Many of these 22 million babies will be born in Africa. In Nigeria, vaccination coverage rates were most recently marked at 41%, meaning only four children in every ten are receiving the full threedoses of the diphtheria-tetanus-pertussis vaccine, which is used as a standard reference to assume a child is fully immunised. This rate is going down. In 2011, Nigeria reached 45% of its children with vaccination services.
Nigeria ranks second in the unenviable top ten of countries with the most unvaccinated children. Four more African countries make the list: Ethiopia, the Democratic Republic of the Congo, South Africa and Uganda. Taken together, the ten account for more than 70% of the world’s unimmunised children.
Low coverage rates are indicative of a multitude of issues, including weak health systems and bulky or cold-chain-dependent vaccines that are hard to deliver in remote settings. But it’s the high cost of vaccines that keeps many African health ministers in a sweat.
Take a look at the cost of the Expanded Programme on Immunisation, the basic package of vaccines that the UN recommends that all children receive. Since 2001, when vaccinating a child with this package of vaccines was just US$1.38, the cost has blown sky high– by 2,700%–to nearly $39 per child today. And $39 is the best possible price, the one paid by the poorest countries that are eligible for support from the GAVI Alliance.
GAVI was founded in 2000 to expand the reach of vaccination to children in developing countries who would otherwise miss out on the newest vaccines, such as pneumococcal conjugate vaccine (PCV), which protects against pneumonia and other infections. Pneumonia is among the leading causes of death for African children under 5 years of age.
If a country’s per-capita annual income is under a certain threshold, it is eligible for the lower prices GAVI negotiates with companies and the heavy subsidies it offers. Thirty-nine African countries are eligible for GAVI support. But there are two issues that these countries need to consider.
First, although the discounts GAVI negotiates are a significant reduction from the price that developed countries pay, the cost of new vaccines is still astronomically high. The cost of three doses of PCV, for example, makes up nearly half the $39 needed to fully vaccinate a child.
Second, what happens when countries “graduate” from GAVI and are no longer eligible for support? This is soon to be the reality for Angola and Congo. In 2016, they will no longer receive the significant subsidies from GAVI and will be faced with the dual challenges of having to fully finance their immunisation programmes, while having to pay the higher cost of newer vaccines. Angola, for example, will see a 714% rise in its bill for PCV and rotavirus vaccines upon graduation.
The problem is that prices negotiated by GAVI are inherited by countries. The poorest are shielded from the high prices for now, but once GAVI support runs out, many may not be able to pay.
GAVI is preparing for a high-level meeting on 30 October in Stockholm, where partners will review results to date and discuss progress since GAVI’s first pledging conference in June 2011. As GAVI’s stakeholders review this work and plan ahead, African health ministers should communicate the strains placed on their already stretched health budgets by the rising cost of vaccination. They should urge GAVI and its donors to reduce prices further, while ensuring continued access to lower prices once countries are no longer eligible for donor subsidies.
Every child born in Africa deserves the best shot at protection against vaccine-preventable diseases, and more affordable vaccines will go a long way towards achieving that goal.
Médecins Sans Frontières Access Campaign: www.msfaccess.org
© OECD Observer No 296 Q3 2013