High Cost Is the Primary Barrier Reported by Physicians Who Prescribe Vaccines Not Included in India's Universal Immunization Program

Journal of Tropical Pediatrics (Impact Factor: 1.26). 02/2014; 60(4). DOI: 10.1093/tropej/fmu012
Source: PubMed


Haemophilus influenzae type B (Hib) vaccine, pneumococcal conjugate vaccine (PCV) and rotavirus (RV) vaccine are available in the private market
in India, but, except for Hib in eight states, are not included in India’s Universal Immunization Program (UIP). Pediatricians
were surveyed about administering non-UIP vaccines. Most give these vaccines to some of their patients (73–83%, depending
on vaccine), but few give them to all patients (7–18%). High cost was the most frequently cited barrier (93–96%). Only 10–12%
of respondents had concerns about the efficacy of PCV or RV vaccine, and concerns about Hib vaccine efficacy or any vaccine
safety issues were rare (1–3%). Practice varied by type of healthcare facility, with pediatricians at government hospitals
least likely to administer non-UIP vaccines. Support for the inclusion of all three in the UIP was high (83–95%). Including
Hib vaccine, PCV and RV vaccine in India’s UIP would be supported by pediatricians and help eliminate the current barrier
of high cost of these immunizations.

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    • "However, Hib vaccines have yet to be introduced in many low-income countries as part of routine immunization programs. This may be due to paucity of available data and cost constraints on Hib disease [Kahn et al. 2014]. It is important to know not only the efficacy of Hib vaccine but also each dose efficacy; a cost-analysis should be made before introducing the vaccine in routine programs. "
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    ABSTRACT: Haemophilus influenzae type b (Hib) is an important cause of meningitis and pneumonia in children. Despite the availability of Hib conjugate vaccine, many countries are still to implement it in their immunization schedule. Before introducing the vaccine in routine immunization programs, it is important to know not only the cumulative efficacy but also the efficacy of each vaccine dose. The primary objective of this review is to find whether two primary dose schedule of Hib vaccine is equally efficacious as the standard three primary dose schedule. A highly sensitive online search was run using the terms ‘Haemophilus Vaccines’ or ‘Haemophilus influenzae type b’ and ‘conjugate vaccine’, and Medline (Ovid), PubMed, Embase, CENTRAL and Scopus were explored for prospective randomized controlled studies. Data were extracted in a predesigned proforma and analyzed using RevMan software. Nine randomized studies were included in the analysis. Pooled vaccine efficacy using a fixed effects model against confirmed invasive Hib disease following the 3, 2 and 1 primary dose schedule were 82% [95% confidence interval (CI) 73-87], 79% (95% CI 54–90) and 65% (95% CI 23–84), respectively, and the overall efficacy was 80% (95% CI 72–85). To conclude, we found that Hib conjugate vaccine is highly efficacious and that the two dose regime is as good as the three dose regime. [The protocol was registered with PROSPERO (CRD42013004490)].
    03/2015; 3(2):31-40. DOI:10.1177/2051013615575871
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    ABSTRACT: Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 02/2015; 5(2):e007038. DOI:10.1136/bmjopen-2014-007038 · 2.27 Impact Factor

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