Biomedical Engineering Reference
In-Depth Information
transparency will lead to a more competitive market and lower prices, especially for
newer vaccines (McNeil 2011 ).
PAHO's Revolving Fund is a mechanism for the joint procurement of vaccines,
syringes, and related supplies for PAHO's 35 member states. 27 In 2007, PAHO pur-
chases amounted to about $225 million, with Brazil, Argentina, Colombia, and
Venezuela being the top four purchasers by value (International AIDS Vaccine
Initiative 2008b ). PAHO procures only vaccines that have been WHO prequalifi ed
or approved in the United States, EU, Canada, Korea, or Australia. Manufacturers
are selected based on the lowest price, the quantity offered, and the producer's
quality and service record. To guarantee supply, PAHO contracts with at least two
manufacturers. PAHO publishes weighted average vaccine prices per dose 28 and
claims that a country that purchases through PAHO can save at least 14 % compared
to purchasing directly from the producer (Pan American Health Organization 2010 ).
Funding of Public Vaccine Purchases
Public purchasers can fi nance vaccines with government funds (national and subna-
tional fi scal resources) or with funds obtained from donors.
The share of government fi nancing of vaccines used in routine immunization was
estimated at 94 % in the Americas, 92 % in Europe, 84 % in the West Pacifi c, 79 %
in the Eastern Mediterranean, 53 % in Africa, and 49 % in South East Asia. Having
a specifi c line item for vaccines in the national health budget, as was the case for
86 % of countries in 2006, was associated with increased governmental budget allo-
cations for vaccines and routine immunization fi nancing (Lydon et al. 2008 ).
Government-funding based on entitlement programs can accommodate the cost of
new vaccines more easily than programs which depend on annual discretionary
appropriations. For example, in the United States, vaccine funding under the VFC
entitlement program increased by nearly 400 % from fi scal year 2000 to fi scal year
2008, compared with a mere 42 % increase for the discretionary Section 317 pro-
gram (Lindley et al. 2009 ).
Donor fi nancing of vaccines is particularly important in low-income countries,
where total per capita government spending on health averaged about $15 in 2008
(Saxenian et al. 2011 ), while the cost of vaccinating a child fully through age 18 at
the US federal contract price amounted to $1,105 for boys and $1,407 for girls
(Lindley et al. 2009 ). Vaccine expenditures without donor contributions in low-
income countries would have accounted for 4.2 % of government spending on
health in 2010, rising to 6.3 % in 2015. By comparison, spending on vaccines in
Latin American countries, which tend to be early adopters of new vaccines, amounts
to slightly less than 1 % of government spending on health (Saxenian et al. 2011 ).
27 As of August 2001, the 35 member states include Argentina, Brazil, Canada, Mexico, and the
United States, among others.
28 http://new.paho.org/hq/index.php?option=com_content&view=article&id=1864&Itemid=2234
&lang=en%20 , accessed July 4, 2013.
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