Griffiths Ulla K, Korczak Viola S, Ayalew Dereje, Yigzaw Asnakew
Hib Initiative, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Vaccine. 2009 Feb 25;27(9):1426-32. doi: 10.1016/j.vaccine.2008.12.037. Epub 2009 Jan 13.
With support from the GAVI Alliance a fully liquid combined DTwP-HepB-Hib (pentavalent) vaccine in a single dose vial was introduced into Ethiopia's routine immunization services in March 2007. This vaccine was substituted with DTwP in a 10-dose vial. We aimed to estimate the incremental system costs of pentavalent vaccine delivery.
Data on cold storage expansion and increased vaccine transport frequency were collected in four regions of Ethiopia over a 2-week period, as part of a Post-Introduction Evaluation of the new vaccine. Interviews were conducted with individuals at all levels of the health system. Information on the costs of training and communication to facilitate the introduction was collected from the Ministry of Health, UNICEF and WHO in Addis Ababa.
The switch from a 10-dose DTwP to a single dose pentavalent vaccine increased refrigeration storage volume per fully vaccinated child by 106% at national and regional levels and by 71% at the three lower levels of vaccine distribution. Cold storage equipment were purchased at all levels and the frequency of vaccine collection more than doubled in many places. Incremental capital costs of cold storage equipment, training and communication amounted to US$ 4.8 million, or US$ 1.53 per child in the 2007 birth cohort. After annualizing capital costs and adding recurrent costs, system costs came to US$ 0.80 per child in the 2007 birth cohort. With a vaccination coverage rate of 78% this is equivalent to US$ 1.13 per fully vaccinated child. The most important system cost item is cold storage, amounting to US$ 0.62 per child in the birth cohort and US$ 0.03 per additional cm(3) of cold storage.
In Ethiopia introduction of pentavalent vaccine necessitated considerable investments in additional cold storage equipment as well as an increase in vaccine transport frequency. A GAVI Alliance introduction grant of US$ 0.30 per child in the birth cohort would cover approximately 20% of the capital investments undertaken to facilitate introduction.
在全球疫苗免疫联盟（GAVI Alliance）的支持下，2007年3月，一种单剂量小瓶包装的全液体联合白百破-乙肝- Hib（五价）疫苗被引入埃塞俄比亚的常规免疫服务。这种疫苗被10剂量小瓶包装的白百破疫苗所替代。我们旨在估算五价疫苗接种的增量系统成本。
作为新疫苗引入后评估的一部分，在埃塞俄比亚四个地区进行了为期两周的数据收集，内容包括冷藏设施扩充情况以及疫苗运输频率增加情况。对卫生系统各级人员进行了访谈。从亚的斯亚贝巴的卫生部、联合国儿童基金会和世界卫生组织收集了有关培训和宣传成本的信息，以促进疫苗的引入。
从10剂量白百破疫苗转换为单剂量五价疫苗后，在国家和地区层面，每个完全接种疫苗儿童的冷藏储存量增加了106%，在疫苗分发的三个较低层面增加了71%。各级都购买了冷藏设备，许多地方疫苗采集频率增加了一倍多。冷藏设备、培训和宣传的增量资本成本达480万美元，即2007年出生队列中每个儿童1.53美元。在将资本成本年度化并加上经常性成本后，2007年出生队列中每个儿童的系统成本为0.80美元。疫苗接种覆盖率为78%时，这相当于每个完全接种疫苗儿童1.13美元。最重要的系统成本项目是冷藏，在出生队列中每个儿童为0.62美元，每增加1立方厘米冷藏空间为0.03美元。
在埃塞俄比亚引入五价疫苗需要在额外的冷藏设备方面进行大量投资，并提高疫苗运输频率。全球疫苗免疫联盟为出生队列中每个儿童提供0.30美元的引入赠款，将覆盖为促进引入而进行的资本投资的约20%。
