Dr Orin Levine, Executive Director of the International Vaccine Access Center (IVAC) at Johns Hopkins Hospital in New York, said economic analysis shows that the cost of investing in vaccines for most developing countries is outweighed by the projected impact of vaccines on health outcomes.
Speaking to Vaccines Today about new research on the cost-effectiveness of the pneumococcal vaccine, Dr Levine said major strides have been taken in fighting vaccine-preventable diseases in GAVI-eligible countries but more can still be done.
The study, of which Dr Levine is a co-author, concludes that the pneumococcal vaccine prevents substantial numbers of deaths at “relatively low incremental costs”.
“Even at prices higher than those negotiated for GAVI countries, the vaccine meets or exceeds the criteria for cost-effectiveness in nearly all GAVI countries. We also know that cost-effectiveness is greatest where burden is highest,” he said.
Traditionally, he said, new vaccines have become available first in areas where the need is least urgent rather than where the economic rationale is greatest.
Dr Levine said the drive to get more vaccines to the developing world has gathered “a ton of momentum” recently, notably following the landmark GAVI conference in June that attracted new donors and commitments from industry to improve access to vaccines.
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“Pneumococcal vaccines are a shining example of the pre-negotiated price design that GAVI has executed. It was negotiated around three years ago but a maximum price was set which means the cost can down but will never exceed a certain level. In June there was further progress on the rotavirus vaccine and others.”
Work in progress
Dr Levine said the progress made in improving immunisation rates in the world’s poorest countries is “unmistakable” but health advocates must build on today’s momentum.
“Coverage rates are up. The number of vaccines we have and the number of diseases we protect against are up. Plus, the time-lag between using vaccines in rich and poor country is gone. We rolled out the pneumococcal vaccine in new York and Nicaragua at the same time,” he said.
The biggest gains have been seen in the world’s lowest income countries but global vaccine delivery systems must be improved to ensure every child is reached. “It’s not enough to reach 80% – we want to reach every child.”
One of the current challenges is to support lower-income countries like the Philippines or the Dominican Republic which are far from wealthy but must compete on the global market, according to Dr Levine.
He noted that the Dominican Republic shares an island with Haiti – the poorest country in the northern hemisphere. Dominican health authorities vaccinate around 15% of Haitians yet they receive no support despite being separated from Haiti by a “pretty thin” border.
While people in developing countries clamour for access to vaccines, a sizeable minority of parents in Europe and the United States have grown weary of immunisation schemes.
“In developing countries I see parents lined up for hours to get their kids vaccinated. What’s amazing about this is that in places like the US, people almost never see the diseases that we vaccinate against any more – measles, meningitis, pneumonia. What they see are self-limited, but not uncommon, adverse events and they make a judgement based on what they see.”
The problem, says Dr Levine, is that parents in the West no longer make the link between vaccination and the lack of illness in developed societies.
“Yet every time we go to Africa to film a story on pneumococcal, the kid we film ends up dying of the disease. We see it over and over again,” he said.