2. The costs of treating these cases, 7 percent of which could be expected to result in severe neurological problems, would run to $24 million. Assuming the price of vaccine is $9, 32 it would cost almost $137 million to completely immunize Brazil’s under-age-2 cohort, a group of some 6.5 million. This is considerably more than the $54 million the country spent in 1994 to purchase all of its other vaccines. Without a significant drop in the price of the Hib conjugate—perhaps through bulk importation and local filling, or local production (involving technology transfer)—Brazil will probably not add this vaccine to its immunization armamentarium.

In the Philippines, some health officials expect that the Hib vaccine will be the next vaccine introduced into that nation’s immunization program. Hib vaccine is a high priority in the country, since pneumonia is the leading cause of death among all Filipinos and is the second most common cause of death among Philippine infants. The Philippines, along with a number of other developing nations, is taking part in the Vaccine Independence Initiative (VII), established by UNICEF and USAID. The VII is a revolving fund that allows countries to purchase vaccine with their own currency and to pay upon receipt of vaccine. There is concern, at least among health officials in some of the participating countries, that the VII will not be sufficiently capitalized with hard currency to allow the purchase of expensive, new vaccines.

While the potential cost and cost-effectiveness of Hib immunization are daunting, programmatic and technologic improvements could be made that would reduce these outlays. By decreasing the age of immunization, for instance, more deaths and cases could be prevented. Increasing vaccine coverage, ideally to the point at which herd immunity takes hold, could similarly save more lives. Cutting vaccine wastage in half would lower the cost per death averted by 17 percent. Decreasing the number of vaccine doses required, improving vaccine efficacy, and lowering vaccine production costs all would improve cost-effectiveness.

In the case of S. pneumoniae, CDC estimates that there are 1.127 million pneumococcal deaths each year around the world. (The agency notes that the assumptions and models used to generate this mortality figure are subject to revision.) Based on serotype data from the developing world, Merck’s seven-valent pneumococcal vaccine would cover about 60 percent of cases, while Lederle-Praxis’ formulation would cover about 68 percent. The vaccines would annually prevent between a quarter and nearly one-third of all pneumococcal deaths. Herd immunity would boost this to 650,000 deaths prevented, or nearly

32  

That the price quote for Hib was higher than the U.S. public-sector price probably reflects the fact that the number of doses to be purchased was relatively small and the supply contract was short term. Both factors would drive up the cost of vaccine (Otavio Oliva; personal communication, 1995).



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