Introduction
The 2017 Community of Practice survey was launched in June by the EPIC project in collaboration with ICAN project. Building from the previous survey distributed at the May 2016 Immunization Costing Workshop in DC. Questions from the EPIC project were aimed to better understand recent, ongoing, and upcoming research on immunization value, costing, financing, and efficiency. The EPIC team also collected information on community members’ position types, regions of residence and work, and resources they feel important to be shared via the website. The final two sections of the survey contained questions from ICAN, which primarily requested input for their systematic review results navigation, cost benchmarks and comparison.
The survey was disseminated through our website (Immunizationeconomics.org) in both the announcement bar and the rotating carousel of news from June to November 2017. In this period, announcements of the survey were included in four newsletter issues (June, July, September, and October). Analysis of ICAN-related questions were done separately to inform their workshop and other project management meetings, and are not included in this report.
After the initial round of dissemination, members of our team followed up with those who started the survey but did not complete it. This resulted in 26 individual follow-up emails. In total, of the 82 submission attempts, 36 respondents filled out the survey. Of those, 30 complete submissions are recorded.
Respondent Demographics
Position type
Respondents were asked to describe their professional position type, selecting as many categories as applied to them. 36 respondents (100%) answered this question, providing a total of 46 responses. Table 1 below shows the response count for each category.
A third of the responses provided were by respondents identifying as an academic researcher, with the next most common response being that of a development partner.
Table 1: Position type
Primary immunization economics research activity
Respondents were then asked about their primary activity on immunization economics research. 35 respondents (97%) answered this question. The majority (54%) identified as a producer of research, with most of the remaining (43%) identifying as a user of research results.
Figure 1: Primary activity on immunization economics research
Country respondents are based in
Respondents were asked which country they are based in. 36 respondents (100%) answered this question, providing a total of 41 responses.
14 of the responses (35%) were in the USA, with most of the remaining countries having 1 or 2 responses each.
Table 2: Country respondents are based in
Region of focus
Respondents were then asked which region(s) their work focuses on. 36 of the respondents (100%) answered this question, providing a total of 50 responses. The graph and table below provide a summary of the results.
Table 3: Region of focus
The following graph shows the number of respondents whose work is in one country / region, compared to those whose work spans multiple regions.
Figure 2: Number of respondents working in one country/region versus multiple
Project summaries
This section of the survey dealt with the projects that respondents are engaged in. 21 respondents (58%) provided at least one project description, with a total of 46 projects described. The projects described can be divided into two overarching categories:
Projects which evaluate the cost of immunization program changes, and
Projects which provide technical support or capacity building around immunization
25 projects were identified which fell into the first category; 14 fell into the second category and 1 project incorporated elements of both categories. 3 projects had scopes that were outside these categories, and an additional 3 did not provide a project description.
Projects in the first category included those using models to predict possible future costs, a modeling project to build a supply chain model which includes the logistics costs per dose administered. Many projects mentioned estimating total and unit costs within a specific country-level context, while some were broader in scope, such as an an estimation of the RoI from a program to vaccinate young girls in many LMICs. Some projects examined the costs of new vaccine introduction.
The second overarching category included those projects whose purpose was around technical support and/or capacity building. For example, a project that provides a leadership training, mentoring, and assistance establishing a local network. Other technical support project provides technical assistance to pilots of a vaccination program planning and costing tool. Other projects combined technical support and an advocacy role, in collaboration with local Ministry of Health, to define, advocate, and enact a legal basis for immunization and assure funding for the program.
Of the 46 projects described, 10 received funding from the Bill & Melinda Gates Foundation, 6 received funding from the Centers for Disease Control & Prevention, 3 from Gavi, 3 from the World Health Organization and 2 each from UNFPA and Pfizer International.
16 of the projects took place in Africa, 16 in Asia, 5 in the United States, 4 in both Africa and Asia, and 2 worldwide.
As disclosed in the survey, project-specific information will not be made public. However, should a member of community ask to learn more for a potential collaboration, we will forward the request to the researchers in that area and allow them to respond, should they want to.
Community need: useful guideline elements
Respondents were asked to describe the elements they would find useful in a guideline / methodological resource in immunization costing and efficiency. 21 of the respondents (60%) provided a response to this question, with 40 total comments provided. Responses covered a wide range of themes; the greatest number of comments were in the areas of costing standards and guidelines, as well as the need for a practical tool for use with policymakers / decisionmakers. Other themes included sampling, data management, discounting, coverage, overhead, unit and delivery costs, and cost effectiveness. If you are working on a guidelines or tool in the area of Immunization Economics for the public good, we're happy to share and discuss our findings to jointly better serve the community.
Community resource sharing: available guidelines
Respondents were asked to share currently available bodies of work in the design, analysis, and/or interpretation of immunization costing and efficiency research, including available guidelines or methodological documents that they have found to be useful. 11 respondents (31%) provided at least one resource, with a total of 22 resources provided. A summary of the resources is listed below.
A stakeholder consultation on investment strategies for routine immunization in Africa. http://3qvw4sd8qlr2o7003493odw1.wpengine.netdna-cdn.com/wp-content/uploads/2012/11/ARISE_StakeholderConsultation_final508.pdf
Content and Financing of an Essential National Package of Health Services, Global Assessments In The Health Sector. Cowley,P.; Bodabilla,L.; Musgrove,P. & Saxenian,H. (1994). World Health Organization
Cost-Effectiveness Analysis in Health: A Practical Approach 2nd edition. Peter Muennig 2nd edition
Design, content and financing of an essential national package of health services. Bobadilla J-L et al. Bulletin of the World Health Organization, 1994, 72:653-662.
EPIC studies
IARC descriptions of cancers related to infectious agents
IHME data on death and prevalence rates for cancers and other diseases
Immunization costing and financing: A tool and user guide for comprehensive Multi-Year Plan (cMYP) - Update 2014. http://www.who.int/immunization/documents/WHO_IVB_14.06/en/
Immunization costing website. immunizationcosting.org
Immunization Financing: a resource guide for advocates, policymakers, and program managers. http://www.immunizationfinancing.org/home/Immunization_Financing_Resource_Guide_2017_FULL.pdf
Immunization Policy & Financing. http://www.sabin.org/programs/immunization-policy-financing
ISPOR/SMDM Guidelines for cost effectiveness
JSI Costing Tool
MCSP study in Tanzania
Methods for the Economic Evaluation of Health Care Programmes. Michael F Drummond et al., Oxford University Press Inc., New York, 1997
RED/REC microplanning guideline
Selecting an Esential Health Package of Health Services Using Cost-Effectiveness Analysis: A Manuel for Developing Countries. Brenzell, L.(1993).
US Panel on CEA (1&2)
WHO data on unit and delivery costs
WHO guide to cost-effectiveness analysis. www.who.int/choice/publications/p_2003_generalised_cea.pdf
WHO Immunization Financing Database
WHO manuals on economic evaluation for various vaccines and VPDs (e.g., HPV, influenza)
Credits
The survey was jointly developed and tested by the members of the EPIC, VoVRN, and ICAN projects in consultation with Dr. Logan Brenzel (Bill & Melinda Gates Foundation). Dr. Christian Suharlim led the development and administration of the survey. Cristina Munk led the outreach efforts, data analysis, and the development of the report.
We would like to thank the members of the Immunization Economics Community of Practice for taking the time to help us better serve the community. Participants of this survey, include: Adnan Kisa (University of Oslo), Damen Haile Mariam (Addis Ababa University), Joey Savoie (Charity Science), John Kitonyo (Strathmore Business School, Kenya), Kim Sweeny (Victoria University, Australia), Lora Shimp (JSI), Nsengiyumba Balinda Steven (Rwanda Biomedical Center), Olivia Bullock (Gavi), Pat Taylor (JSI), Saurabh Sharma (Sanofi), Soewarta Kosen (NIHRD MoH, Indonesia), Sid Rupani (Llamasoft), Simiao Chen (Harvard), and other participants who requested to remain anonymous