DecisionMaking for Vaccine Introduction

1
Decision-Making for Vaccine Introduction

• Introduction of new vaccines into the Expanded
  Programme on Immunisation (EPI) in Southern
  Africa public health, educational and economical
  aspects
• Cape Town, 13 to 15 October 2004
• Dr. Patrick Zuber
• WHO/FCH/IVB/EPI

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Estimated deaths of selected diseases with
current levels of vaccination versus no
vaccination, 2001
Source World Health Organization
3
33 million children not immunized (DTP3) 2002
Source WHO/UNICEF estimates, 2003
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24 old, newer and needed vaccines

• Vaccines gt40 years old BCG, DTP, Polio, Measles,
  Yellow Fever
• More recent vaccines Hep B, HiB, Rubella, S.
  pneumoniae, Rotavirus, N. meningitidis
• Priority future vaccines HIV, TB, Malaria, SARS
• Neglected vaccines Shigella, Dengue, Japanese
  encephalitis, Leishmaniasis, Schistosomiasis,
  Cholera, HPV, RSV, HS2, ETEC

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Deaths from Vaccine-Preventable Diseases - 2000
4 Million Deaths to Be Prevented
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Steps for Decision Making
7
Country-specific incidence, by quartile, of Hib
meningitis per 100 000 children lt 5 years of age
in the pre-vaccine era, 46 countries
Unpublished Studies
Rapid Assessments
Excluding studies of special-risk groups and
those with lt15 cases.
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Burden of Hib Diseases
Lumbar puncture done? Lab performance? Use of
antibiotics?
Unconfirmed Hib meningitis
Estimated Annual Deaths Due to Invasive Hib
infections 200 000 700 000
Severity? Blood culture? Lung aspirate?
Hib Pneumonia
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Is Vaccine the Best Prevention Strategy? Estimated
global distribution of annual deaths caused by
rotavirus
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Cost Effectiveness of Hib Vaccination

• Cost per life year saved 17 - 54 000
• (Brinsmead et al. Pediatr Inf Dis J 2004)
• Variable methodologies
• Most studies only include meningitis
• Costing not standardized
• Only 3 published studies from developing
  countries (South Africa, Chile, Philippines)

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Public Health Priority

• Use of scarce public health resources
• Equitable intervention
• Perception
• Of the problem
• Of the intervention
• Planning for the future

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Pentavalent DTwP-HepB-Hib Vaccine

• Monopoly
• Supply lower than demand at least until 2005
• Combined liquid-lyophilized vaccine
• High price (3.50 per dose)
• Uncertain price trend after 2006

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Current GAVI Product Menu
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Resource Requirements in 22 Countries by Cost
Category, 2002 - 2008
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Average Resource Requirements per Fully
Vaccinated Child
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Government Funding of Immunization and Unfunded
Resources (Post VF Period)
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Decision-Making Summary
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Building the investment case
Disease burden (global/country)
Economics (global/country)
Vaccine safety and efficacy (regional
representation)

• Disease surveillance
• Serotype distribution

• Economic burden of preventable illness/death
• Cost-effectiveness of vaccination

• Clinical trials
• Demonstration projects

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Building the investment case

• Analyze market development
• Address regulatory obstacles

• Support countries in identification of financial
  options
• Identify vaccine infrastructure requirements

• Conduct audience research
• Coordinate demand forecast process
• Develop strategy for country prioritization

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Increasing impact of new vaccines

• Immunization services
• Establish and maintain immunization at the top of
  the public health agenda
• Reinforce countries capacity in reaching high
  vaccine coverage to optimize impact
• Continue advocacy for equitable access to vaccine
  by the children who need them the most
• Challenges specific to new vaccines
• Develop partnerships with manufacturers in order
  to reduce barriers to production of affordable
  vaccines
• Reinforce vaccine production capacity especially
  in emerging economies
• Establish sustainable vaccine financing systems