Thursday, 09 March 2006
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POST 00896E : Hib INITIATIVE Follow-up on Posts 00885E, 00887E and 00890E 9 March 2006 ___________________________________ Anthony Battersby (mailto:[email protected]) challenges the response from Patrick Zuber (mailto:[email protected]) in Post 00890E. It is indeed difficult to grasp all the intricate details of policies and strategies that affect vaccine prices, and their political and economic implications. So I would risk this question, although I am not an economist. Maybe one in the audience could comment. With such pressures at the WTO to eliminate subsidies for many years now, one could wonder if GAVI support channelling public funds and recycling profits from giant corporations isn’t a form of subsidy that keeps vaccine prices artificial instead of following the market’s offer and demand. NOTE : Please be also informed that from tomorrow, our colleague Paul Mallins will no longer be with WHO. We do not know where he is heading at but wish him the best of luck. For all work related matters, please communicate with Ãœmit Kartoglu. His personal contact will be mailto:[email protected] ___________________________________ Patrick The Report on Financial Sustainability Implementation in 8 countries, Progress, Opportunities and Challenges 8 - 12 March 2004 found: "Other issues were noted with financial resources. The highly volatile and never reducing vaccine prices, with countries expressing disappointment at the inability of GAVI and the international partners to lower vaccine prices as had been promised. As a result of this, countries are highly unsure of the medium term pricing structure for vaccines, and are also not able to make informed programmatic decisions based on the financial information derived from their FS process. The countries have also identified the main cost driver as the Hib vaccine, which is responsible for doubling and in some cases quadrupling the cost of the immunisation programme. Countries have put in place surveillance systems to gather evidence of the impact of Hib introduction in order to justify the investment in the vaccine. Without strong supportive evidence, the change in strategy to a cheaper vaccine combination is fast becoming an attractive option." The conclusion of the meetings were: "9. Concluding Message The Financial Sustainability process has helped countries to critically review the financing of their EPI program activities. It has enabled initiation of small steps towards trying to address the financial challenges the countries are facing. However, they feel these financial challenges are insurmountable and program strategies may have to be modified to fit into the financial realities within which the program is operating. Strategies exist at the country level that can improve the financial viability of the programs. However, it is felt that these, implemented at their best, will not mobilize the required resources. The many initiatives to support programs at the global level need to mature fast for them to guide the decision making process in these countries. " It must be remembered that amongst the 75 poorest countries supported by GAVI there is about a third which have never been able to pay for the original 6 vaccines. Whatever the cost of Hib, it is going to be enormously more expensive than the original 6. For example Hep B which has been available for a long time is more than twice as expensive as the most expensive of the original six. So multiple manufacturers may bring the price down, but not to a cost that poor countries can afford. It is good that GAVI plans to support to 2015 but this is through the IFF (if I am not mistaken) and as we pointed out when we were asked to assess the suitability of IFF to eternal demand such as immunisation, what happens after 2015? The meeting cited above clearly indicates that the chances for increasing indigenous funding are very slight. It is a curious use of language to cite as an obstacle the absence of a disease. Surely the first thing to do is see if Hib is a problem and then decide what to do about it, NOT introduce Hib first. The objective is to stop children getting sick and or dying. Your response seems to suggest that the objective is to introduce Hib vaccine all over the world. Once when vaccines were very cheap their universal introduction was a clear benefit. Now that the cost has risen so dramatically and the financial health of many countries has not improved or indeed gone backwards there has to be a cost analysis to demonstrate that spending money on Hib is the best use of money in the particular country. In our report on IFF we concluded: "However, if donor funds are sunk into new products for which no local epidemiological assessment of relative benefit has been carried out, future governments will be able to say that there was no supporting analysis; countries' procurement of these products may be discontinued. Similarly donors also change their minds. Long term investments with future pay-back must be based on sound and robust epidemiological evidence and analysis of the relative priorities given the profile of each country's health needs." 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