80,000 Hours Podcast
#113 – Varsha Venugopal on using gossip to help vaccinate every child in India
18 Oct 2021
Our failure to make sure all kids globally get all of their basic vaccinations leads to 1.5 million child deaths every year.According to today’s guest, Varsha Venugopal, for the great majority this has nothing to do with weird conspiracy theories or medical worries — in India 80% of undervaccinated children are already getting some shots. They just aren't getting all of them, for the tragically mundane reason that life can get in the way.Links to learn more, summary and full transcript. As Varsha says, we're all sometimes guilty of "valuing our present very differently from the way we value the future", leading to short-term thinking whether about getting vaccines or going to the gym. So who should we call on to help fix this universal problem? The government, extended family, or maybe village elders? Varsha says that research shows the most influential figures might actually be local gossips. In 2018, Varsha heard about the ideas around effective altruism for the first time. By the end of 2019, she’d gone through Charity Entrepreneurship’s strategy incubation program, and quit her normal, stable job to co-found Suvita, a non-profit focused on improving the uptake of immunization in India, which focuses on two models: 1. Sending SMS reminders directly to parents and carers 2. Gossip The first one is intuitive. You collect birth registers, digitize the paper records, process the data, and send out personalised SMS messages to hundreds of thousands of families. The effect size varies depending on the context but these messages usually increase vaccination rates by 8-18%. The second approach is less intuitive and isn't yet entirely understood either. Here’s what happens: Suvita calls up random households and asks, “if there were an event in town, who would be most likely to tell you about it?” In over 90% of the cases, the households gave both the name and the phone number of a local ‘influencer’. And when tracked down, more than 95% of the most frequently named 'influencers' agreed to become vaccination ambassadors. Those ambassadors then go on to share information about when and where to get vaccinations, in whatever way seems best to them. When tested by a team of top academics at the Poverty Action Lab (J-PAL) it raised vaccination rates by 10 percentage points, or about 27%. The advantage of SMS reminders is that they’re easier to scale up. But Varsha says the ambassador program isn’t actually that far from being a scalable model as well. A phone call to get a name, another call to ask the influencer join, and boom — you might have just covered a whole village rather than just a single family. Varsha says that Suvita has two major challenges on the horizon: 1. Maintaining the same degree of oversight of their surveyors as they attempt to scale up the program, in order to ensure the program continues to work just as well 2. Deciding between focusing on reaching a few more additional districts now vs. making longer term investments which could build up to a future exponential increase. In this episode, Varsha and Rob talk about making these kinds of high-stakes, high-stress decisions, as well as: • How Suvita got started, and their experience with Charity Entrepreneurship • Weaknesses of the J-PAL studies • The importance of co-founders • Deciding how broad a program should be • Varsha’s day-to-day experience • And much moreChapters:Rob’s intro (00:00:00)The interview begins (00:01:47)The problem of undervaccinated kids (00:03:16)Suvita (00:12:47)Evidence on SMS reminders (00:20:30)Gossip intervention (00:28:43)Why parents aren’t already prioritizing vaccinations (00:38:29)Weaknesses of studies (00:43:01)Biggest challenges for Suvita (00:46:05)Staff location (01:06:57)Charity Entrepreneurship (01:14:37)The importance of co-founders (01:23:23)Deciding how broad a program should be (01:28:29)Careers at Suvita (01:34:11)Varsha’s advice (01:42:30)Varsha’s day-to-day experience (01:56:19)Producer: Keiran HarrisAudio mastering: Ben CordellTranscriptions: Katy Moore
Full Episode
Hi listeners, this is the 80,000 Hours podcast, where we have unusually in-depth conversations about the world's most pressing problems, what you can do to solve them, and how a bit of gossip can save a life. I'm Rob Woodland, head of research at 80,000 Hours. Most of us have at some point read about a randomized trial showing that some product or service really helps people out.
Maybe exercise programs for mental health or free vapes in order to help people quit smoking or electric cook stoves to reduce indoor air pollution and premature death. Sometimes those studies suggest the intervention is incredibly cost effective, offering huge benefits relative to their cost. And other times they might look too expensive to be a high priority.
But either way, we look at a summary of the study, think, huh, that's cool, and close our browser tab and never to think about it again. I mean, what are you going to do? Start an electric cookstove business? Well, today's guest, Varsha Vinugopal, decided to quit her job, roll up her sleeves, and do the equivalent of starting an electric cookstove business.
Except it isn't air pollution she's been trying to fix, it's young children going unvaccinated, just because their parents didn't make it a top priority to get them back to the doctor's office on time. We talk about a lot of big, high-level ideas in this show, and of course I totally love that stuff.
But none of those ideas matter if nobody figures out how to convert them into something that someone can actually do. A project that a real person can implement in this messy world of actual people, and then figure out how to scale it so they can go on and make a meaningful difference.
We haven't had so many episodes on that kind of thing lately, so I decided to go out looking for people on the sharp end of taking ideas about how to have a big impact and then executing on them. Varsha stood out for the process she used to figure out what to do, the success of her and her team building a presence in India, and her ability to explain all of it.
Varsha and her colleagues are still in the thick of growing, so fortunately they haven't forgotten what things are really like. I think everyone can get something out of this episode, but that's particularly the case if you want to start your own project or work in global health and development. All right, without further ado, here's Varsha Venugopal. Today, I'm speaking with Varsha Vinugopal.
Varsha started out her career studying urban and regional planning, then working as a local governance specialist at the World Bank for five years. She then did a master's in development management at LSE before working at the Natural Resource Governance Institute, the global health nonprofit called Options Consultancy Services, and the International Governance and Risk Institute.
But in 2019, though, she made a big career change and co-founded the nonprofit Savita, which aims to ensure that every child in India gets all of their basic vaccinations, which is what we're going to talk about today. So thanks for coming on the podcast, Varsha.
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