Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada.
The Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
Vaccine. 2014 Feb 7;32(7):766-70. doi: 10.1016/j.vaccine.2013.12.027. Epub 2013 Dec 25.
Funded immunization programs are best able to achieve high participation rates, optimal protection of the target population, and indirect protection of others. However, in many countries public funding of approved vaccines can be substantially delayed, limited to a portion of the at-risk population or denied altogether. In these situations, unfunded vaccines are often inaccessible to individuals at risk, allowing potentially avoidable morbidity and mortality to continue to occur. We contend that private access to approved but unfunded vaccines should be reconsidered and encouraged, with recognition that individuals have a prerogative to take advantage of a vaccine of potential benefit to them whether it is publicly funded or not. Moreover, numbers of "approved but unfunded" vaccines are likely to grow because governments will not be able to fund all future vaccines of potential benefit to some citizens. New strategies are needed to better use unfunded vaccines even though the net benefits will fall short of those of funded programs. Canada, after recent delays funding several new vaccine programs, has developed means to encourage private vaccine use. Physicians are required to inform relevant patients about risks and benefits of all recommended vaccines, publicly funded or not. Likewise, some provincial public health departments now recommend and promote both funded and unfunded vaccines. Pharmacists are key players in making unfunded vaccines locally available. Professional organizations are contributing to public and provider education about unfunded vaccines (e.g. herpes zoster, not funded in any province). Vaccine companies are gaining expertise with direct-to-consumer advertising. However, major challenges remain, such as making unfunded vaccines more available to low-income families and overcoming public expectations that all vaccines will be provided cost-free, when many other recommended personal preventive measures are user-pay. The greatest need is to change the widespread perception that approved vaccines should be publicly funded or ignored.
免疫规划项目能够最大限度地提高参与率，为目标人群提供最佳保护，并间接地保护其他人。然而，在许多国家，经批准的疫苗的公共资金可能会大量延迟，仅限于一部分高危人群，或者完全被拒绝。在这些情况下，未被资助的疫苗通常无法被有风险的个人获得，从而导致潜在可避免的发病率和死亡率继续发生。我们认为，应该重新考虑和鼓励私人获得已批准但未被资助的疫苗，因为个人有权利用对他们有潜在益处的疫苗，无论该疫苗是否由公共资金资助。此外，“已批准但未被资助”的疫苗数量可能会增加，因为政府无法为所有未来对一些公民有潜在益处的疫苗提供资金。需要新的策略来更好地利用未被资助的疫苗，尽管其净效益将低于资助计划。加拿大在最近延迟为几个新疫苗项目提供资金后，已经制定了鼓励私人使用疫苗的方法。医生必须告知相关患者所有推荐疫苗（无论是否由公共资金资助）的风险和益处。同样，一些省级公共卫生部门现在推荐和推广资助和未资助的疫苗。药剂师是使未资助疫苗在当地可用的关键角色。专业组织正在为公众和医疗服务提供者提供有关未资助疫苗的教育（例如，带状疱疹，在任何省份都没有资助）。疫苗公司在直接面向消费者的广告方面正在获得专业知识。然而，仍然存在重大挑战，例如使未资助的疫苗更容易为低收入家庭获得，并克服公众的期望，即所有疫苗都将免费提供，而许多其他推荐的个人预防措施都需要自费。最大的需求是改变广泛存在的看法，即批准的疫苗应该由公共资金资助或被忽视。
