Fangjun Zhou

Policy making for vaccine use as a driver of vaccine innovation and development in the developed world

In the past 200years, vaccines have had unmistakable impacts on public health including declines in morbidity and mortality, most markedly in economically-developed countries. Highly engineered vaccines including vaccines for conditions other than infectious diseases are expected to dominate future vaccine development. We examine immunization vaccine policy as a driver of vaccine innovation and development. The pathways to recommendation for use of licensed vaccines in the US, UK, Canada and Australia have been similar, including: expert review of disease epidemiology, disease burden and severity; vaccine immunogenicity, efficacy and safety; programmatic feasibility; public demand; and increasingly cost-effectiveness. Other attributes particularly important in development of future vaccines are likely to include: duration of immunity for improved vaccines such as pertussis; a greater emphasis on optimizing community protection rather than direct protection only; programmatic implementation, feasibility, improvements (as in the case of development of a universal influenza vaccine); public concerns/confidence/fears related to outbreak pathogens like Ebola and Zika virus; and major societal burden for combating hard to treat diseases like HIV and antimicrobial resistant pathogens. Driving innovation and production of future vaccines faces enormous economic hurdles as available approaches, technologies and regulatory pathways become more complex. As such, cost-mitigating strategies and focused, aligned efforts (by governments, private organizations, and private-public partnerships) will likely be needed to continue to spur major advances in vaccine technologies and development.

Trends in childhood vaccine purchase costs in the US public sector: 1996–2014

While vaccination remains as one of the most cost-effective preventive strategies, the cost of fully immunizing a child has grown considerably over the last few decades. This study examines trends in non-influenza childhood vaccine purchase costs in the public sector from 1996 to 2014. Non-influenza vaccine purchase cost per child for children aged 0 through 18years was calculated based on public-sector purchase prices. Purchase cost changes were then decomposed into changes attributable to recommendation updates and changes attributable to price variation. The study analyzed the growth rate of combination vaccine prices separately and compared these prices with the sum of prices of component vaccines. It is found that the average annual growth rate of non-influenza vaccine purchase cost per child during 1996-2014 was 12.6%. The growth rate attributable to price changes was 1.0% on average. Combination vaccine prices showed greater variation. The study concludes that vaccine price variation was one but a minor reason for purchase cost changes. Recommendation updates, particularly the introduction of new vaccines, played a much larger role in raising the purchase costs. If the 12.6% annual growth rate found during 1996-2014 in the study continues to apply, the purchase costs of childhood vaccines may more than double by 2020.

Factors associated with the pricing of childhood vaccines in the U.S. public sector

Vaccine purchase cost has grown substantially over the last few decades. A closer look at vaccine prices reveals that not all vaccines shared the same increasing pattern. Various factors, such as vaccine attributes, competition, and supply shortages, could relate to price changes. In this study, we examined whether a variety of factors influenced the prices of noninfluenza childhood vaccines purchased in the public sector from 1996 to 2014. The association differed among price-capped vaccines and combination vaccines. There was an increasing time trend in real prices for non-price-capped vaccines, which was mostly offset by the effect of market longevity. The effect of competition in lowering prices was more pronounced among non-price-capped vaccines when manufacturer and vaccine component fixed effects were excluded. Supply shortage, manufacturer name change, and number of vaccine doses in series showed no effect. The results may help policy makers better understand price behaviors and make more informed decisions in vaccine planning and financing.

Corrigendum to “Trends in childhood vaccine purchase costs in the US public sector: 1996–2014” [Vaccine 34 (2016) 4706–4711]

http://dx.doi.org/10.1016/j.vaccine.2016.12.010 0264-410X/ 2016 Elsevier Ltd. All rights reserved. DOI of original article: http://dx.doi.org/10.1016/j.vaccine.2016.08.012 ⇑ Corresponding author at: Florida International University, 11200 SW 8th St AHC5, Miami, FL 33199, USA. E-mail address: wechen@fiu.edu (W. Chen). Fig. 1. Purchase costs of a complete series of routinely recommended non-influenza vaccines for girls and boys aged 0–18 years, United States, 1996–2014. The costs were calculated based on the CDC purchase prices and quantity data of 12 routinely recommended vaccines with the following dose series: DTP/DTaP (5), Hep A B (3), Hib (3/4), HPV (3), OPV/IPV (4), MenACWY (1 before year 2011 and 2 doses afterwards), MMR (2), Td/Tdap (1), PCV7/PCV13 (4), Rota (2/3), Var (1 before year 20 doses afterwards). Combination vaccines that contain any of the above vaccines were considered separately and not included here. Since HPV vaccines recommended for females in 2007 and then for males in 2011, two bars were presented from 2007 to 2014, with the bars on the left representing purchase costs for costs were in 2014 dollars. DTP/DTAP: diphtheria and tetanus toxoids and pertussis vaccine or diphtheria and tetanus toxoids and acellular pertussis vaccine. Hep A: A vaccine. Hep B: hepatitis B vaccine. Hib: haemophilus influenza type b vaccine. HPV: human papillomavirus vaccine. MenACWY: meningococcal conjugate vaccin measles-mumps-rubella vaccine. OPV/IPV: oral poliovirus vaccine or inactivated poliovirus vaccine. PCV7/PCV13: pneumococcal conjugate vaccines. Rota: rotavirus Td/Tdap: tetanus and diphtheria toxoids vaccine or tetanus and reduced diphtheria toxoids and acellular pertussis vaccine. Var: varicella vaccine.

Economic Evaluation of Diphtheria, Tetanus, and Acellular Pertussis (DTaP) Vaccine in the United States: A Cost-Benefit and Cost-Effectiveness Model with Visual Basic Application

Economic Evaluation of Diphtheria, Tetanus, and Acellular Pertussis (DTaP) Vaccine in the United States: A Cost-Benefit and Cost-Effectiveness Model with Visual Basic Application

A Discrete-Event Computer Simulation of an STD Clinic to Evaluate the Feasibility of Implementing Hepatitis B Vaccination in San Diego County

A Discrete-Event Computer Simulation of an STD Clinic to Evaluate the Feasibility of Implementing Hepatitis B Vaccination in San Diego County