Beyond methods and studies: Building institutions for better public spending on vaccination

Abstract

While overall public spending on health as a percentage of GDPremains relativelylow,astheireconomiesgrow,mostgovernmentsin Latin America and the Caribbean (LAC) are spending more perperson on health care and public health. In the area of vaccines,public spendinghasalsogrown;between2010and2011alone,theWorld Health Organization (WHO) estimated that public spend-ing on vaccination in LAC grew by 15% on average [1], althoughthere isconsiderableheterogeneityinpercapitaspendingbetweencountries.In many ways, LAC has been and remains a leader in vaccineintroduction relative to other regions. Even so and in spite ofincreasing spending overall and global evidence on the potentialvalue of new and underutilized vaccines [2], there is uneven con-sideration and adoption of new vaccines. As of 2012, less than halfof the 48 LAC countries and territories have adopted the Rotavirusvaccine, 21 countries and 5 territories have adopted the pneumo-coccal vaccine, and six countries have adopted HPV as part of theirnational immunization programs [3].Many LAC governments have established WHO-recommendedNational Immunization Technical Advisory Groups (NITAG) toadvise on new vaccine adoption and the national immunizationprogram ingeneral[4].Inspiteoftheseefforts,Andrusetal.identi-fied instances of decision making without reference to availableevidence, limited use of cost-effectiveness analyses in decisionmaking, and limited technical capacity to carry out economic eval-uation [5]. Further, a 2008 report of the independent Commissionon the Future of Vaccines in Latin America also noted the absenceof cost-effectiveness analyses using national data, information oncosts and risk groups for specific preventable diseases, and disag-gregated data on local and municipal levels as major obstacles tobetter priority-setting for vaccines [6].