Who pays for measles? The economic arguments for sustained immunization

Abstract

In April 1990 the Centre for Tropical Disease Research (CIET) at the Universidad Autonoma de Guerrero in Acapulco Mexico conducted an epidemiologic study of the September 1989-March 1990 measles epidemic and analyzed its cost in 43 representative communities to quantify all costs of the epidemic in order to estimate the full social benefit of immunization. The researchers examined loss of human life physical and mental effects on the survivors future earnings foregone due to death monetary costs and loss of household reserve capital. 70% of families of the measles cases experienced financial loss. 30% of them did not have enough money to pay for care so they sold labor farm animals or other assets. Specifically 20% borrowed money 19% sold their grain reserve and 4% sold future labor. The measles attack rate stood at 2.4% (1211 measles cases/50294 people) and 8% for 1-4 year old children. The case fatality rate was 3.7% for estimated cases and 12.3% for registered cases. When CIET included communities without health services the total number of deaths from measles was around 6000 with about 4000 deaths among under-5-year-old children. Economic costs of the epidemic equalled 18.8 workdays/case or a total of 1.6 million workdays for the 43 communities. These included out-of-pocket payment for medical care work time due to illness or caring for someone with measles and funerals. Future earnings foregone due to early death were more than 250000 person years of work. Costs of the epidemic to the states health service equalled 161557 days or 10% of the community costs. The health services cost and the cost to the communities were greater than the cost of an annual measles immunization program which would vaccinate all children less than 5 years old in Mexico for 5 years assuming a 10% increase/year (1788881 days vs. 1457565 days). These results may motivate policymakers to consider community costs and promote universal child immunization.