Our Recommendation
New Incentives is a high‑evidence, highly cost‑effective organization that uses conditional cash transfers to dramatically increase infant vaccination coverage in northern Nigeria, with gold‑standard RCT evidence and strong external validation. For donors seeking maximum lives‑saved per dollar through a focused, measurable intervention, New Incentives is one of the strongest available options.
New Incentives' Fierce Certification score is 76/100 points based on our criteria:
✔ Has Ultimate Outcome Goals (20 pts)
✔ Measures Intermediate Outcomes (15 pts)
◪ Measures Ultimate Outcomes (5 pts)
◪ Measures Intermediate and/or Ultimate Counterfactual (10 pts)
✔ Shows Continual Learning & Adaptation (25 pts)
The Social Problem
New Incentives addresses low routine childhood vaccination rates leading to preventable child deaths in northern Nigeria. In this region, coverage of key infant vaccines has historically lagged national targets, leaving many children unprotected against measles, pertussis, tetanus, and other deadly diseases. Weak demand, travel costs, opportunity costs for caregivers, and practical barriers at clinics all contribute to under‑immunization and the continued burden of vaccine‑preventable disease.
The Solution
New Incentives’ solution is to offer small, conditional cash transfers to caregivers when their infants receive specific routine vaccinations at government clinics, directly addressing the economic and behavioral barriers to completing the schedule. The program enrolls infants, tracks their vaccination status, and pays caregivers upon completion of key doses, while working within existing public health facilities and aligning with government immunization policies. The intervention is tightly focused, evidence‑driven, and designed for high cost‑effectiveness, with constant monitoring of cost per enrolled child and per fully vaccinated child.
Key Outputs
Key outputs include:
- Infants served: as of late 2024, New Incentives reports serving about 6.7 million infants with its cash‑for‑vaccination program.
- Geographic expansion: the program has scaled from ~70,000 children in 3 states in 2020 to ~1.5 million children annually in 9 states by 2023.
- Transfers delivered: tens of millions of conditional cash transfers have been made to caregivers at vaccination visits, though the exact number varies by period.
- Cost per child enrolled: cost per enrolled child has fallen from about $39 in 2020 to roughly $18 in 2024, due to economies of scale and operational efficiencies.
These outputs demonstrate both reach and improving cost‑efficiency as the program scales.
Key Intermediate Outcomes
This is where New Incentives' evidence is strongest. The independent IDinsight RCT found that the program raised full routine immunization by 27 percentage points over the control group, from 25% to roughly 52%, with tight confidence bounds and high statistical significance.
Individual vaccines rose in step (BCG +16 pp, Penta-1 +21 pp, Measles +14 pp), children were 33 percentage points more likely to get the measles vaccine on time, and clinics were far less likely to run out of stock.
Key Ultimate Outcomes
New Incentives does not measure its ultimate outcome, children surviving who would otherwise have died. No study followed treatment and control children to compare mortality.
The widely cited "lives saved" figures come from GiveWell's cost-effectiveness model, which converts the RCT's proven coverage gains into estimated deaths averted using established vaccine-efficacy and background-mortality assumptions, arriving at a range of roughly $1,500–$6,000 per death averted.
We regard that modeled estimate as credible, because the underlying vaccine science is about as settled as evidence gets. But credible modeling is not the same as measurement, and under our framework the ultimate outcome here remains inferred, not demonstrated.
Continual Learning & Adaptation
New Incentives demonstrates a strong learning culture:
- Its “Pilot. Test. Scale.” mantra reflects a deliberate sequence of small‑scale trials, RCT testing, and then rapid—but monitored—scale‑up.
- It publishes regular impact and financial reports, responds to external re‑analyses (e.g., GiveWell’s error correction and updated cost‑effectiveness), and adapts its operations to improve cost per infant and program efficiency.
- The organization refines its site selection, enrollment, and payment processes based on data and partner feedback, while remaining tightly aligned with the evidence that its core mechanism—conditional cash transfers—moves the needle on vaccination.
Altogether, New Incentives embodies our desired cycle: an explicit theory of change, implementation disciplined by that theory, rigorous counterfactual evaluation, and iterative adaptation guided by data and external scrutiny.
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