Immunization against childhood communicable diseases are among the most cost-effective public health interventions and is one of the most significant medical advances of our time. In recent history, it has eradicated smallpox, reduced the global incidence of polio by 99%, and dramatically decreased many other causes of illness and death. Immunization reduces the costs of treatment and of disability caused by infectious diseases. However, many obstacles remain in providing low and middle income countries with appropriate vaccines to meet global objectives of eradicating vaccine-preventable diseases. Efforts to increase coverage are hampered by weak health and immunization systems. Shortage of health staff is an important obstacle to scaling up immunization.
To meet the Millennium Development Goal 4 (Reduce by two thirds the mortality rate among children under five by 2015), significant challenges must be overcome. There is still an important immunization coverage gap that needs to be addressed. Coverage correlates with low access in rural areas, mobility and migration, acceptance, low educational level of mothers and low socioeconomic status.

Vaccine technologies have been evolving rapidly but the benefits are unevenly spread. Formulating and testing new products is a lengthy and expensive process and the pharmaceutical industry seeks to recoup its investments by targeting rich markets. Product R&D is a first step that must be followed by developing provider and user friendly formulations and administration methods. Moreover, vaccine product profiles should also consider ease of administration, logistics and programmatic aspects. Efforts to accelerate the introduction of new vaccine products must be matched by investments to ensure their safe, efficient use.
Technological improvements such as fully liquid combination vaccines in a single injection have been developed to rationalize vaccine delivery and to simplify supply and administration of vaccines. The availability of new vaccines and easy-to use technologies will strengthen vaccination delivery systems, alleviate immunization workload and hence contribute to increasing health service performance. A fully liquid DTP-HepB-Hib vaccine offers advantages and including it in national immunization programs might prove to be a cost-effective use of resources.

Rationalising vaccination delivery, for example by combining vaccines, can enable the introduction of new vaccines into immunization programs without necessitating additional visits to the healthcare provider. Furthermore, simplification of vaccine delivery reduces the potential for handling errors, facilitates training and enables vaccination programs to reach children in remote areas.
Analyses of the costs and cost-effectiveness of vaccines are important because of the need to determine the level of resources required for improving immunization programs and to optimise the allocation of scarce public and external resources available for immunization.

The Swiss Tropical Institute carried out a time-motion study in Calcutta, India to understand implications of a single vial fully liquid pentavalent DTP-HepB-Hib vaccine given as one injection in terms of resource requirements, efficiency and impact on vaccination programs. Study results indicated:
- Statistically significant time savings for vaccine preparation and total vaccine consultation for the single vial combination vaccine of about 50% and 20% as compared to multiple vial combination vaccines.
- At current vaccine load, working time savings at the Institute of Child Health, Calcutta are estimated to be about 20 working days per year. Extrapolated to India, delivery time savings could be over 100,000 working days per year.

In addition, the STI conducted an economic assessment to highlight potential financial and economic implications of introducing a fully liquid DTP-HepB-Hib vaccine into the national immunization program of South Africa. Results indicated that

- the total potential financial savings of replacing the currently used DTP-Hib plus HepB vaccines with a fully liquid DTP-HepB-Hib vaccine, would be around US$ 2.5 million per year.
- Financial savings hide more important economic benefits of a fully liquid vaccine such as the reduction of over 7000 health staff working days yearly.
A DTP-HepB-Hib fully liquid vaccine provides substantial financial and economic benefits in all aspects including storage and distribution, vaccine delivery and waste management. However, the most important advantage is related to economic benefits due to simplified vaccine delivery reducing delivery time, given the country’s shortage of health workers.

Wiedenmayer K et al (2008) Simplifying paediatric immunization with a fully liquid DTP-HepB-Hib combination vaccine: evidence from a time-motion study in India. Submitted to Vaccine
Tediosi F et al (2008) Exploring the potential financial and economic implications of a fully liquid DTP-HepB-Hib vaccine: an assessment for South Africa. Report STI

GAVI Alliance
www.gavialliance.org
www.gavialliance.org/resources/Fact_Sheet_New_Technologies_en.pdf
www.gavialliance.org/resources/GAVI_Alliance_Strategy__2007_2010_.pdf

GIVS, Global Immunization Vision and Strategy 2006-2015
www.who.int/immunization/givs/en/index.html
www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf

 

Dr. Karin Wiedenmayer

 

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