A randomized controlled trial published in Human Vaccines & Immunotherapeutics provides new evidence that small conditional cash incentives can substantially increase tetanus toxoid (TT) vaccination coverage among rural women in Nigeria. The study enrolled 3,371 women across 80 communities in Ebonyi State and randomly assigned them to receive either no incentive (control), a small incentive (500 Nigerian Naira per dose), or a larger incentive (2,000 Naira per dose) to complete the two-dose TT series. The results were striking: uptake of at least one TT dose rose from 18% in the control group to 42% and 62% in the small and large incentive groups, respectively. Completion of the full two-dose series also increased significantly, highlighting the effectiveness of financial incentives in improving maternal immunization rates.
The findings have critical implications for reducing maternal and neonatal tetanus (MNT) in regions where vaccine uptake remains low despite high disease burden. The study suggests that even modest cash payments—delivered in a straightforward, transparent manner—can address demand-side barriers such as transportation costs and lost income. With maternal immunization increasingly prioritized in global health agendas, this research adds timely and locally grounded evidence supporting the use of targeted incentives as part of broader strategies to expand vaccine access and protect maternal and newborn health.
Thumbnail image credit: Gavi
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