Low Tech Life Saver: How the Immunity Charm is Saving Children

Afghanistan has some of the lowest vaccination rates in the world, which contribute to high levels of infant and childhood mortality especially in poor and rural communities.  Diseases that are rare in the developed world are far too frequent causes of child mortality in Afghanistan.  

 “The opportunity [to tackle the issue] came about last year when McCann Global Health and McCann Health India were working through a contract with UNICEF to support the Afghanistan Ministry of Public Health (MoPH) to develop more effective health communications strategies,” said John Cahill, Global CEO, McCann Health. 

After spending some time in Kabul working on health issues with the MoPH team, McCann Global Health’s Senior Medical Advisor, Dr. Daniel Carucci became acutely aware of the the need to develop more effective ways to increase vaccination rates and he shared this insight with Dr. Harshit Jain, Marketing Director (APAC) & Country Head (INDIA), McCann Health.  They discussed ways of harnessing traditional beliefs to overcome cultural barriers to immunization that could be easily implemented and immensely scalable. Together they came up with The Immunity Charm™ as a potentially powerful way to drive mothers to get their children vaccinated and provide a readily visible means of tracking vaccinations.

“From the very beginning of realizing the bigger creative idea of just what this simple insight could achieve, McCann Health India, led by Dr. Jain, began a journey of collaborative thinking and contributions with our colleagues at McCann Worldgroup India that resulted in a campaign rich with initiatives and executions,” said Jeremy Perrott, Global Chief Creative Officer, McCann Health. “The beauty of this innovative charm was the charm itself.”

Perrott continued, “Prasoon Joshi, Chairman McCann Worldgroup Asia Pacific CEO & CCO McCann Worldgroup India has been a huge champion of this idea and has given his full support. The concept of The Immunity Charm resonated emotionally with his teams too, who enthusiastically engaged in the production of bringing the idea to life in strategy, in execution in posters, in video, in packaging, in digital and actual production of the bracelets themselves. It’s a testament to McCann’s commitment as a global network to creativity, collaboration, integration and humanity.” 

Mr. Joshi added, “When an idea is seeded into culture and plays a meaningful role in people's life, the impact and salience is far reaching.”

“Believe it or not, it happened at a dinner Dr. Carucci was having with Dr. Jain and his family,” said Cahill. “Dr. Jain’s 8-month old son was wearing a traditional thread bracelet widespread among South Asia cultures designed to protect children from evil forces – and that sparked the initial idea.” 

Dr. Carucci asked about the bracelet’s significance, which led to a discussion about whether a similar bracelet could be developed that harnessed this long-standing cultural tradition and be linked to protection from disease through vaccination. They decided it was a powerful idea and committed to work together to develop and test the concept in partnership with MoPH Afghanistan.

In some places, the lack of information or perceived conflict with traditional practices and beliefs, mean that caregivers do not recognize the value vaccines have for the health and well being of their children. To overcome both the information gap and cultural bias against vaccine, Dr. Jain and Dr. Carucci, realized that they needed to reframe the issue to show both the value of vaccines and how immunization practice can be consistent with traditional values.

Together with MoPH they designed a program by which healthcare works developed a program by which healthcare workers would provide The Immunity Charm™ to mothers to place on their newborn’s wrist as a symbol of protection against disease.  Each time the child is brought for an immunization, a color-coded bead corresponding to the specific vaccine received is added to the bracelet symbolizing the protective effects of the vaccine.  As the child receives additional vaccines against such diseases as measles, polio, diphtheria, and others, colour-coded beads are added to the bracelet.  

In April 2016, Harshit and Dan were invited to present at a workshop in New Delhi sponsored by The World Bank to discuss how insight-driven communications can drive uptake of healthcare products and services to change people’s behavior. During this workshop, they established the relationships with the MoPH that eventually led to working together on this project. 

In October 2016, after spending time in Kabul working with the MOPH team, Dan met with Harshit to review their work. They knew there was a need for a more effective vaccination program and He shared this insight with Harshit and together they devised The Immunity Charm™ concept.

In India, Dr. Jain led his team at McCann Health India in collaboration with McCann Worldgroup to bring the creative idea to life and produced the communications materials for The Immunity Charm™ campaign that included Posters, a Parent’s Guide Brochure, a Training Video and a Training Manual for Healthcare Providers in English and Pashto as well as an Immunity Charm Kit. They prototyped concepts which lead to a kit that included a simple bracelet comprised of black thread and screw enclosure preloaded with a nazar charm and a series of black beads. The nazar or “evil eye” is an ancient, deep-rooted traditional symbol of protection and coloured beads representing each of the EPI vaccine antigens are provided with the kit. 

We began training healthcare workers and testing the Immunity Charm in a public health vaccination centre in Kabul, Afghanistan at the end of March 2017.  Much of the background technical support and coordination with MoPH to get the bracelet into the market was done by McCann Global Health, led by president, Andrew Schirmer, whose team also designed the web site at http://www.theimmunitycharm.org

However, putting the Immunity Charm into action was not straightforward and without issues. With security threats, logistics problems and a poor communications infrastructure, Afghanistan was a challenging place to work. 

“In fact, it is these very challenges that contribute to the state of poor health of women and children in these communities,” said the team. “But it is also why a simple and inexpensive bracelet that is tied to powerful cultural beliefs has the potential to be transformative for children’s health.  What has made the project a success, was the personal connection we established with the dedicated staff at the MoPH and their partners in country.  

Although the hard data establishing long-term effectiveness will be established over the coming months, early qualitative feedback has been positive. Demand for The Immunity Charm has been overwhelming with bracelet demand being triple what we had anticipated.  But more importantly, health workers told us that the Immunity Charm has stimulated conversations among mothers about vaccines, mothers never discussed vaccinations in detail, were now speaking about them with enthusiasm discussing which vaccines their children had received.  Mothers are actually asking for the bracelet for their other children.  

Dr. Carucci summarizes the power of The Immunity Charm™ in three important ways: First, mothers see The Immunity Charm™ as a symbol of protection against disease and as being a good mother among her peers. It is a visible symbol to influential family and community members to encourage mothers to have their children vaccinated. And third, for healthcare workers, it is an additional and readily visible indication of a child’s immunization status of children (if the official immunization record is not available.)

Once detailed effectiveness data is available (end 2017), the development community will evaluate scale-up efforts.  

Will it charm the rest of the world?

The problem of parents being unable to keep track of infants’ vaccinations is one that affects many parts of the world, not just Afghanistan, and is particularly problematic in places where people are displaced and forced to leave their homes. In the first wave of the project the team is focused on getting it up and running in Afghanistan and India.

“Right now, we’re focused on Afghanistan and India, and ensuring that this community’s needs are well met,” said Cahill. “Additionally we would like to start generating some robust metrics, learn from these, and refine the idea and communication moving forward – we are definitely interested in making this global in a well thought out systematic way.”

But could it work in parts of the world where the baby charm bracelet is not an existing tradition? “We believe so – it just has to be made culturally relevant – it has an immediate tie in with a very powerful universal truth – a mother’s instinct to protect her children,” said Cahill.

Jeremy Perrott added, “We feel we can take the charm bracelet to a wider, more far reaching audience and it could be embraced by diverse cultures, communities and ethnicities around the world. Moving beyond traditional culture, we believe it could also be relevant in modern, pop culture and fashion enabling it to continue its journey of education, enlightenment and knowledge to all who wear and see it. “

“The concept of protection against evil forces is widespread throughout South Asia, and even in pockets across the world including the U.S. within diaspora populations.  However, we have had discussions with global health leaders in Africa who feel that the Immunity Charm could actually create a new social norm around vaccination, and so may work to drive vaccination and compliance rates there as well,” explained Carucci.  

Rather excitingly, the team is working on the project with a number of UN agencies so watch this space – news soon. In particular, they’re seeing enthusiastic support from the broader development community, who see The Immunity Charm™ as an inexpensive and powerful new tool in reducing childhood mortality and to improve the impact of investments in vaccination programs. With additional effectiveness data, we will have further discussions with them regarding taking The Immunity Charm™ to scale.

In a year where crazily advanced tech, like artificial intelligence has been such big news, it’s striking to see a project that leverages tradition and culture rather than fighting against it.

"The beauty and simplicity of the Immunity Charm is how it harnesses powerful existing belief systems to improve the perceived value of vaccines among mothers in rural communities", said Dr. Jain.

Cahill added, “In all the work we do at McCann Health we honour the influence of culture, climate and creed on health – our global footprint enables us to see first-hand how people live their lives and how this living affects the way they manage their health needs.”

Why simple ideas worked a charm with Cannes juries…

At this year’s Cannes, The Immunity Charm was the first of six Grand Prix trophies to go to McCann Worldgroup. It was also strikingly analogue – as most of the year’s big winners were. Just look at Fearless Girl, another McCann project that took home of clutch of top awards. So why are these lo-fi ideas so appealing?

 “One word: empathy. In a world of technological enablement many have been left behind – ideas that can bring everyone with them will win big time,” said Cahill.

Jeremy Perrott, Global Chief Creative Officer, McCann Health added, “When you stand back and look at the work that resonated most in Cannes this year, from consumer to health, it’s very interesting to note that the two most awarded pieces were not traditional executions. Instead they were a statue of a little girl and a simple bracelet.”

Perrott added, “These are incredible examples of change and human engagement as well as empathy, humanity, human connection and powerful messaging. It’s a message to us all, that we can still be surprised -- even the most hardened among us – and that discovery of the unexpected is still rich, and out there to be found. ” 

Now that the excitement and, let’s face it, silliness of Cannes is out of the way, the team can re-focus on the next steps for the Immunity Charm. And, according to Cahill, the hope this simple tool will revolutionise childhood health in developing countries.

“We see the Immunity Charm as a powerful new, simple, and inexpensive tool that countries will be able use to improve vaccination and compliance with the full set of childhood vaccinations.  We will work with the development community to ensure that The Immunity Charm has the impact on the health and well being that we hoped it would, improving vaccination rates, and saving lives.”