POST 00890E : Hib INITIATIVE
Follow-up on Posts 00885E and 00887E
19 February 2006
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NOTE : It appears that LISTSERV sent the previous message to the wrong list. Or it is me who did it?? More likely! I apologize and here it is again.
Anthony Battersby (mailto:[email protected]) from the United Kingdom sent a second message giving more details to his question in Post 00886E. It is followed by the response from Patrick Zuber (mailto:[email protected]) from WHO in Geneva.
NOTE : My apologies for having sent the previous Post with an unfinished introduction.
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In 2004 there was a financial sustainability meeting in Gaborone and Nairobi specifically discussing the question of sustaining EPI when the new vaccines had been included. FBA was working on assessing the suitability of GAVI as a vehicle for testing IFF at the time and we received a memo originating from Violaine Mitchell which highlighted that the African countries were very fed up with the fact that
a) their EPI programmes had become much more expensive since the introduction of new vaccines, and
b) that the price was not falling as promised by GAVI. Hib was specifically identified as the major culprit in this regard.
Hence my question. If Hib is not to be promoted on morbidity grounds, how do you get over the problem that many countries cannot afford it out of their own budgets?
What is your long term plan for financial sustainability?
Cheers,
Anthony
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Anthony,
There have been several important developments over the past18 months that should provide countries with a different outlook on the sustainability of Hib vaccine introduction.
First of all, there are now multiple manufacturers who have a business plan for Hib combination vaccines, including manufacturers from emerging economies. It is therefore reasonable to expect that market competition forces will start affecting the price of Hib-containing vaccines.
Second, for GAVI-eligible countries, a new financing scheme is now being proposed. This scheme will provide financial support until 2015 instead of the original 5-years. Based on that scheme, countries will have to co-finance a small initial amount and propose an increasing scale in order to reach a proposed working price per dose by 2015. This working price has been set at a value of half the current price, which is generally considered a conservative approach.
Third, GAVI has secured substantial donor commitment and is therefore operating with a reasonable financial backing for the foreseable future.
And fourth, the new recommendation from WHO's SAGE endorses global use of Hib vaccine unless specific obstacles are documented, one of those obstacles being evidence for low disease burden.
Much remains to be done in working with countries to identify the optimal schemes for financing their contributions and secure long-term procurement of Hib containing vaccines. However, the current situation is a huge step forward towards the generalization of Hib vaccine use. This experience will hopefully pave the way for the addition of many other important vaccines that are needed to accomplish the Millenium Development Goal of child mortality reduction.
I hope this helps,
Patrick
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