Debellut Frédéric, Bello George, Chisema Mike, Mkisi Rouden, Kamzati Moses, Pecenka Clint, Mugisha Emmanuel
Center for Vaccine Innovation and Access, PATH, Geneva, Switzerland.
Epidemiology Unit, Ministry of Health, Lilongwe, Malawi.
Vaccine X. 2024 Nov 13;21:100583. doi: 10.1016/j.jvacx.2024.100583. eCollection 2024 Dec.
Malawi introduced typhoid conjugate vaccine (TCV) in 2023 through an integrated campaign delivering TCV alongside other vaccines and interventions (measles rubella vaccine (MRV), bivalent oral polio vaccine (OPV), and vitamin A Supplementation). The campaign sought to reach all children 9 months to younger than 14 years, representing more than 9 million individuals, and about half the country's population. Following the campaign, TCV was incorporated into the routine immunization program for 9-month-old infants. We conducted a micro-costing study at 50 randomly selected health facilities, 10 districts, and at national level to retrospectively assess the financial and economic cost of the integrated campaign, as well as prospectively estimate the cost of delivering TCV in the routine immunization system. The financial and economic costs per dose for all interventions delivered in the campaign were $0.49 ($0.42;$0.57) and $0.84 ($0.67;$1.02), respectively. The main activities and cost types varied; human resources represented the main resource at health facility level, and per diem at district and national levels. The financial and economic cost to routinely deliver a dose of TCV were $0.44 ($0.17;$0.87), and $2.37 ($1.39;$3.53), respectively, with human resources as the main resource used by the routine program at all levels. The cost per dose delivered in the integrated campaign in Malawi was comparable with other integrated campaigns and was lower than the reported cost to deliver TCV in single antigen campaigns in India and Zimbabwe. Integrated campaigns may represent an opportunity to introduce new vaccines such as TCV to lower the cost per dose delivered. Attention should be given to challenges coming with integration, such as the burden for healthcare workers. Evidence produced by this study can be used in Malawi to inform financial sustainability of the TCV program and should inform decisions and strategies for implementation by other countries.
马拉维于2023年通过一项综合活动引入了伤寒结合疫苗（TCV），该活动在提供TCV的同时还提供其他疫苗和干预措施（麻疹风疹疫苗（MRV）、二价口服脊髓灰质炎疫苗（OPV）和维生素A补充剂）。该活动旨在覆盖所有9个月至未满14岁的儿童，超过900万人，约占该国人口的一半。活动结束后，TCV被纳入9个月大婴儿的常规免疫计划。我们在50个随机选择的卫生设施、10个地区和国家层面进行了微观成本核算研究，以回顾性评估综合活动的财务和经济成本，并前瞻性估计在常规免疫系统中提供TCV的成本。活动中提供的所有干预措施每剂的财务和经济成本分别为0.49美元（0.42美元；0.57美元）和0.84美元（0.67美元；1.02美元）。主要活动和成本类型各不相同；人力资源是卫生设施层面的主要资源，而每日津贴是地区和国家层面的主要资源。常规提供一剂TCV的财务和经济成本分别为0.44美元（0.17美元；0.87美元）和2.37美元（1.39美元；3.53美元），人力资源是各级常规计划使用的主要资源。马拉维综合活动中每剂的成本与其他综合活动相当，低于印度和津巴布韦在单抗原活动中提供TCV的报告成本。综合活动可能是引入TCV等新疫苗以降低每剂交付成本的一个机会。应关注整合带来的挑战，如医护人员的负担。本研究产生的证据可用于马拉维，为TCV计划的财务可持续性提供信息，并应为其他国家的实施决策和战略提供参考。
