Academic journal article Bulletin of the World Health Organization

Estimating the Costs of Achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015/estimation Des Courts Pour Realiser L'objectif De L'initiative OMS-UNICEF « la Vaccination Dans le Monde : Vision et Strategie » Pour la Periode 2006-2015/estimacion De Los Costos De Llevar a Termino la Vision Y Estrategia Mundial De Immunizacion OMS-UNICEF, 2006-2015

Academic journal article Bulletin of the World Health Organization

Estimating the Costs of Achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015/estimation Des Courts Pour Realiser L'objectif De L'initiative OMS-UNICEF « la Vaccination Dans le Monde : Vision et Strategie » Pour la Periode 2006-2015/estimacion De Los Costos De Llevar a Termino la Vision Y Estrategia Mundial De Immunizacion OMS-UNICEF, 2006-2015

Article excerpt

Introduction

In 2005, the World Health Assembly approved, and the United Nations Children's Fund (UNICEF) Executive Board endorsed, the Global Immunization Vision and Strategy (GIVS). (1,2) The primary objective of GIVS is to reduce vaccine-preventable disease mortality and morbidity by two-thirds by 2015 compared to 2000, a contribution towards achieving the Millennium Development Goals, especially Goal 4, which calls for a two-thirds reduction of under-5 mortality by 2015. (3)

GIVS identifies four strategic areas: immunizing more people against more diseases; introducing newly available vaccines and technologies; linking immunization to other critical health interventions; and managing vaccination programmes and activities within the context of global interdependence. GIVS articulates more than 25 new ideas and innovative approaches, and it is anticipated that countries will adopt the strategies most suited to their needs.

GIVS was developed in the context of increasing resources for immunization; in 1999 a public--private partnership, The Global Alliance for Vaccines and Immunization (GAVI Alliance) was initiated to provide financial support for immunization in the world's poorest countries. (4,6) By the end of 2005, government and private sources had pledged a total of US$ 3.3 billion to the GAVI Alliance, enabling it to provide support to 73 of 75 eligible countries. Between 2000 and 2005, total GAVI Alliance disbursements were US$ 760.5 million. (7) GAVI Alliance's resource outlook over the next decade has improved with the launch of two innovative funding mechanisms: the International Finance Facility for Immunisation (IFFIm), (8) which could provide up to US$ 4 billion over the next 10 years, and the Pneumo Advance Market Commitment (AMC), (9) which will provide US$ 1.5 billion to support low-income countries for the purchase of new vaccines against Streptococcus pneumoniae, a leading cause of childhood meningitis and pneumonia mortality.

In 2005, WHO and UNICEF undertook, as a companion to the GIVS document, to estimate the costs to reach immunization goals; (10) this paper reports on the methods and results of that initial exercise.

Methods

Countries included

Estimates were done for all low- and lower-middle-income countries (as of 2003) (11) focusing on the subset of GAVI Alliance-eligible countries (12) (for 2005-2010, countries with 2003 gross national income (GNI) per capita < US$ 1000), whose characteristics (11,13,34) are highlighted in Table 1.

Cost components included

The costing has two main components: the first estimates current spending for immunization as of 2005 and how much will be needed to maintain the current immunization system. The second component estimates the incremental costs needed to scale up immunization coverage, including routine delivery and campaigns, and to introduce all available and safe vaccines according to WHO recommendations, including a finite set of new vaccines expected to become widely available (see Fig. 1).

For vaccine-specific costs, we define "traditional" vaccines as those in widespread use in the Expanded Programme on Immunization (EPI): Baccillus Calmette-Guerin (BCG), three doses each of diphtheria-tetanus-pertussis (DTP) and oral polio vaccine (OPV); (we assume use of this ceases in 2010 following polio eradication), a single dose of measles vaccine (MCV1) for children under one year of age, and two doses of tetanus toxoid (TT2+) vaccine for pregnant women. "Underused" vaccines include a second dose of measles (MCV2); three doses of hepatitis B (HepB) and Haemophilus influenzae type b (Hib) vaccines; yellow fever (YF); and rubella. "New" vaccines include three doses of rotavirus and conjugare pneumococcal vaccines; and single doses of Japanese encephalitis (JE) and conjugate meningococcal A (MenA) vaccine, for populations at risk.

Deriving country-specific projections

Costs are projected using the following assumptions: (a) routine coverage of existing vaccines based on actual 2005 country-specific immunization schedules in use reaching 90% by 2015; (b) mortality reduction campaigns; and (c) introduction of underused and new vaccines as rapidly as feasible. …

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