Economic Evaluation of New Vaccine Introduction

1
Economic Evaluation of New Vaccine Introduction
2
Fact

• In recent years the vaccine and immunization
  financing have broadened due to
• Increase divergences in vaccination schedule
  between developed and developing countries
• Increase diversity of products and available to
  countries
• Emergence of developing country manufacturers
• Importance of new global initiatives such as GAVI.

3
Global Trends

• Countries and partners are increasingly concerned
  about costs and financing
• Complex picture lack of resources, financial
  management, absorptive capacity
• More reliable information is now available on
  immunization financing based on FSP submitted by
  countries 2 rounds, more coming this year..

4
Vaccine Presentation in selected Hib countries
5
Cost per DTP3 child in a sample of Hib
introducing countries
() Guyana provides MMR vaccine instead of
measles.
6
GAVI Achievements

• Countries supported through GAVI are required to
  develop financial sustainability plans (FSPs)
• The first round of FSPs have provided new
  information about the challenges of financing new
  vaccines in poor countries

7
FSP Analysis

• A quick look at
• Cost implication of VF supported new vaccine
  introduction
• Some financing and sustainability issues

• Methodological points
• Based on 2002 and 2003 FSP data - 24 countries
• Focused on routine services
• Immunization specific costs
• Two snap-shot years
• Generalizations are difficult
• Findings are very preliminary!

8
Cost Implication of NVI (24)
120
Vaccines and injection supplies are becoming the
main cost drivers of programs
108 million
13
100
50
80
26
68 million
Vaccines (basic 6 antigens)
Vaccines (new underused)
60
11
Injection Supplies
11
Personnel

40

Other Recurrent Costs ()
22
Vehicles, Cold Chain and

other Equipment
20
13

Slight reduction in spending on basic vaccines
(DTP now the platform of new vaccines)
-
Pre-Vaccine Fund Year
Year with Vaccine Fund
(Baseline)
Support (VF Year)
()
Other recurrent program specific costs include
spending on tranportation
(
fuel
)
,
cold chain maintenance
and building overhead, training, social
mobilization and disease surveillance.
9
Cost Per DTP3 Child With Hib
15
4
2
DTP-HepB-Hib at different rates of introduction
10
Cost Per DTP3 Child With Hep B
Wide variability in costs across countries
Different rates of introduction make comparisons
difficult
11
Non-Vaccine/Delivery Costs
Overall increase in total non-vaccine costs of
26 (24)
Not clear how much of the increase relates to the
introduction of new vaccines
32 of this increases is financed using ISS funds
12
A Look At Financing (24)
120
Vaccine Fund resources are additive
108 million
100
29
80
Other (NGO, foundations...)
68 million
GAVI-Vaccine Fund
11

60
Development Bank
Multilaterals
13
Bilaterals
40
Pooled Funds
Government
37
20
51
Governments are increasing their support for
routine immunization
-
Pre-Vaccine Fund Year
Year with Vaccine Fund Support
(Baseline)
(VF Year)
() Multilaterals are mainly UNICEF and WHO
13
Government Financing
Wide variability in government funding for
routine immunization across countries
The challenge of financial sustainability will be
greater for those that are donor dependant
Pre-Vaccine Fund baseline year
14
Financing of Basic Vaccines
Some countries do not pay for basic vaccines
Financing new vaccines will be a challenge
Picture changes quite dramatically when Vaccine
Fund support is included
Pre-Vaccine Fund baseline year
15
Summary of Findings

• Costs
• Overall rise in immunization costs after NVI
  (about 40)
• Vaccines are becoming the largest cost driver
• Important rise in the cost of injection supplies
  with AD syringes and safety boxes (almost as much
  as traditional vaccines)
• Wide country variability in cost per DTP3 child.
  For the most part lt 20
• Important cost implications of Hib
• Significant rise in non-vaccine costs. Some of it
  due to ISS funds
• Financing Sustainability
• Increase in spending even if Vaccine Fund support
  is excluded (governments have increased their
  support)
• Wide variability in government funding for
  immunization across countries
• Some countries do not pay for basic vaccines

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Sustainability Implications

• The recurrent cost burden of programs is
  increasing countries will be more vulnerable to
  annual fluctuations in funding
• Some countries are not financing basic inputs
• The challenge of financial sustainability will be
  greater for countries that are donor dependant
  more resources need to be mobilized from outside
  sources
• Sustaining the increasing costs of programs to
  meet program objectives will be a challenge (new
  vaccines, non-vaccine costs, campaigns.)
• Facing the challenge is a question of priority
  setting and firm commitments from governments and
  partners to support immunization

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Challenges
Finance Reduce the financial barriers, to allow
everyone to access existing, new and future
vaccines
Advocacy Ensure that both governments and
international development partners adopt policies
and take actions to stable and adequate financing
for vaccine and immunization
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FSP for New Vaccine Introduction

• A long-term FSP should be submitted for the
  introduction of costly vaccines such as Hep B and
  Hib, in the immunization programmes in low-income
  countries
• Experience shows immunization programme-specific
  costs sometimes trebling with the introduction of
  Hib containing vaccines in combination form such
  as the pentavalent

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Joint Efforts

• For countries that have already introduced Hib
  vaccination, fostering joint efforts between
  national authorities, donors, vaccine
  manufacturers and technical agencies is required
  to help alleviate Hib-containing vaccines
  financial challenge
• In the field of vaccine financing, pursuing the
  efforts of systematic assessment of national
  immunization programmes will likely provide
  extremely valuable insights