Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015
Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015
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DOI：
10.2471/blt.07.045096
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发表时间：
2008-01-01
期刊：
影响因子：
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通讯作者：
Okwo-Bele, Jean-Marie
中科院分区：
文献类型：
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作者：
Wolfson, Lara J;Gasse, François;Okwo-Bele, Jean-Marie
目的估算为实现WHO-UNICEF全球免疫远景与战略（GIVS）提出的到2015年将疫苗可预防疾病的死亡率降低三分之二的目标而扩大儿童免疫服务所需的费用。方法建立模型，估算117个中低收入国家到2015年实现GIVS目标的总费用。通过分析国家规划文件中的数据估算了当前支出，并采用自下而上、基于成分的方法估算了扩大规模的费用。按国家和年份估计了所有现有疫苗达到90%覆盖率的财务成本;引进一套独立的新疫苗（轮状病毒、肺炎球菌结合物、A型脑膜炎球菌结合物和日本脑炎）;开展免疫接种运动，保护高危人群预防小儿麻痹症、破伤风、麻疹，黄热病和脑膜炎球菌性脑膜炎。结果世界上72个最贫穷的国家花了2.5美元2005年用于免疫接种的资金从2000年的11亿美元（范围：18 - 42亿美元）增加到2005年的11亿美元（范围：9 - 16亿美元）。到2015年，每年的免疫费用将平均增加到约40亿美元（范围为29 - 67亿美元）。2006-2015年免疫接种总费用估计为35美元（范围：130 - 400亿美元）;其中162亿美元为增支费用，包括56亿美元用于系统扩大，87亿美元用于疫苗;将免疫方案维持在2005年的水平需要193亿美元，在所有117个低收入和中低收入国家，2006-2015年的总费用估计为76美元在72个最贫穷的国家，如果要实现全球免疫展望和战略的目标，总的资源需求中有110 - 150亿美元（30%-40%）没有得到满足。本文中开发的方法是具有局限性的近似估计，但提供了到2015年扩大免疫接种所需填补的资金缺口的路线图。
Objective To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015.Methods A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle-income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis.Findings The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels.In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up.Conclusion In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.