Improving the Costs and Cost-Effectiveness of Immunization Programs
The cost-effectiveness of immunization programs could be improved by either reducing costs or improving programs' health benefits. Programs could reduce costs by using a more efficient mix of delivery strategies, reducing vaccine wastage, and using lower-cost inputs while maintaining the same quality of service. Reductions in the price of vaccines in the near future will also reduce costs. Innovations in vaccine technology may result in more widespread use of vaccine vial monitors, and increased use of heat-stable vaccines could potentially reduce the cost of the cold chain, although these innovations may themselves add to costs. The number of children and adults immunized can be increased by creating additional demand for vaccination; reducing missed opportunities; and reducing the dropout rate between the first and third doses of DTP, hepatitis B, and other vaccines. Finally, changes in the EPI schedule could affect total costs by reducing the number of doses required to achieve immunity and thereby reducing the number of visits, resulting in savings in the costs of labor, supplies, transport, and perhaps overhead.
The EPI schedule was established in 1984 based on a review of immune responses to diphtheria, tetanus, pertussis, polio, and measles vaccines starting at different ages and with varying intervals between doses (Halsey and Galazka 1985). The EPI schedule administers three doses of DTP at the shortest possible intervals to complete the immunization series as early in life as possible. However, if the primary series could be reduced to two doses with a booster dose at 12 to 15 months of age, the cost savings from reduced visits and one fewer dose of DTP in countries that administer a fourth dose of DTP would be considerable. Additional serological studies would be needed to compare the existing EPI schedule with the theoretical schedule before a new schedule could be adopted. Also, other vaccines to be introduced into immunization programs would need to be revaluated in this schedule. Two doses of IPV administered beginning at two months of age induce protective levels of antibodies between 95 and 100 percent for each of the three polio types (Halsey and others 1997; Plotkin and Vidor 2004).
Some countries with a low incidence of tuberculosis (such as those of Eastern Europe) are considering the discontinuation of routine BCG vaccination, given the low risk of acquiring tuberculosis in early childhood. If the BCG were not administered during the first month of life, program costs would be reduced by the value of one visit and by the costs associated with vaccine purchase, shipping, storage, and administration.
