Griffiths Ulla Kou, Bozzani Fiammetta Maria, Chansa Collins, Kinghorn Anthony, Kalesha-Masumbu Penelope, Rudd Cheryl, Chilengi Roma, Brenzel Logan, Schutte Carl
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
Vaccine. 2016 Jul 29;34(35):4213-4220. doi: 10.1016/j.vaccine.2016.06.050. Epub 2016 Jun 28.
Introduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi's co-financing and eligibility policies.
Data on 'one-time' costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures.
'One-time' costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008-2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases.
While the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision.
自2000年疫苗免疫全球联盟（Gavi）成立以来，低收入和中低收入国家引入新疫苗的速度加快。本研究旨在：（i）估计在赞比亚引入肺炎球菌结合疫苗、轮状病毒疫苗和第二剂麻疹疫苗的成本；（ii）根据Gavi的共同融资和资格政策评估新疫苗的可负担性。
从政府和发展伙伴收集了有关冷藏设施扩建、培训和社会动员的“一次性”成本数据。基于51个卫生设施的代表性样本进行的常规免疫详细经济成本研究提供了劳动力和疫苗运输成本信息。预计到2022年赞比亚有望从Gavi的支持过渡时，对Gavi共同融资支付和免疫规划成本进行了预测。通过将这些成本与预计的政府卫生支出进行比较，评估了赞比亚自行资助新疫苗和传统疫苗的能力。
引入三种疫苗的“一次性”成本为人均0.28美元。新疫苗使年度免疫规划成本增加了38%，导致每名完全免疫儿童的经济成本为102美元。2008 - 2017年期间，共同融资支付平均增加了10%，但在2017年至2022年期间必须每年增加49%。2014年，政府将其卫生支出的约6%用于免疫。假设实际预算不增加，2022年免疫将占约10%。疫苗在2014年占政府卫生非人员支出 的1%，假设实际预算不增加，2022年将为6%。
虽然引入新疫苗因预期对健康有积极影响而合理，但鉴于赞比亚目前的经济形势，长期可负担性将具有挑战性。政府需要既向卫生部门分配更多资源，又在服务提供中寻求提高效率。
