For the second time in its four-year history, the pharma jury at the Cannes Lions Health International Festival of Creativity did not award a Grand Prix.

According to the judges, the standout work in the category this year was a campaign for Afghanistan’s Ministry of Public Health, developed by McCann Health New Delhi and Global Health Consulting, called Immunity Charm.

See also: Lions Health: The 2017 pharma winners

The country has some of the highest infant and under-five mortality rates in the world, in part due to difficulty tracking childhood immunizations and a tradition of mistrust of immunizations. So, the ministry’s agency partners developed a bracelet with beads, each one a different color and indicating a different immunization, that is similar to a bracelet already worn by Afghan children.

The campaign won four of the six Gold Lions in the pharma category as well as the United Nations Foundation Grand Prix for Good.

“It’s so scaleable,” said June Laffey, creative director at McCann Health in Australia and Southeast Asia, and this year’s Lions Health pharma jury president, during a news conference on Saturday in Cannes. “It empowers people. It helps doctors. It helps patients. It’s culturally significant. It’s an amazing piece of work.”

Ritesh Patel, a pharma juror and chief digital officer at WPP Health & Wellness, described the bracelet as the “ultimate wearable.”

See also: Lions Health: The 2017 health and wellness winners

But it’s public health work, not a pharma campaign, and that’s why the jury declined to award a Grand Prix in the pharma category this year.

“We want to send a clear and strong message what a pharma entry and what a pharma winner looks like,” Laffey said. “We only awarded what was the best work in the pharma industry.”

The only U.S. work to win a Gold Lion was a campaign developed by Polaris, a non-profit that fights human trafficking, and Interpublic Group’s Area 23, called the Anti-Trafficking Exam and Otoscope. It won for its use of technology.

Several drugmakers won Bronze Lions: Boehringer Ingelheim, with McCann Health and Craft Worldwide, for a Pradaxa campaign; Merck, with Matter Unlimited, The Whitelist Collective, and Marina Maher Communications, for a Merck for Mothers campaign; and Roche, with Langland, for a clinical trial campaign.

In the first year of Lions Health, the pharma jury declined to award a Grand Prix. AstraZeneca later won, in 2015, for its unbranded campaign for Take It From a Fish and last Philips took home the Grand Prix for its Breathless Choir campaign.

The decision not to avoid a Grand Prix may be taken with a grain of salt. Most of the pharma jury presidents were wearing the Immunity Charm bracelets on Saturday.