The following post by Lois Privor-Dumm, IMBA, Director of Alliances and Information for the PneumoADIP at Johns Hopkins Bloomberg School of Public Health, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.
Lois heads up several vaccine projects related to advocacy and communications as well as access and implementation. She is currently working as Director, Large Country Introduction for the Accelerated Vaccine Introduction Technical Assistance Consortium (AVI TAC), a GAVI-funded project with an aim to accelerate introduction of pneumococcal and rotavirus vaccines in low-income countries. Lois has been at Johns Hopkins since 2005 helping guide strategies and accelerated uptake on both the Hib Initiative and PneumoADIP and has been leading projects in developing and donor countries to support strengthening of policies and awareness for childhood pneumonia as part of a global World Pneumonia Day Coalition effort.
Hib, pneumococcal and rotavirus vaccines that have long been available in the US, offer significant promise to the children in developing countries. Not only could these vaccines, save millions of lives over the course of the next couple of decades, but they also have the potential to add to the wealth of nations. Yet, despite enormous promise, there are still delays 1-2 decades before children in developing countries have access.
Vaccines have long been considered one of the most affordable and cost-effective public health interventions available today. Historically, they have been pennies per dose. According to the World Bank’s Disease Control Priorities Report, at $7 per DALY averted in Sub-Saharan Africa for the Expanded Program on Immunization (EPI), a package of six WHO recommended vaccines including diphtheria, tetanus, pertussis, polio, measles and represents excellent value for money. By comparison, statin with aspirin, beta blocker and ACE inhibitors for ischemic heart disease costs $2,028/DALY averted.
However, with newer vaccines costing not pennies, but dollars per dose, do we need to reestablish our paradigm for affordability?
A recent review of the economic case for expanding vaccination coverage of children done by researchers at Harvard and Johns Hopkins suggests that new vaccines are a good investment. Cost-benefit analyses of Hib vaccination, for example, indicate that the cost of vaccination is less than the savings accrued by preventing mortality, lowering future health care costs, and reducing productivity losses among parents (who no longer have to stay home with a sick child). However, even these analyses may underestimate the true economic benefits of childhood vaccination.
Cost-benefit analyses of childhood vaccination have typically focused on a narrow set of benefits such as those mentioned above. However, these calculations fail to account for a broader range of indirect effects, such as herd-immunity—which occurs when an unvaccinated individual experiences a lower risk of infection due to the vaccination of others in the community—and lower fertility rates as families decide to have fewer children due to improved survival rates, thereby generating a demographic dividend.
Perhaps most interestingly, vaccination may have long-term implications for a child’s productivity potential. Measles vaccination has been shown to improve education attainment among children in Bangladesh and South Africa. Hib, pneumococcal and rotavirus are expected to show similar results Early improvements may have a positive impact on long-term economic wellbeing.
Health is not just an outcome of economic development; it may be a critical driving force. A study published in World Economics suggests that childhood vaccination may have as great a return on investment as primary education. Consequently, our economic development initiatives cannot afford to neglect health, especially health in the earliest years of life.
The GAVI Alliance and donors have been convinced by the investment case for these new vaccines and now offer vaccines for as low as 15 cents per dose to help accelerate introduction. More money is needed to support the investment in saving lives and helping in the development of nations. Stakeholders will need to reset their paradigm of affordability and recognize the investment required to make significant changes to benefit the developing world.
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