Brazilian health-service organisation: problems at a glance.

316 www.thelancet.com Vol 378 July 23, 2011 is substan tial (3·8 million disabilityadjusted life-years [DALYs]), it ranks well behind that of other vaccinepreventable diseases such as tetanus (8·3 million DALYs) and measles (23 million DALYs). Second, the eff ectiveness of the HPV vaccine against cervical cancer is still unknown. This uncertainty concerns African populations in particular, with their high HIV prevalence. Third, to remain cost-eff ective in GAVI-eligible countries, the costs for a vaccinated individual should not exceed US$10 for the three doses. This cost contrasts un favourably with the arguably lowest price negotiated so far—$16·95 per dose. When the donations are drained off , GAVI will be in a diffi cult position: terminating this highly publicised programme will be unpopular. Representatives of vaccine manufacturers and the Rwandan Minister of Health are on the GAVI Board—an obvious confl ict of interest. It would be a tragedy if funds were shifted from proven, cost-eff ective vaccines and the strengthening of health systems to new but costly vaccines of unknown eff ectiveness.