To Raise Vaccine Spending in Low-Income Countries, Legislation Works
Mortality rates in Latin America have declined over the past century, due in part to the institutionalization of key public health programs. In a recent study published in the Journal of Public Health Policy, the Sabin Vaccine Institute and colleagues demonstrate a link between passing a vaccine law and spending on vaccines. The study examined the dynamics of vaccine spending and legislation in 31 countries in Latin America and the Caribbean over the period 1980-2013.
Immunization financing is critical to the success of national immunization programs and is an increasingly urgent issue for countries around the world. As low-income countries become more prosperous, they will become ineligible for donor support available through Gavi, the Vaccine Alliance, which currently funds a large portion of vaccine purchases in lower-income countries. By providing financial support to these low-income countries, Gavi’s work to ensure equal access to vaccines has helped prevent more than 8 million deaths. According to the World Health Organization, of the 73 countries ever eligible for Gavi support, in 2016, 16 countries are transitioning out of Gavi support and 5 have reached the end of Gavi support.
Domestic financing of immunization programs is therefore more important than ever. Sabin works with government officials and policy makers in Africa, Asia and Europe to establish sustainable financing solutions for immunization so countries can take full ownership of these programs and protect their citizens from preventable diseases once they graduate from Gavi funding.
Latin America serves as a model for countries striving to improve immunization rates. Over the period from 1980 to 2016, DTP3 vaccine coverage in the Americas increased from 50 percent to 91 percent. One factor that drove improvement was the Revolving Fund established by the Pan American Health Organization in 1977. Through the fund, member countries pool their resources to procure vaccines and related products at the best prices.
In order to participate in the Revolving Fund, countries were required to establish a line item in the national budget to buy vaccines and syringes. Many countries accomplished and institutionalized this by passing legislation. In 1980, only two Latin American countries had vaccine laws. By 2011, 27 countries had some kind of legal framework for immunization, covering 92 percent of the region’s population. As of 2013, 29 of 31 countries studied not only had vaccine laws, but had laws with explicit provisions for public vaccine financing, according to the Journal of Public Health Policy study.
The study, published in October, showed that “countries with laws spent 98 percent more on vaccines [from 2000-2013] compared to countries without vaccine laws,” even after controlling for population size, income, vaccine coverage, infant mortality, and the prevalence of vaccine-preventable diseases. The study was authored by Mike McQuestion, Ana Gabriela Felix Garcia, Cara Janusz, and Dr. Jon Andrus, executive vice president and director of Vaccine Advocacy and Education at Sabin.
Why might a vaccine law make such a difference in vaccine spending? Specific outcomes depend on the content of the law, but one thing is true. Social factors drive vaccination– perceived risk of disease, political popularity of immunization, public expectations and use of government services. These factors ebb and flow depending on a country’s economic situation and political climate, but once a law is passed, it endures, exerting a long-term impact on prioritization of vaccines by the government. Legislation provides legal protection of vaccines (and in many of the cases studied here, vaccine financing) against external shocks and competing priorities in years to come. Immunization is one of the most cost-effective methods to improve public health, as vaccines boost economic growth both directly and indirectly, and, in most cases, provide lifelong protection.
“We hope this information will serve as inspiration to countries considering their own vaccine laws,” said Dr. Andrus. “Sabin is proud to have worked with lawmakers in Nepal, Uganda and Nigeria to develop and pass legislation establishing and protecting financing for immunization, and continues to partner with other countries on legislative projects. We hope these laws will have just as great an impact on vaccine spending, so that life-saving vaccines reach every child in need. Such laws really reflect the current status of social conditions in countries. Latin America has led the way. Other countries are gaining from this experience.”