in Nigeria, Pakistan, and Colombia. The goal of the Phase II study is to determine the bracelets’ effectiveness at reminding mothers of the vaccination dates—to see whether the bracelets’ use impacts vaccine completeness, timeliness, and coverage. The bracelet will also be redesigned for each country to fit parents’ unique needs, preferences, and cultural values. What does any of this have to do with me?
I met Lauren via an interview on Skype because I had read about Alma Sana and wanted to help as a summer intern. I have had the honor of helping to plan the fundraiser for the Phase II study, a crowdfunding campaign, which just launched a few weeks ago!
I have gotten a lot from my experience with Alma Sana.
- I had a lot to learn about communications. I admit that I expected that the internship would be an easy job for me, that I would be a “natural” at emailing people in different public relations positions and finding donors for the cause. I am, after all, a good communicator. This was a naive Perhaps, as a medical student, I assumed that anything would easy compared to studying medicine. This is not true.
- Public health initiatives really matter. I am still surprised at the results of Alma Sana’s Phase I study and the impact that a simple bracelet had on mothers who truly want the best for their infants but need a feasible way to keep up with the vaccine schedule. Increases in immunization rates lead not only to increases in infant and childhood survival but also declines in life-threatening viruses worldwide. I believe that immunization is the key to the eradication of many illnesses that have plagued humans for centuries. Organizations like Alma Sana can help change the future of how we approach disease prevention.
- One person can make a big difference. I am constantly inspired and humbled by Lauren, who left a corporate job at Humana to pursue Alma Sana and her dream full-time. There are many times in life when we encounter problems, and most of the time we turn our backs because we do not feel responsible for creating solutions. Lauren did not turn her back on the problem she found in Cusco. She found a way to help, and she won’t stop fundraising until she is able to test her vaccine bracelet in many other countries. I am now eager to face the problems that come my way in the healthcare profession—and find solutions for them.
- We need each other. Ultimately, though, we are all connected. If we are serious about having a sustainable, long-term impact on vaccinating every child, then we all have a shared responsibility as global citizens to support those change-makers. Beyond that, those of us playing the game of healthcare have a responsibility to work as a team, not in isolation.
Whether you are a medical student, a physician, or someone who happened upon this blog, next time you think about vaccines, take a moment to be thankful for what you have at your fingertips in the United States. While you’re at it, take a look at Alma Sana’s crowdfunding campaign page. I encourage you to share this important project with your fellow med students, public health friends, and families so that the full impact of this project on children’s lives can be realized where it’s needed most. Together let’s vaccinate all the world’s children.
Maggie is a second year medical student from small-town Mississippi who serves as a Mayo Medical School Class Representative. She is interested in end-of-life care and is a collaborator on a clinical research project in the field of pediatric hematology. She hopes to one day have a career in pediatric hematology and oncology.