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Weigh costs and benefits of new vaccines



Washington DC – The Pan American Health Organization (PAHO) has urged immunization advocates to demonstrate the economic feasibility of using newer, more expensive vaccine technologies to reduce deaths and illnesses in Latin America and the Caribbean.

PAHO convened a four-day meeting last week of health and economic experts to encourage the use of economic analysis to support decision-making about whether to incorporate new vaccines into countries’ national vaccine programs.{{more}}

“Vaccines have long proven to be among the most cost-effective investments in public health, for both developed and developing countries,” said Jon Andrus, PAHO’s lead technical advisor on immunization. “It is essential that we demonstrate similar cost-effectiveness for newer, more expensive vaccines if we want to make them available to save lives and improve health in our region.”

Countries in Latin America and the Caribbean have seen major successes in controlling and eradicating harmful diseases through the use of vaccines. Examples include polio, which was eradicated from the region in 1994, and measles, for which no endemic cases have been reported since 2002. Rubella and congenital rubella syndrome are also well on their way to elimination.

Recently, new vaccines have become available against other major diseases including pneumococcal disease, rotavirus diarrhea, influenza, and human papillomavirus (HPV) infection, which causes cervical cancer in women. These new vaccines, however, are more expensive by orders of magnitude than traditional ones. Yet their use could have a major impact on health in the region. Cervical cancer, for example, is in many countries the leading cause of death among women, and both rotavirus and pneumococcal disease kill thousands of children in the region each year.

“The vaccine against pneumococcal disease has a tremendous potential for saving more child lives,” said Orin Levine, director of the Pneumococcal Vaccine Accelerated Development Program, funded by the Bill and Melinda Gates Foundation. “We know that annually there are nearly 800,000 childhood deaths that occur globally as a result of this disease.”

Incorporating these new vaccines into countries’ immunization programs is a major challenge, given limited resources for public health and rising health care costs. For this reason, PAHO and the World Health Organization (WHO) are urging countries to use economic analysis to provide evidence for making decisions about expenditures on vaccines and other health costs.

“Most if not all our member countries face serious constraints on health spending, and need an objective basis for making decisions and setting priorities,” noted Andrus. “We want to see countries accelerate their efforts to collect and analyze the necessary information to make evidence-based decisions for these vaccines. You need evidence to support and justify introducing these vaccines in the context of national disease priorities.”

To facilitate this process, this week’s meeting presented guidelines and tools for use in collecting data on costs and disease burdens, and for conducting economic analyses to support decision-making about new and underutilized vaccines. Participants included managers of national immunization programs in PAHO member countries, disease surveillance coordinators, PAHO and WHO staff, and representatives of partner organizations including the Bill and Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention (CDC), the Sabin Vaccine Institute, RVP-PATH, the World Bank, and Harvard and Emory universities.

“PAHO has helped us move forward by bringing both health and economic experts to work together and pave the way to take advantage of these new vaccines,” said Mac Otten, a medical epidemiologist and surveillance expert from the CDC.

Gina Tambini, PAHO area manager for Family and Community Health, noted that expanded immunization is key for advancing toward the Millennium Development Goals in Latin America and the Caribbean. “Countries can achieve these goals to further reduce child mortality if we pull together as partners with a common vision and goal. PAHO is very appreciative of the support it has received from the Gates Foundation in order to advance this important cause in the region of the Americas.”