1 |

Economic characteristics

of Vaccines and

Immunizations

Miloud Kaddar

WHO-IVB

www.who.int/immunization_financing

2 | 2

Outline

Key questions that an economist working in

vaccinations ask her/himself ?

Economic features of vaccines and vaccinations

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VACCINE AND VACCINATIONS

a fabulous world for an economist...

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REDUCING VPD

INDUSTRY

HUMAN

RIGHTS COMMODITY

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Key questions: multidimensional

1) WHAT IS THE DISTRIBUTION OF

DISEASE BURDEN/VPD ?

2) WHAT ARE THE PRIORITIES ?

3) WHAT ARE THE MOST COST EFFECTIVE INTERVENTIONS ?

4) WHO PAYS: SOURCES AND MECHANISMS ?

DATA and

SITUATION ANALYSIS

PRIORITY SETTING

COST ANALYSIS

FINANCING

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ECONOMICS OF IMMUNIZATION AREAS OF WORK and CONCERNS

SUPPLY and DEMAND

OF VACCINES

PRODUCTS

Vaccinations

SERVICES

EFFICIENCY ACCESS

VIABILITY/SUSTAINABILITY

AVAILABILITY

7 |

Evidence-Based Decision Making Process

1. Burden of 1. Burden of DiseaseDisease

What is the situation What is the situation

with mortality and with mortality and

morbidity of VPDs in morbidity of VPDs in

countriescountries?

2. Cost 2. Cost Effectiveness Effectiveness

AnalysisAnalysis

What are the strategies What are the strategies

that maximize that maximize

outcomes for every outcomes for every

dollar spentdollar spent

3. Supply and 3. Supply and ProcurementProcurement

Supply? Procurement? Supply? Procurement?

4. Planning 4. Planning and and

BudgetingBudgetingWho is going to Who is going to

pay? Options and pay? Options and

strategies for strategies for

financing? Financial financing? Financial

sustainability?sustainability?

Country Country ContextContext

1. Burden of 1. Burden of DiseaseDisease

What is the situation What is the situation

with mortality and with mortality and

morbidity of VPDs in morbidity of VPDs in

countriescountries?

2. Cost 2. Cost Effectiveness Effectiveness

AnalysisAnalysis

What are the strategies What are the strategies

that maximize that maximize

outcomes for every outcomes for every

dollar spentdollar spent

3. Supply and 3. Supply and ProcurementProcurement

Supply? Procurement? Supply? Procurement?

4. Planning 4. Planning and and

BudgetingBudgetingWho is going to Who is going to

pay? Options and pay? Options and

strategies for strategies for

financing? Financial financing? Financial

sustainability?sustainability?

Country Country ContextContext

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VACCINES AND VACCINATIONS ARE

DIFFERENT FROM OTHER

PRODUCTS AND SERVICES

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Vaccines vs Pharmaceuticals

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Vaccines Pharmaceuticals

- Focus mainly on prevention – not

patients but healthy subjects

- Key role for the government agencies

- Very low acceptance of side effects

Focus on treatment – patient is

generally suffering or sick

Key role for healthcare players

Acceptance of side effects varies by

severity of disease

High manufacturing and supply chain

complexity

(Cold Chain Management, complex

biological processes)

Medium manufacturing and supply

chain complexity

minimal generic competition and

limited price competition

Very few producers

Major sales through government

Number of products and generics

Increasing generic threat

Significant sales force and transaction

costs

Sales through physician as prescriber

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Vaccine: Economic characteristics…

Strategic product: part of national and global security

concern

Life saving product: one of most cost effective interventions

Induced demand and consumption: role of national and

international health agencies and of health professionals

Highly regulated (R&D, product, import , export and

distribution,..) : entry barriers.

Public Funding in most countries: Role of GoV and global

community in R&D and access

12 |

Vaccine: Economic characteristics…(2)

Vaccine manufacturing is capital intensive

– Technology

– Expertise and know how

– High GMP standards

Vaccine manufacturing is a risky business

– Risk aversion: healthy and vulnerable people

– Biological products

– Clinical trials requirements

– Stringent regulation

Economy of scale, investment capacity and risk management are key

Few players both on supply and demand side

13 |

Benefits of vaccines and vaccinations

Positive Externalities: Vaccination has positive effect

beyond individuals and provides indirect benefits to the

unvaccinated

Rationale for compulsory vaccination against infectious

diseases?

Most health economic evaluations of childhood vaccination

only capture the health and short term economic benefits

Measuring broader, long-term economic effects of

vaccination provide a more complete picture of the value

of vaccines.

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Immunization is an investment with a broad

economic impact

Immunization is a public health priority at national as well as at global level: MDGs, DoV/GVAP

Immunization is an international public good : multiple positive externalities. Collective benefit goes well beyond mortality and morbidity reduction.

Immunization is one of the most cost effective health interventions

Immunization should be seen as an investment

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www.who.int/immunization_financing

If you want to know more:

Immunization Financing Website

In partnership with the

Immunization Financing Website News

Featured Updates

The immunization financing website has been updated with information from new countries

New menus have been created on the website for immunization financing analyses and indicators

A new analysis of vaccine financing indicators in WHO member states for 2000-2006 is now available

The status of multi-year strategic planning for immunization in WHO member states for 2006 is posted on a new webpage

Other news, highlights and expected future updates of the site in 2008

New Country Pages Go to country pages

Ten new immunization financing country pages are available. At a glance, these country pages present a summary of the immunization financing situation and provide key data and indicators of interest. The information provided in these pages are based on the Financial Sustainability Plans (FSP). These pages are intended for country-focused analyses and offer the possibility to download existing Financial Sustainability Plan documents, accompanying annex materials, tools, and other relevant country specific information (ex: costing studies, financing assessments…). Pages are now available for the following 50 countries : County pages :: Afghanistan NEW :: Lao PDR :: Albania :: Lesotho :: Armenia :: Madagascar :: Azerbaijan :: Malawi :: Benin :: Mali :: Bhutan :: Mauritania :: Bosnia and Herzegovina :: Mozambique :: Burkina Faso :: Myanmar NEW

:: Burundi :: Nepal NEW :: Cambodia :: Niger NEW :: Cameroon NEW :: Republic of Moldova NEW

:: Comoros :: Rwanda :: Côte d'Ivoire :: Senegal :: DPR Korea :: Sierra Leone :: DR Congo :: Sri Lanka NEW :: Eritrea NEW :: Sudan NEW :: Ethiopia :: Tajikistan :: Gambia :: Uganda :: Georgia :: Ukraine :: Ghana :: United Republic of Tanzania :: Guinea :: Uzbekistan :: Guyana :: Viet Nam :: Haiti :: Yemen :: Kenya :: Zambia :: Kyrgyzstan :: Zimbabwe NEW

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Thank you !

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DTP

DT/TT/Td

Hep B

Yellow

Fever DTP-HepB

Hib Lyo

Hib Liq

Rubella JE PHK

Rotavirus

Varicella

MMR

Rabies

Influenza

IPV

Hep A

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Cholera/

Typhoid

Live

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Miloud Kaddar

kaddarm@who.int

+41227911436