From the Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Pfizer Inc., Collegeville, Pennsylvania.
Pediatr Infect Dis J. 2020 Feb;39(2):145-156. doi: 10.1097/INF.0000000000002521.
Pediatric pneumococcal disease exacts a substantial burden on global health, much of which is vaccine-preventable. Despite this considerable burden and the demonstrably high efficacy of pneumococcal conjugate vaccines (PCVs), the overall level of PCV uptake remains concerningly low, especially compared with that of other childhood-recommended vaccines, such as tuberculosis and polio. A broad set of plausible explanations exists for this low uptake, including logistical challenges, psychosocial factors and affordability. One additional and systematic cause of low uptake, which is the focus of our discussion, is economists' and policymakers' tendency to undervalue vaccination in general by adopting a narrow health sector perspective when performing economic evaluations of vaccines. We present an alternative, societal framework for economic evaluations that encompasses a broader set of socioeconomic benefits in addition to health benefits. Quantifying a more comprehensive taxonomy of PCV's benefits will help to address potential undervaluation and may be sufficient not only to justify recommendation and reimbursement but also to stimulate efforts and investment toward closing coverage gaps.
儿童肺炎球菌病给全球健康带来了巨大负担，其中很大一部分是可以通过疫苗预防的。尽管如此，肺炎球菌结合疫苗（PCV）的效果显著，但 PCV 的总体接种率仍然令人担忧，尤其是与结核病和脊髓灰质炎等其他推荐给儿童的疫苗相比。造成这种低接种率的原因有很多，包括后勤方面的挑战、社会心理因素和可负担性。我们讨论的另一个造成低接种率的系统原因是，经济学家和政策制定者在对疫苗进行经济评估时，往往由于采用了狭隘的卫生部门视角，而低估了疫苗接种的总体价值。我们提出了一种替代的、以社会为基础的经济评估框架，除了健康效益外，还包括更广泛的社会经济效益。对 PCV 效益的更全面分类进行量化，有助于解决潜在的低估问题，不仅足以证明推荐和报销的合理性，还足以激励为缩小覆盖差距而做出努力和投资。
