Public finance of universal routine childhood immunization in India: district-level cost estimates.

Despite a reduction in disease burden of vaccine preventable diseases through childhood immunization, considerable progress needs to be made in terms of ensuring efficiency and equity of vaccination coverage. To conduct a systematic review to identify and explore factors associated with inequities in routine vaccination of children in India. Publications reporting vaccination inequity were retrieved through a systematic search of Medline and websites of the WHO, UNICEF and demographic health surveys in India. No restrictions were applied in terms of study designs. The primary outcome measure was complete vaccination or immunization defined as per the standard WHO definition. There were three nationwide data sets viz. the three National Family Health Surveys (NFHS), a research study conducted by the Indian Council of Medical Research (ICMR) and a UNICEF coverage evaluation survey. In addition, several publications representing different population groups or geographic regions were available. A small number of publications were reanalyses of data from the NFHS series. There is considerable inequity in vaccination coverage in different states. Within states, traditionally poor performing states have greater inequities, although there are significant inequities even within better performing states. There are significant inequities in childhood vaccination based on various factors related to individual (gender, birth order), family (area of residence, wealth, parental education), demography (religion, caste), and the society (access to health-care, community literacy level) characteristics. Girls fare uniformly worse than boys and higher birth order infants have lower vaccination coverage. Urban infants have higher coverage than rural infants and those living in urban slums. There is an almost direct relationship between household wealth and vaccination rates. The vaccination rates are lower among infants with mothers having no or low literacy, and families with insufficient empowerment of women. Paternal literacy has an inconsistent positive relationship with infant vaccination. There is a relationship between religion and caste and childhood vaccination. Access to health services and other infrastructure, is associated with better vaccination coverage of infants. The precise impact of specific risk factors operating singly or in combination cannot be calculated from this systematic review. This systematic review identifies and explores factors associated with inequity in childhood immunization in India; and provides information for urgent action to redress the imbalances.

This article is to understand the current status of Routine Immunization (RI) in India the challenges and way forward with a perspective of enabling the medical institutions and civil society organizations to engage in the program objectively. Routine Immunization (RI) program in India caters toa birth cohort of 27 million infants and 30 million pregnant women. Thus the Indias Universal Immunization Programme (UIP) is one of the largest in the wortd in terms of quantities of vaccine used number of beneficiaries number of immunization sessions organized and the geographical spread and diversity of areas covered.

Effectiveness of rotavirus pentavalent vaccine under a universal immunization programme in Israel, 2011–2015: a case–control study

Hepatitis B vaccine has been recommended for high-risk individuals in the United States for more than a decade. This targeted strategy, however, has failed to control hepatitis B virus (HBV) infection. Universal immunization is being considered as an alternative approach, in particular the inclusion of hepatitis B vaccine with routine childhood vaccinations. Data presented herein demonstrate a high degree of efficacy for hepatitis vaccine with hepatitis B immune globulin in preventing perinatal HBV infection in newborns. Immune response to vaccine was dependent in part on the dose administered, with some enhancement of response if the infant was older at the time of initial injection or if the booster dose was given later. Long-term follow-up showed persistence of vaccine-induced antibody for 5 to 10 years in 90% of immunized infants and adults. Only 3% to 5% of these high-risk individuals had serologic evidence of an HBV infection. None of the infections had been symptomatic and none resulted in a chronic HBV carrier state. Thus, immune responses and efficacy of hepatitis B vaccine in infants were excellent, and immunity and protection against clinically significant HBV infection persisted for at least 5 to 10 years, features essential to success of a program of universal childhood immunization against HBV.

Immunisation is a vital component of public health it is the foundation of a healthy, productive population. Preventing infections reduces the burden on health systems, and a healthier population is a more productive one Vaccines benefit not only infants, children, and pregnant women but also older people. India has the largest global immunisation program including vaccine coverage, new vaccines, vaccine hesitancy, advances in medical science, technological innovations, public-private partnerships, public health policies, and public awareness. Therefore Mission Indradhanush (MI) was launched by the Ministry of Health and Family Welfare (MoHFW), which is focused on covering children who are either unvaccinated or partially vaccinated against vaccine-preventable diseases. Universal Immunization Programme (UIP) provides to all children across the country free of cost to protect seven vaccine-preventable diseases such as Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B etc. This study aimed to focus Universal Immunization Programme (UIP), Mission Indradhanush (MI), Objectives, implementation, strategy, intensified Mission Indradhanush (IMI), Intensified Mission Indradhanush (IMI) 2.0, Intensified Mission Indradhanush (IMI) 3.0, Intensified Mission Indradhanush (IMI) 4.0, and Intensified Mission Indradhanush (IMI) 5.0. It has helped save countless lives and will help save more if the 2030 Immunization Agenda (IA2030) goals are achieved.

In anticipation of the imminent licensure of rotavirus vaccine, we evaluated the cost-effectiveness of rotavirus vaccine in Japan by taking into account the considerable variations in the incidence of rotavirus-associated hospitalizations previously reported in the literature. We assumed that the variation was due to local differences in healthcare utilization practices rather than a true difference in the incidence of severe rotavirus gastroenteritis. Thus, a Markov model was constructed such that the sum of rotavirus-associated hospitalizations and outpatient visits was set a constant value of 129 cases per 1,000 child-years. We calculated the direct medical cost, the indirect cost, and the quality-adjusted life year (QALY) loss in children aged less than 5 years. For the base case scenario, the incremental cost-effectiveness ratio (ICER) per QALY gained was 9.8 million Japanese yen from the healthcare perspective, but it was 900,000 Japanese yen from the societal perspective, making the program of universal immunization against rotavirus highly cost-effective. Furthermore, the universal immunization program was found to be cost-effective from the societal perspective for any of the previously reported incidence rates of rotavirus-associated hospitalization. Thus, the introduction of the rotavirus vaccine into the childhood immunization schedule and its co-administration with other childhood vaccines will be a cost-effective public health intervention in Japan.

Vaccination is recommended throughout life to prevent infectious diseases and their sequelae. Vaccines are crucial to prevent mortality in that >25% of deaths are due to infections. Vaccines are recommended for adults on the basis of a range of factors. Substantial improvement and increases in adult vaccination are needed to reduce the health consequences of vaccine-preventable diseases among adults. Incomplete and inadequate immunization in India against these communicable diseases results in substantial and unnecessary costs both in terms of hospitalization and treatment. The government of India as well as the World Health Organization (WHO) consider childhood vaccination as the first priority, but there is not yet focus on adult immunization. Adult immunization in India is the most ignored part of heath care services. The Expert Group recommended that data on infectious diseases in India should be updated, refined, and reviewed periodically and published regularly. This group suggested that the consensus guidelines about adult immunization should be reviewed every 3 years to incorporate new strategies from any emerging research from India. There is an immediate need to address the problem of adult immunization in India. Although many issues revolving around efficacy, safety, and cost of introducing vaccines for adults at the national level are yet to be resolved, there is an urgent need to sensitize the health planners as well as health care providers regarding this pertinent issue.

Streptococcus pneumoniae (sp) is a leading cause of invasive and noninvasive bacterial disease in children. 7-valent pneumococcal conjugate vaccine (PCV-7) has been shown to significantly reduce the incidence of pneumococcal diseases, such as meningitis, bacteremia, pneumonia, and otitis media. Although PCV-7 was introduced in Korea in 2003, it is not yet included in the universal immunization program. To evaluate the health outcomes, costs, and cost-effectiveness of universal vaccination with PCV-7 in Korean infants and to estimate the break-even price for PCV-7 from a societal perspective. A decision analytic model was used to evaluate the cost-effectiveness of immunization with PCV-7 in a birth cohort of Korean infants born in 2006. A universal vaccination strategy was compared with no vaccination in terms of costs and life years gained (LYG) over a 5-year time horizon. The birth cohort size, incidence of disease, resource utilization, and associated costs were obtained from the Korea National Statistical Office, the Korean Centers for Disease Control and Prevention, the Korean National Health and Nutrition Examination Survey, and the Korean Ministry of Health and Welfare. Inputs on the probabilities of clinical treatment pathways (e.g., tympanostomy) were derived from international literature if data specific to Korea did not exist. To estimate the benefits of universal immunization, the serotype-specific efficacy of PCV-7 was derived from studies conducted by Northern California Kaiser Permanente and by the Finnish Otitis Media Vaccine Study and applied to the serotypes isolated in Korean children with sp infections. The effects of vaccination on quality of life, herd immunity, benefits after the first 5 years of life, and patient copayments were not considered. A 4-dose schedule was used in the base-case analysis. A 3-dose schedule was also evaluated. The assumed price per dose was Korean won (KW) 70,000 (approximately US$54; 2009 exchange rate US$1 = KW1,300). Univariate and probabilistic sensitivity analyses were performed. Implementing a 4-dose universal PCV-7 vaccination strategy in a birth cohort of 451,514 infants in Korea would prevent 96,728 cases of pneumococcal-related infections (591 meningitis, 1,379 bacteremia, 43,950 pneumonia, and 50,808 otitis media cases) and 218 deaths (199 discounted deaths averted, 575 discounted LYG over 5 years). The medical and nonmedical cost burden of pneumococcal diseases offset with vaccination was KW44,033 million (US$33.87 million). The incremental discounted cost of universal vaccination was estimated to be KW86,384 million (US$66.45 million). The incremental cost per LYG was KW150.2 million (US$115,549) for the 4-dose schedule and KW103.91 million (US$79,955) for the 3-dose schedule. The break-even costs were KW22,100 and KW28,100 per dose for the 4- and 3-dose schedules, respectively. Universal PCV-7 vaccination of infants in Korea could substantially reduce pneumococcal disease morbidity, mortality, and related costs by preventing pneumococcal infections. However, at current market prices for the vaccine, a universal vaccination strategy is not cost-effective. The literature suggests that factors not considered in this analysis, including vaccine price reduction and indirect effects on public health (e.g., herd immunity), have the potential to make the public health impact and cost-effectiveness of universal PCV-7 vaccination in Korea more favorable.

A possible correlation between the impact of Covid-19 and universal immunization program against tuberculosis with Bacillus Calmette-Guérin (BCG) vaccine was suggested previously, based on apparent correlation between lower impact of the epidemics and a record of national BCG immunization program. In this work a time-adjusted dataset of Covid-19 statistical data by national and subnational health jurisdictions at the time point of six months after the local arrival of the epidemics was used to perform a statistical analysis of the significance of the correlation hypothesis between universal BCG immunization and a milder early phase Covid-19 scenario. With the data accumulated up to the point of the analysis, the significance of the correlation hypothesis was evaluated both qualitatively and quantitatively with the conclusion that it has achieved statistically significant level of confidence. The conclusions of this research can be used in development of epidemiological policy as well as the rationale to investigate the origin and mechanisms of a broad immunity protection that can be associated with an early-age exposure to BCG vaccine. Doi: 10.28991/SciMedJ-2021-03-SI-8 Full Text: PDF

India launched Expanded Programme on Immunization (EPI) in India in 1978 to control Vaccine Preventable Diseases (VPD). In 1978, EPI coverage was included for six diseases: diphtheria, peruses, tetanus, poliomyelitis, typhoid and childhood tuberculosis. The aim of EIP was to cover 80% of all infants. Subsequently, the programme was universalized and renamed as Universal Immunization Programme (UIP) in 1985. Measles vaccine was included in the programme and typhoid vaccine was discontinued. The UIP was phased in from 1985 to cover all districts in the country by 1990, targeting all infants with the primary Immunization schedule and all pregnant women with Tetanus Toxic Immunization.1 2

Vaccines are formulations that equip the human immune system to fight against a pathogen. All the vaccines approved for use are safe. On vaccination, the body produces enough clonal B and T cells to resist infection. Vaccines are the most cost-effective defense against infectious diseases. In India, there are at least 19 manufactures of vaccines. In addition, there are also a large number of companies that import specific vaccine formulations and sell these in India. These include two multinational companies that have also established repacking facilities. India has a well-established Universal Immunization Program (UIP) that targets vaccination of 30 million pregnant women and 27 million newborns annually. Indian vaccines are available at affordable prices to the private consumers but are supplied free of cost to the Indian beneficiaries through the UIP. Several kinds of vaccines technology are being researched all over the world. India has concentrated on the production and supply of conventional vaccines at cost-effective prices. India is also engaged in some level of research at manufacturing companies as well as at the institutional level. Effective vaccination of pregnant women and children would translate into a generally more healthy and productive society globally. India is poised to contribute in such an endeavor.

ObjectivesUnderstanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. MethodWe calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. ResultsThe total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. ConclusionResource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.

Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children < 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities. Key messages • Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities. • Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.

Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines. This report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non-VFC-eligible children born during 1994-2023. Diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; oral and inactivated poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine were included. Averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during 1994-2023 were estimated using established economic models. Net savings were calculated from the payer and societal perspectives. Among approximately 117 million children born during 1994-2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. From both payer and societal perspectives, routine childhood vaccinations among children born during 1994-2023 resulted in substantial cost savings. Childhood immunizations continue to provide substantial health and economic benefits, while promoting health equity.

With the adoption of policies requiring mainstreaming of institutionalized mentally disabled children into regular schools, the transmission of hepatitis B virus (HBV) from carriers to susceptible students and staff poses a potential problem.1,2 The recent rise in hepatitis B infection in the United States, especially in adolescents, has led the American Academy of Pediatrics and the Centers for Disease Control Advisory Committee on Immunization Practices to recommend universal HBV immunization of infants and to encourage immunization of all adolescents.3,4 Adolescents at increased risk of acquiring HBV infection should receive priority for immunization, but if resources permit, the immunization of all adolescents is recommended. These new recommendations, therefore, encourage the use of HBV vaccine in children with the eventual aim that all children be immunized against HBV infection. Cost and feasibility are the major limiting factors. Thus, the use of HBV vaccine in school settings should also be liberalized and encouraged. There is a growing body of evidence that demonstrates the spread of HBV infection under certain conditions to classroom contacts in schools and nursery school programs.5-9 When universal immunization is achieved, the need for special school concerns will be eliminated. Until universal immunization is well established, school systems need guidance as they undertake HBV infection control programs. A prevention strategy should be adopted that is based on studies of HBV transmission. It has been known for several decades that HBV is endemic in institutions for the mentally disabled. Surveys conducted in large institutions have shown that between 5% and 20% of residents may be carriers of the hepatitis B surface antigen (HBsAg) and an additional 60% may have antibody to HBsAg (anti-HBs).6