The economics of vaccination in low- and middle-income countries.

Economic principles and tools have aided policy-making on the allocation of resources for health and have been applied convincingly to vaccination. In the late 1970s cost-effectiveness studies of immunization programmes in lowand middle-income countries led to a better understanding of the resources required to reduce morbidity and mortality (1). The push for increased coverage under Universal Childhood Immunization in the 1980s led to cost-effectiveness studies of alternative delivery strategies and interest in sustainability and affordability at country level (2). New vaccines, which cost more per child immunized, present financing challenges for countries — a concern that the Global Alliance for Vaccines and Immunization is responding to by planning for financial sustainability. What can economists bring to the question of how to finance services? Because vaccination of one child confers health benefits for others, in free markets vaccinations will be undersupplied, as the true marginal costs will not be recouped by providers. Families also have disincentives to bear the time and money costs of vaccination: those choosing not to vaccinate reap the benefit of protection created by those who do, but the greater the numbers of unimmunized children the greater the chances of disease transmission. Public financing and provision help to overcome these problems and to ensure an optimal level of service delivery. What can economics bring to the current policy and programmatic questions facing immunization services and the broader global health community? This issue of the Bulletin draws on an international meeting (3), and shows The economics of vaccination in lowand middle-income countries J.A. Fox-Rushby,1 Miloud Kaddar,2 R. Levine,3 & L. Brenzel4