POST 00896E : Hib INITIATIVE
Follow-up on Posts 00885E, 00887E and 00890E
9 March 2006
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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]
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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."
Best wishes,
Anthony
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