Ethical considerations for vaccination programmes in acute humanitarian emergencies
Waldman, Ronald J
Durrheim, David N
KeywordsKeywords: measles vaccine
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Study on Comparative Efficiencies in Vaccine Procurement MechanismsBumpas, Janet (World Bank, Washington, DC, 2008-06)Vaccinations are amongst the most cost-effective public health interventions. Vaccine procurement is a complex issue that interweaves the domains of public health, commodity security, ethics, and procurement. Its cross-disciplinary nature means that neither a straightforward analysis stemming from just one discipline nor a cookie-cutter application of World Bank procurement principles of economy, efficiency, equal opportunity, promoting domestic contracting and transparency will lead to an optimal solution. A more holistic approach is required. The World Bank has therefore historically considered vaccine procurement as 'special' and has allowed for exceptions from its guidelines for World Bank funded vaccine procurement. The study was designed to provide strong operational recommendations for issues such as efficiency, price, quality control, and logistics management. This study is intended mainly for internal purposes to facilitate discussions with Operations Policy and Country Service (OPCS) regarding refining the World Bank's position on procurement or supply of vaccine through United Nations Children's Fund (UNICEF).
Randomized trials to study the nonspecific effects of vaccines in children in low-income countriesShann F.; Nohynek H.; Scott J.A.; Hesseling A.; Flanagan K.L. (2011-05-15)The Expanded Program on Immunization (EPI) has led to large reductions in morbidity and mortality among children in low-income countries. However, the basic EPI schedule may no longer be optimal because of changes in vaccines, programs, and epidemiologic circumstances. In addition, evidence has accumulated that some EPI vaccines may have nonspecific effects that increase or decrease mortality from subsequent infections with other unrelated organisms. There is therefore a need for randomized trials to evaluate the effects of alternative EPI schedules on all-cause mortality, as well as vaccine efficacy against the target diseases. We have reviewed the available literature on the nonspecific effects of vaccines on mortality, and compiled a list of potential trials that might address this issue. We have then ranked the trials based on the potential importance of the results and the ethical and practical considerations. Trials of early BCG vaccination in low-birth-weight babies, early measles vaccination, and altered timing of DTP vaccination all have a high priority. © 2010 Lippincott Williams & Wilkins.
The Potential Demand for and Strategic Use of an HIV-1 Vaccine in Southern IndiaJha, Prabhat; Seshadri, Shreelata Rao; Subramaniyam, P. (World Bank, Washington, DC, 2014-05-09)Even a modestly effective HIV-1 vaccine
would be highly useful in India and could avoid millions of
deaths. How should such a vaccine be introduced? Based on
evidence of adoption of other vaccines in India, current
levels of spending on them and coverage of prevention
programs targeting both high- and low-risk groups, Seshadri,
Subramaniyam, and Jha assess the potential demand for and
strategic use of an HIV-1 vaccine in the four southern
Indian states of Andhra Pradesh, Karnataka, Maharashtra, and
Tamil Nadu. The authors also discuss potential strategies
for delivery of the vaccine, prioritization for vaccination,
and the political economy of such a vaccine in India.
Assuming a vaccine cost of $10 a dose and including
estimated delivery costs, the total cost of vaccinating 21.6
million adolescents 11-14 years of age and 1 percent of
adults would be Rs. 12.25 billion (US$ 245 million). To
maintain the vaccination rate in the 11-14 year old cohort,
an additional 6.77 million in that age range would have to
be vaccinated each year, at a vaccine cost of Rs. 3.39
billion (US$ 67.5 million). An HIV-1 vaccine will greatly
reduce HIV/AIDS in India, but it will not be a panacea.
There will be a continued need for effective prevention
programs to guard against behavior reversals or an imperfect
vaccine. Key inputs for prevention, immunization, and
treatment programs such as identification of various groups
that could be immunized (vulnerable groups or general
populations), strengthened surveillance, capacity building,
operations research, and evaluation at local levels will
continue to require intensive support.