National legislation and spending on vaccines in Latin America and the Caribbean.

This study examined the dynamics of vaccine spending and vaccine legislation in the Americas Region over the period 1980-2013. Annual vaccine expenditures from thirty-one countries were extracted from the Pan American Health Organization Revolving Fund database. Information on vaccine laws and regulations was provided by the PAHO Family, Gender, and Life Course Unit. Both time series and event history models were estimated. The results show that passing an immunization law led a representative country to increase its vaccine spending, controlling for income, infant mortality, population size, and DPT3 vaccine coverage. Countries with higher vaccine coverage were also more likely to have passed laws. Conversely, higher income countries were less likely to have vaccine laws. Vaccine legislation will likely play a similarly important role in other regions as more countries move towards immunization program ownership.

Country Ownership And Gavi Transition: Comprehensive Approaches To Supporting New Vaccine Introduction.

Since the mid-2000s low- and lower-middle-income countries have been focusing on developing and using evidence for immunization policy making, with an increasing emphasis on cost-effectiveness analysis, program costing, and financial flows-particularly for the introduction of newer, more expensive vaccines. While this is critical to informing decisions, countries still need to increase national immunization investment and explore innovative approaches to augment financing of immunization programs. The need for increased financing is especially strong in countries transitioning from support by Gavi, the Vaccine Alliance. With increased fiscal space to finance health and immunization programs as a result of improved economic performance, low- and lower-middle-income countries can reach the health status enjoyed by wealthier nations within a generation. However, new strategies and approaches related to domestic resources for immunization programs are needed to achieve this goal. Governments will need to increase their investments and modify existing external immunization financing arrangements if country ownership of immunization programs and the full promise of new vaccines are to be realized.

Routes Countries Can Take To Achieve Full Ownership Of Immunization Programs.

A goal of the Global Vaccine Action Plan, led by the World Health Organization, is country ownership by 2020, defined here as the point when a country fully finances its routine immunization program with domestic resources. This article reports the progress made toward country ownership in twenty-two lower- and lower-middle-income countries engaged in the Sabin Vaccine Institute's Sustainable Immunization Financing Program. We focus on new practices developed in the key public institutions concerned with immunization financing, budget and resource tracking, and legislation, using case studies as examples. Our analysis found that many countries are undertaking new funding mechanisms to reach financing goals. However, budget transparency remains a problem, as only eleven of the twenty-two countries have performed sequential analyses of their immunization program budgets. Promisingly, six countries (Cameroon, the Republic of the Congo, Nepal, Nigeria, Senegal, and Uganda) are creating new national immunization funding sources that are backed by legislation. Seven countries already have laws regarding immunization, and new immunization legislative projects are under way in thirteen others.

An analysis of government immunization program expenditures in lower and lower middle income countries 2006-12.

Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs.

Creating sustainable financing and support for immunization programs in fifteen developing countries.

Immunization programs are important tools for reducing child mortality, and they need to be in place for each new generation. However, most national immunization programs in developing countries are financially and organizationally weak, in part because they depend heavily on funding from foreign sources. Through its Sustainable Immunization Financing Program, launched in 2007, the Sabin Vaccine Institute is working with fifteen African and Asian countries to establish stable internal funding for their immunization programs. The Sabin program advocates strengthening immunization programs through budget reforms, decentralization, and legislation. Six of the fifteen countries have increased their national immunization budgets, and nine are preparing legislation to finance immunization sustainably. Lessons from this work with immunization programs may be applicable in other countries as well as to other health programs.

The health benefits of social mobilization: experiences with community-based Integrated Management of Childhood Illness in Chao, Peru and San Luis, Honduras.

This article reviews the implementation of the community component of the Integrated Management of Childhood Illness (IMCI) strategy in Chao, Peru (2001 to 2004) and San Luis, Honduras (2003 to 2005). An evaluation was conducted in 2005 and included a project documentation review, key-informant interviews, and a household level baseline and follow-up survey of the WHO/UNICEF key family practices in each intervention site. The promotion of the key family practices in Chao and San Luís demonstrated measurable success. In comparison with the initial survey in 2002, the percentage of participant mothers ( N = 78) in Chao in 2004 who knew that they should breastfeed exclusively for at least six months increased from 33% to 94%; the presentation of complete vaccination records for one-year-old children increased by 19%; the recognition of danger signs for pneumonia increased 18% and for diarrhea by 8%; and the percentage of mothers who received four or more prenatal check-ups increased by 25%. A dramatic reduction in malaria cases was also attributed to the intervention in Chao. In San Luis, a quasi-experimental, random household sample ( N = 300) showed that the incidence of diarrheal disease among children under five years old declined by 18% between survey rounds (from 44% in August 2004 to 26% in December 2005). Social mobilization has promoted inter-sector consensus-building around community health issues, especially those related to maternal and child health. The promotion of the participation of representatives from various organizations via the community IMCI social-actor methodology has led to increased civic cooperation. Positive changes in health behaviors have been documented through an increase in preventive health practices, greater demand for primary health care services, and concrete community actions to improve public health.

The costs of scaling up vaccination in the world's poorest countries.

We examine the relationship between country-level average costs and coverage levels for diptheria-pertussis-tetanus (DTP) vaccines. Coverage data are from the World Health Organization, and cost data are from financial sustainability plans filed with the Global Alliance for Vaccines and Immunization (GAVI) by forty countries from 2000 to 2003. In this data set, average costs are lower for countries that vaccinate more children. At the highest numbers of covered children, there was no trend toward higher average costs. Vaccine programs in this set of poor countries have not yet scaled up to the point at which diminishing marginal returns are observed.

The role of public health programmes in reducing socioeconomic inequities in childhood immunization coverage.

OBJECTIVES: This paper asks whether intensive outreach services can eliminate socioeconomic differentials in vaccine coverage. METHODS: In 1990, the Matlab Maternal and Child Health/Family Planning Project (MCH-FP) surveyed 4238 respondents in an intervention area that received outreach and 3708 respondents in a comparison area in rural Bangladesh. Interacted multiple regression methods assessed the degree to which various socioeconomic indicators predicted the probability of vaccine receipt in each area. RESULTS: Low parental schooling, small dwelling size and female gender were significantly associated with incomplete vaccination in the comparison area, where only the limited government services existed. Residence in the MCH-FP outreach area greatly reduced, and in some cases eliminated, the effects of these socioeconomic barriers to vaccine receipt. CONCLUSIONS: Public health programmes utilizing outreach can reduce prevailing gender and socioeconomic differentials in vaccine receipt.