Vaccination programmes now represent a major part of the effort devoted to improving the health of children in developing countries. These donor-funded programmes tend to be global in scope and focus on worldwide goals and targets such as 'polio eradication', and the Millennium Development Goals. Health policy makers at the national level are expected to implement these programmes in a standard manner and report progress according to a few standard indicators. Pressures and incentives to meet the targets set are then transmitted down to the community level health worker who actually meets the...