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okeeffe

Reference Case Guidelines for Benefit-Cost Analysis in Global Health and Development

Presenter: Lucy O'Keeffe

Co-authors: Lisa A. Robinson, James K. Hammitt, Michele Cecchini, Kalipso Chalkidou, Karl Claxton, Maureen Cropper, Patrick Hoang-Vu Eozenou, David de Ferranti, Anil B. Deolalikar, Frederico Guanais, Dean T. Jamison, Soonman Kwon, Jeremy A. Lauer, Lucy O’Keeffe, Damian Walker, Dale Whittington, Thomas Wilkinson, David Wilson, and Brad Wong


Poster file: [download]

ozawa

Hard-to-reach Populations: A systems mapping approach to bridging the gaps for vaccination

Presenter: Sachiko Ozawa


Twitter: '@GHEP_UNC

Co-authors: Elizabeth Mitgang, Tatenda Yemeke, Sarah Bartsch, Patrick Wedlock, Aaron Wallace, Sarah W Pallas, Taiwo Abimbola, Bruce Y. Lee


Poster file: [download]
Abstract:
Expanding vaccination coverage into populations that are hard-to-reach for vaccination has increased in priority for immunization initiatives; however, economic evidence to inform decision making on how to best expand vaccination coverage among these populations remains unclear. Vaccination involves a complex system of people, equipment, processes, and locations, which can make it challenging for policy makers, health officials, logisticians, and managers of national immunization programs to determine the costs or economic impacts of vaccination. We developed a systems map of the steps involved in an individual getting vaccinated, the associated vaccination program costs at service delivery level, and the health and economic impacts of vaccination in order to help decision makers see the whole picture of the processes involved, including the mechanisms that create hard-to-reach populations for vaccination. Systems maps are diagrams of the relevant components of a system and the connections among and between them. A systems map utilizes shapes, words, colors, and relational arrows to visually depict the components and processes of a system. To validate the content of our map and solicit expert feedback, we interviewed and incorporated the feedback of twenty-four immunization economics experts from academic institutions, government agencies, major technical organizations, and key philanthropies. Using this systems map, decision makers can consider where mechanisms or processes may be interrupted or weak, leading to hard-to-reach populations for vaccination, as well as possible health and economic effects throughout the entire system, when designing interventions to improve vaccination coverage and allocating finite resources.

paiman

Immunization Program Economy & Sustainability in Afghanistan

Presenter: Mohammad Akbar Paiman

Poster file: [download]
Abstract:
Immunization Program Economy & Sustainability in Afghanistan Mohammad Akbar Paiman MD. MSc Epidemiology National Immunization Program, Kabul Afghanistan Background: Afghanistan is one of the poorest countries located between south and central Asia with approximately 35 million population. The four-decade long war has undermined almost all infrastructure and systems in this country. Therefore, lack of sustainability of most programs in this country is cause of concern for both the government and international community, which has long presence in Afghanistan. National Expanded Program on Immunization (NEPI) is one of the core programs of the Ministry of Public Health (MoPH) which has the mandate of management and coordination of all immunization related activities in close coordination with other international partners. Afghanistan is one of the GAVI eligible countries and it hardly affords to provide co-finance for the vaccine purchased by the GAVI. Despite injection of huge amount of fund by different donors from 2001, until now more than 50 % of its population live under poverty line, Afghanistan remained donor depended and it is not clear when this country will be able to repair its fragile economy. In addition, high expenditures of war further put this country in danger regarding sustainability of vaccine economy. Currently GAVI supports this country both in term of vaccine cost and health system strengthening. Below picture shows different durations of GAVI support to fragile countries. Aim: To review the available data on immunization in Afghanistan and recommend new methods for sustainability of immunization program in this country. Methods: We reviewed available data on immunization, minutes of meetings and the author’s personal communications with national and international colleagues who are closely involved in immunization activities of the country from Jan 2016 to September 2018. The author triangulated all the data sources systematically. Main themes from the analyses included: 1. Provision of co-finance for purchasing of vaccine by the government of Afghanistan. 2. Donor dependency of the country for long time. 3. Fragile security and political situation of the country. Findings: The huge amount of fund provided by donors to Afghanistan did little impact and this country still hardly afford to pay the co-finance for its basic vaccines. System building is still a huge problem for this country and evidence shows frustration of donors in long run. Insecurity contributed to weakness of the immunization services a clear example of which is the huge number of polio cases (22) 2018 and (7) in 2019. All these indicate urgent need action for sustainability of immunization program in country. Ensuring political stability in the country is joint responsibly of the world particularly of the neighbor countries. This will pave the way to mobilization of domestic resources for improving systems particularly immunization programs in the country. Conclusion: Afghanistan needs political and security stability, system building and mobilization of domestic resources for having a stable health infrastructure and functional immunization program. Capacity of EPI program should be build regarding cost and economy of vaccine in Afghanistan. Key words: Immunization, Sustainability, Afghanistan

pempa

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

Presenter: Pempa

Co-authors: Kinley Dorji, Sonam Phuntsho, Suthasinee Kumluang, Sarayuth Khuntha, Wantanee Kulpeng, Sneha Rajbhandari, Yot Teerawattananon


Poster file: [download]
Abstract:
Introduction: Despite high disease burden PCV introduction is limited in many low-income countries due to the competing health priorities and limited resources. Ministry of Health, Royal Government of Bhutan felt a need for evidence on cost and benefit of introducing PCV in the routine immunization program. Objective: To determine the Cost-Utility of introducing PCV10 and PCV13 in Bhutan compared to no vaccination. Methodology: A Markov model was used to estimate the costs and outcomes of three options in a government perspective cost-utility-analysis: PCV 10, PCV 13 and No PCV for a lifetime horizon. Discount rate at 3% per annum was applied. Health outcomes were measured in terms of pneumococcal-episode and death averted, and Quality-Adjusted-Life-Year (QALY) gained. Results are presented using an incremental cost-effectiveness ratio (ICER) per QALY gained. One-Way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty. Results. Compared to no vaccination, PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained, respectively. And PCV13 produced an ICER of USD 92 compared with PCV10. Inclusion of PCV into the routine immunization program would increase the 5-year budgetary requirement to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6–1.1 FTE) and nurse (1–1.6 FTE). Conclusion: The study recommends the introduction of PCV routine immunization program as both PCVs are cost-effective at the suggested threshold of one-time GDP per-capita (USD 2708). However, the implementation of PCV-13 would able to save more lives and costs in the long run.

Additional Files:
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pinheiro

Cost of implementing the Intensified Mission Indradhanush Programme

Presenter: Anita Pinheiro

Co-authors: Palash Das, Susmita Chatterjee, Logan Brenzel, William Lodge, Christian Suharlim, Nicholas Menzies, Stephen Resch


Poster file: [download]
Abstract:
Background: Despite being operational over 30 years, only 65% children in India receive complete immunization during their first year of life through India’s Universal Immunization Programme (UIP). Intensified Mission Indradhanush (IMI) programme was a government of India initiative to reach each and every child up to two years of age and all those pregnant women who have been left uncovered under UIP. IMI was implemented in 173 low coverage districts in 24 states for 7 days every month between October 2017 and January 2018. The basic strategy of IMI involved • a process of head count survey to identify children with missing doses • prepare a due list with missed children • prepare a microplan accordingly to identify areas for outreach sessions • deliver immunization at identified temporary vaccination sites during one week of each month for four consecutive months Special drive like IMI requires additional resources, however, no information on the incremental cost of conducting such special initiative. Objective: Estimate actual additional government expenditures for IMI Methods Sampling: We purposefully selected five states: Assam, Bihar, Maharashtra, Rajasthan and Uttar Pradesh which have a high concentration of IMI activity. Within these five states, we selected 40 districts including six urban districts, 91 blocks (sub-districts) and 281 sub-centres. Data collection: A five member team were responsible for data collection during the period of July 2018 to January 2019. Data were collected from administrative records, financial records as well as interviewing different categories of staff involved in IMI. Financial cost components include Vaccines, Syringes, Vaccine transport, Communication, Training, Meeting, Mobility support, Payment for alternate vaccine delivery (AVD), Incentives for Accredited Social Health Activists (ASHAs), Printing, Waste management, Supervision, Microplanning, Mobile team, Line listing, Travel expenses to session sites. District wise additional financial costs were calculated to understand the incremental resource requirements for IMI. Results: Vaccines and supplies were the major cost components for Bihar, Rajasthan and Uttar Pradesh. In Maharashtra, communication, incentives for accredited social health activists (ASHAs) and supervision were the major cost components. In Assam, no specific trend of expenditure was found across study districts. Cost of reaching per child during IMI programme was US$2.15 in Uttar Pradesh while the same was US$8.25 in Assam. Discussion: Given the lower baseline coverage in Rajasthan and Uttar Pradesh, the increasing cost per dose in Rajasthan, Uttar Pradesh to Maharashtra probably reflect the increasing marginal cost of covering more children in a given population. Higher unit cost and cost per child in Assam is probably because of the geographical hard to reach areas in the state which includes riverine islands, hilly terrain.

riewpaiboon

Micro-costing vs FLUTool; Cost Analysis of Influenza Vaccination for Pregnant Women in Thailand

Presenter: Arthorn Riewpaiboon

Poster file: [download]
Abstract:
Seven of eight hospitals provided campaign-based vaccination. One hospital included the service in routine antenatal care clinic (ANC). Number of pregnant women received the vaccine in each district varied from none to thirty-one depending on the size of population in each catchment area and vaccine uptake. Vaccine is delivered on a “first-come-first-served” basis leading to a disproportionate number among the target groups. In addition, due to rumors of AEFI in some areas, pregnant women might be reluctant to be vaccinated. Given these issues, there was no vaccinated pregnant woman in two hospitals. Cost per dose vaccinated was calculated by activity and total cost. Total cost per vaccinated dose was in range of Int$10.8-31.4. The activities included in this study were modified from those of the FLUTool version 3.0 that includes micro planning, training, social and mobilization/introduction/IEC, vaccine procurement, continuing IEC, service delivery, supervision/monitoring/evaluation, other current cost, cold chain supplement and other capital costs. Major difference of this study and that of the tool is objective and scope. The FLUTool is applied for the whole national program in a public health perspective. This study was conducted in a hospital perspective. Therefore, costs of planning and training and others are only costs incurred by the hospitals (not included those of other organizations). When comparing the micro-costing approach in this study to the FLUTool, the FLUTool does not cover mobile delivery service. This might be an input to develop the next version.

Additional Files:
[file 1]

rosettie

The estimated cost-effectiveness of a Shigella vaccine in children under five in Ethiopia

Presenter: Katherine Rosettie

Co-authors: James Collins, Michelle Park, Abraham D. Flaxman, Ibrahim Khalil, Kelly Compton, Paola Pedroza, Ali H. Mokdad, Marcia R. Weaver


Poster file: [download]
Abstract:
Shigella is the second leading cause of diarrhea mortality in children under five globally, and was responsible for approximately 8,500,000 disability-adjusted-life-years (DALYs) in 2017 in this age group. Shigella incidence peaks among children one to four years, and Shigella trials are being designed to test a vaccine with doses administered in the first and second year of life. We aim to estimate the cost-effectiveness of a Shigella vaccine in Ethiopia, given the country’s mid-range diarrhea mortality and increasing vaccine coverage. Our objectives are to answer the following four questions in Ethiopia: (1) What is the effect of adding a primary Shigella vaccine series at 9 and 12 months to the routine immunization schedule?; (2) What is the effect of adding a booster dose at 15 months to the primary series?; (3) What is the effect of a booster dose at 18 versus 15 months?; and (4) What is the effect of starting the primary series at 6 months versus 9 months? We used an open-source, individual-based predictive simulation framework developed at the Institute for Health Metrics and Evaluation called Vivarium to estimate the cost-effectiveness of a Shigella vaccine under different vaccine schedules. Vivarium leverages the most recent estimates from the Global Burden of Disease (GBD) study to model interactions between diarrhea risk factors, diarrhea incidence, and mortality by age, sex, year, and location. We used a time horizon of 15 years (2025-2040) with an initial population of 32,000 simulants ages 0-5 years and an open-cohort structure wherein newborns entered the model each time step (1 day). We conservatively assumed 50% vaccine efficacy. Cost estimates were based on summary estimates of routine immunizations in low-income countries. We used GBD-reported annual measles and DTP3 vaccines coverage in Ethiopia, which correspond to the timing of the Shigella vaccine in the routine immunization schedule, as a proxy for Shigella vaccine coverage. We quantified parameter uncertainty for our estimates by using the Monte Carlo method whereby we drew 500 values from the distributions of each input parameter. All results were scaled to the national level. Compared to a baseline scenario with no Shigella vaccine, adding two doses of the vaccine at 9 and 12 months would avert 101,000 DALYs, with an ICER of $2110/DALY averted. Compared to a primary series at 9 and 12 months, adding a booster dose at 15 months would avert 157,000 DALYs save US$16.5 million. Compared to booster at 15 months, a later booster at 18 months would be cost-saving (20,000 DALYs averted; US$20.56 million saved). Finally, when comparing an earlier primary series at 6 and 9 months to a later primary series at 9 and 12 months, the earlier series would be cost-saving with 62,000 DALYs averted and US$44.3 million saved. This suggests a primary series at 6 and 9 months with a booster 15 months is the most optimal Shigella vaccine schedule, yet we estimated that all four vaccine schedules would be cost-saving in Ethiopia and would result in a reduction in the Shigella burden.

Additional Files:
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sarker

Willingness to Pay for Oral Cholera Vaccines in urban Bangladesh

Presenter: Abdur Razzaque Sarker


Twitter: Razzaque_Sarker

Co-authors: Ziaul Islam, Marufa Sultana, Ashraful Islam Khan, Firdausi Qadri, Alec Morton and Jahangir AM Khan


Poster file: [download]
Abstract:
Introduction: Cholera remains a serious public health burden globally and especially in regions where poverty and poor sanitation are prevalent. Bangladesh has one of the largest burdens of endemic cholera, with an estimated 109,052 cases each year, and approximately 66 million people are at risk of cholera. There are over 3,000-5,000 deaths annually and high caseloads and frequent outbreaks in the country. To address this problem, policy makers recognized that an effective vaccine and vaccination strategy is essential for Bangladesh. Objectives: The objective of the study is to measure the private demand for oral cholera vaccines (OCV) in Bangladesh and to investigate the key determinants of this demand, reflected on household’s willingness to pay for oral cholera vaccine. Methods: A contingent valuation method was employed in an urban setting of Bangladesh during December 2015 to January 2016. All respondents (N= 1051) received a description of a cholera oral vaccine (OCV) Shanchol™ which has around 60% efficacy for 2-5 years and is WHO prequalified and available in the WHO stockpile. Interviews were conducted with either the head of households or his/her spouse or a major economic contributor of the households. Natural log-linear regression model was employed to examine the factors influencing participants’ WTP for OCV. Results: The mean and median WTP for OCV per vaccination (2 doses) was estimated to BDT US$ 2.23 and US$ 1.92 respectively for protection of the respondent against cholera infection. On the household level with an average number of 4.62 members, the estimated WTP was US $10 (mean) and US$ 7.69 (median) which represents the perceived private economic benefits to a household of vaccination against cholera. Among the total respondents approximately 99.4% were willing to pay for the vaccines for their own protection at some price, while 99.8% reported they would purchase the vaccine for their household members. The natural log-linear regression model revealed that a number of factors such as sex of the respondents, occupation, knowledge about cholera and oral cholera vaccine, household income, size of the households and age composition of household members are significantly associated with WTP. Discussion: Our research provided evidence on the perceived demand for OCV, suggesting that the households may not wait for the public vaccination campaign rather can protect themselves from cholera if the vaccine is available in private market. Our estimation supported that the households with members of age under five years were willing to pay more than any other age groups. A free of cost supply of OCV to entire population of the country would bring a perceived economic benefit of corresponding to the average maximum WTP of the households. Major Findings: The demand for Oral Cholera vaccines indicates that there is a potential scope for recovering a certain portion of the expenditure of immunization program by introducing direct user fees for future cholera vaccination in Bangladesh. A combination of revenue from private market and pooled fund (e.g., taxes) could be considered as a sustainable way of financing oral cholera vaccine in Bangladesh to secure protection against cholera infection.

sato

Effect of Vaccine Direct Delivery (VDD) on vaccine stockouts and vaccination cases

Presenter: Ryoko Sato

Co-authors: Aisha Giwa, Loveth Metiboba, Vivian Odezugo, Adam Thompson


Poster file: [download]
Abstract:
Objective Vaccine stockouts are prevalent in Africa. Despite the potential importance of this as a barrier to universal vaccination coverage, rigorous study looking at ways to reduce vaccine stockouts has been limited. We causally evaluate the effect of Vaccine Direct Delivery (VDD), an intervention to ensure the vaccine-stock availability at health facilities, on the reduction of stockouts in Bauchi state, Nigeria. Methods Employing the interrupted time-series method, we evaluate the change in the occurrence of vaccine stockouts before and after the introduction of VDD in July 2015. We use the health-facility level data, collected through the District Health Information Software 2 (DHIS2), for monthly information on stockouts and stock balance in all the health facilities in Nigeria. To validate the causal relationship between VDD and vaccine stockouts, we conduct two sets of robustness checks. First, we evaluate the effect of VDD on the stockouts of other commodities. Second, we compare the trend of the prevalence of vaccine stockouts among health facilities between Bauchi state where VDD was introduced, and another state (Adamawa state) where VDD was never introduced. Results After the introduction of VDD, vaccine stockouts in Bauchi state decreased by 9 percentage points on average, and they have been decreasing monthly by 0.4 percentage points more than pre-VDD. There was no change in the level of other stockouts. In Adamawa state, where VDD was never introduced, the prevalence of vaccine stockouts did not change over time. In Bauchi state after VDD introduction, the stock balance of target vaccines all increased but we did not observe an increase in the number of vaccinations carried out. Conclusions The VDD intervention resulted in a significant reduction of vaccine stockouts, but not an increase in the number of vaccinations performed. More effort should be channeled into creating a demand for vaccines.

sibeudu

Cost-Effectiveness Analysis of Routine immunization and Supplemental immunization Activities for measles immunization to children in Anambra state, South-east,Nigeria

Presenter: Florence Sibeudu


Twitter: '@ftsibeudu

Co-authors: Obinna Onwujekwe,Ijeoma Okoronkwo


Poster file: [download]
Abstract:
Background: Measles immunization is critical for elimination of measles among children to enhance their life prospects and improve economy. However, immunization financing is a serious challenge in Nigeria as gaps exists between available fund and estimated costs. This study aimed to determine the most cost effective strategy to deliver measles immunization to children Method: A cross sectional design was used. Data were collected at six Local Government areas(LGAs) immunization offices and 12 health facilities with immunization costing questionnaire. Ingredient approach to costing was used based on providers’ perspective. The effectiveness measures considered were DALYs averted, cases averted, death averted. One-way sensitivity analysis was used to test the robustness of the initial result. Microsoft excel was used for the data analysis. Result: The Average Cost–effectiveness Ratios for the delivery of Measles Containing Vaccine through Routine Immunization were ₦ 0.34($0.002) per DALYs averted, ₦ 218.66($1.12) per case averted and ₦5,466.59 ($27.93) per death averted. While Average Cost-effectiveness Ratios through Supplemental Immunization Activity were ₦117.23 ($0.599) per DALY averted, ₦315.07 ($1.61) per case averted and ₦7,876.43 ($40.24) per death averted. The Incremental Cost-effectiveness Ratio for the delivery of MCV through SIA was ₦212.02 ($1.083) per DALY averted. The effect of 50% increase in the cost of personnel,50% increase in cost of social mobilization, inclusion of cost for supervision and short training on the initial cost per DALY for the delivery of MCV through Routine Immunization were ₦0.42($0.002),₦ 0.34($0.002), ₦0.44($0.002) , ₦0.47($0.002) and ₦1.50($0.008),. Conclusion: Measles Routine Immunization is more cost effective than Supplemental immunization Activity. Routine immunization could be more cost effective if policy makers consider to strengthen or include activities like training, social mobilization, and supervision in Routine immunization services.

suwantika

Cost-effectiveness and Budget Impact Analyses of Pneumococcal Vaccination in Indonesia

Presenter: Auliya Abdurrohim Suwantika

Co-authors: Vensya Sitohang, Gertrudis Tandy, Putri Herliana, Sri Rezeki Hadinegoro


Poster file: [download]
Abstract:
As a country with the high number of deaths due to pneumococcal disease, Indonesia has not yet included pneumococcal vaccination into the routine program. The aim of this study was to investigate the cost-effectiveness and budget impact analyses of pneumococcal vaccination in Indonesia. An age-structured cohort based on a decision tree model was developed to assess the cost-effectiveness and affordability values of universal pneumococcal vaccination in Indonesia by making comparison between two vaccines (PCV-10 and PCV-13) within two pricing scenarios (UNICEF and government contract price) in a 6-year time horizon analyses (2019-2014). A nationwide vaccination was targeted to be implemented in 2021. A single birth cohort of infants in each year was followed-up until 5 years of age with 1 month analytical cycles for children < 1 year of age and annual cycles beyond 1 year. The result showed that vaccination would reduce pneumococcal disease by 1,696,548 and 2,268,411 cases when using PCV-10 and PCV-13, respectively. Vaccination would save treatment cost from the payer perspective at $54 million and $71 million for PCV-10 and PCV-13, respectively. The Incremental Cost-Effectiveness Ratio (ICER) would be $218 and $162 per QALY-gained for PCV-10 and PCV-13, respectively, under the UNICEF price. Applying the contract price, the ICER would be $997 and $747 per QALY-gained for PCV-10 and PCV-13, respectively. Vaccine cost per 1 vaccinated child was estimated to be $5.27/dose and $17.5/dose under UNICEF and contract price, respectively. Implementation of nationwide PCV vaccination would require approximately $61-63 million (17-20% of routine immunization budget) and $238-244 million (67-80%) under UNICEF and contract price, respectively. Sensitivity analysis showed that vaccine efficacy, mortality rate and vaccine price were the most influential parameters affecting the ICER. In conclusion, pneumococcal vaccination would be a highly cost-effective intervention to be implemented in Indonesia. Yet, applying PCV-13 under UNICEF price would give the best cost-effectiveness value and biggest budget impact on routine immunization budget.

vu

Factors Associated with the Funding Gap Between the Full Economic Delivery Costs and the Full Fiscal Delivery Costs of the Routine EPI in Vietnam

Presenter: Vu Quynh Mai

Co-authors: Hoang Van Minh


Poster file: [download]
Abstract:
Accurate cost data is needed to ensure adequate financing to achieve high coverage of vaccines offered as part of the National Expanded Program on Immunization (NEPI). A costing study was done as a first step in estimating the correct, complete calculation for the package of immunization services. Here we analyze the difference between full economic (adjusted fiscal cost based on Ministry of Finance (MOF) cost norms) and fiscal delivery costs (actual spending) of EPI at the sub-national levels in Vietnam. We present methods for this ingredients-based, retrospective economic and fiscal costing of routine activities of the EPI in 2017, calculation of the total funding gap and a multilevel regression analysis to determine the factors associated with the funding gap. Results indicate that the total funding gap is US$7.4 million, with the largest gaps at district and facility levels. By line item, volunteer labor and per diem contribute the most to funding gap. By activity, the largest contributing items are routine facility-based delivery, supervision, and vaccine storage & supply. Factors significantly associated with funding gap are storage at province level, waste management at district level, and number of full time equivalent staff at facility level.

watts

VIEW-hub at your Fingertips: Freely Available Real-time Monitoring of Vaccine Use, Coverage, and Impact

Presenter: Elizabeth Watts

Co-authors: Kirthini Muralidharan, Maria Deloria Knoll


Poster file: [download]
Abstract:
Economists, policy-makers, health researchers all require current data on the status of vaccine use, and its impact globally. VIEW-hub collates information in one place. VIEW-hub gathers data on vaccine introduction, coverage, and impact from a range of sources, including WHO, Gavi, and the World Bank. VIEW-hub users can download world maps and graphs for use in visual presentations.

yemeke

Role of Pharmacists in Vaccination in Low-and Middle-Income Countries (LMICs)

Presenter: Tatenda Yemeke


Twitter: '@GHEP_UNC

Co-authors: Stephen McMillan, Ian Bates, Lina Bader, Victoria Rutter, Helena Rosado, Sachiko Ozawa


Poster file: [download]
Abstract:
Global childhood immunization coverage has stalled at around 86% in recent years, resulting in nearly 1.5 million deaths annually from vaccine-preventable diseases. Under-vaccination of populations threatens the attainment of global vaccination goals. Current estimates indicate a worldwide shortage of 7.2 million healthcare workers in low-and middle income countries (LMICs), exacerbating the difficulty of vaccinating every child. Pharmacists have demonstrated their value in increasing awareness and access to vaccines, as well as improving vaccination coverage in high-income countries. However, evidence of their role in LMICs remains limited. This study synthesizes evidence about the current roles pharmacists play in vaccination across LMICs. We conducted a survey targeting individuals in the fields of pharmacy and pharmaceutical sciences to assess current practice, as well as performed a systematic review of published literature. The survey assessed pharmacists’ involvement in various vaccination service domains and elicited their perceptions on their role and perceived barriers. We received 255 responses representing 55 LMICs. Our systematic review identified 21 studies describing pharmacist involvement in vaccination in LMICs. Currently, the majority of pharmacists in LMICs engage in patient education, with few pharmacists administering vaccines or receiving immunization training. Greater immunization training among pharmacists could facilitate their increased involvement in vaccination, from increasing vaccination referrals, educating patients about vaccines, ordering and storing vaccines, to administering vaccines. Greater pharmacist involvement in vaccination in LMICs could build upon pharmacists’ accessibility and relationships in the community to improve vaccination outcomes.