Publication

Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus, and pneumococcal vaccines in low-income and middle-income countries: a modeling study

Authored by:

Riumallo-Herl, C., Chang, A.Y., Clark, S., et al.

Full Citation:

Riumallo-Herl, C., Chang, A.Y., Clark, S., et al. 2018. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus, and pneumococcal vaccines in low-income and middle-income countries: a modeling study. British Journal of Medicine Global Health. 3:e000612.

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Additional key concepts from this publication:

Illness episodes can cause catastrophic health expenditures to a household, both medical and non-medical out-of-pocket expenditures.

Key Evidence: In 41 Gavi-eligible countries, in the absence of vaccine coverage, the number of Catastrophic Health Costs (CHC) cases caused by measles would be 18.9 million, by severe pneumococcal disease would be 6.6 million and by severe rotavirus disease would be 2.2 million. Expanding vaccine coverage in these countries would reduce the number of cases of CHC due to measles by 90%, due to pneumococcal disease by 30% and due to rotavirus disease by 40%.

Illness episodes can cause catastrophic health expenditures to a household, both medical and non-medical out-of-pocket expenditures.

Key Evidence: In 41 Gavi-eligible countries it is estimated that, in the absence of any measles vaccine use, approximately 18.9 million households would have Catastrophic Health Costs (CHC) attributable to measles. The number of CHC decreases to 3.4 million households in these countries if the current vaccine coverage forecasts is unchanged and decreases to 2.6 million cases if coverage was enhanced with Gavi support. Overall, optimizing vaccine coverage for measles can reduce by approximately 90% the incidence of CHC due to measles disease.

In addition to causing substantial child mortality, pneumonia also pushes many families into poverty; Vaccination can protect against both.

Key Evidence: It is estimated that in 41 Gavi-eligible countries, approximately 6.6 million households would suffer Catastrophic Health Costs (CHC) in the absence of pneumococcal vaccine coverage. Due to the current absence of a pneumococcal immunization plan in many of these countries, the number of CHC cases would only decrease slightly to 6.4 million with current immunization programs. If pneumococcal vaccine programs would be implemented or expanded with Gavi support, the number of households experiencing CHC would decrease to 4.6 million – a decrease of approximately 30%.
Similarly, the estimates of medical impoverishment without vaccine coverage in this model showed that pneumococcal disease would cause 800,000 households to fall under the poverty line.

Use of vaccines, including strengthening existing immunization programs, provides opportunities for significant reductions in disease burden with resultant economic benefits.

Key Evidence: In 41 Gavi-eligible countries, it is estimated that without any rotavirus vaccine (RVV) coverage, an estimated 2.2 million Catastrophic Health Costs (CHC) cases and 600,000 Medical Impoverishment (MI) cases would occur due to rotavirus gastroenteritis. Unfortunately these figures would not significantly decrease under the current immunization forecasts because very few countries have introduced the RVV. However, with the introduction of RVV the number of CHC cases would drop to 1.3 million and MI cases to 400,000, representing a 40% reduction.

Immunization can offer some financial protection against significant illness treatment costs among the poor.

Key Evidence: In a financial risk model analysis of 41 Gavi-eligible countries, the burden of Catastrophic Health Costs (CHC) and Medical Impoverishment (MI) would be greatest in the lowest income populations. With expanded vaccine coverage, the share of prevented cases of measles, pneumococcal disease, and rotavirus, in relation to the total number of cases prevented, would be larger in the lowest income populations thereby providing a larger financial risk protection (FRP) to these populations.

Vaccines represent a valuable pro-poor intervention that not only improves health but also protects poor households from catastrophic and improverishing health expenditures.

Key Evidence: In 41 Gavi-eligible countries it is estimated that, in the absence of measles vaccination, the occurrence of Medical Impoverishment (MI) or households falling below the poverty line due to medical expenditures to manage measles disease would be 5.3 million. With current coverage rates, 700 thousand households would suffer MI. If Gavi support afforded enhanced coverage, the estimate of households suffering MI would decrease to 500 thousand.

Expanding vaccine coverage would improve household financial well-being by increasing disposable income that could further improve living conditions

Key Evidence: It is estimated that under current vaccine coverage trends in 41 Gavi-eligible countries, enhanced Gavi funding would help to avoid out-of-pocket health expenditures in an amount that surpasses US$4.5 billion attributable to measles, US$168 million attributable to severe pneumococcal disease, and US$200 million attributable to severe rotavirus.