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Heidi Larson, UNICEF
Vaccination in Tomorow's Society - Fondation Merieux
NEW COMMUNICATION ISSUES AROUND IMMUNISATION
Heidi Larson, Ph.D.Senior Communication AdvisorUNICEF New York
GLOBAL ENVIRONMENTNew vaccines, new issues,
new “costs” of vaccination
Global vaccine divide between developed and developing countries
GLOBAL ENVIRONMENT 2 Less visible disease threats -
immunization success - has lead to increased questioning around do we (still) need vaccines?
Additional questions around immunization technology - injection safety, waste management, immunization schedules, mass campaigns
GLOBAL ENVIRONMENT 3
At the same time, new threats - bioterrorism - and the return of an old vaccine against disease that was once declared as eradicated
GLOBAL ENVIRONMENT 4
Stronger rights-based, “right to know” environment - growing civil society demands on access to information
The public increasingly challenging “quality” and “safety” of commodities
Previously locally isolated adverse events now national/international media events
GLOBAL ENVIRONMENT 5 Increased and more rapid communication
channels Less-government controlled information
and more global and commercially driven media
Internet, e-mail, global and satellite TV More frequent global travel, more
exposure/understanding of different languages - “francophone issues”
GLOBAL ENVIRONMENT 6
Proliferation of research giving sometimes incomplete or controversial information
How to address the “incomplete” scientific evidence?
Why does it matter to UNICEF?
In 2001 UNICEF delivered over 2.8 billion doses of vaccine to ~ 100 countries
UNICEF supplies vaccines for over 40% of the world’s children
but,
. . . this equals only 5% of the world’s expenditures on vaccines
nearly 60% of vaccine is procured from developing countries manufacturers
Value of the vaccine market has doubled but value of basic vaccines has dropped by 40%
0
1000
2000
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6000
7000
1992 2000
mill
ion
$ TravelProprietaryEnhancedBasic
Mercer Management
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2
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12
BCG DTP TT Measles
1992199219921992
1997
19971997
1997
USA/EU manufacturers leaving the developing country market1992 to 2001
2001200120012001
3 3 3
7
The high social value of vaccines in contrast with their relatively low economic value, compared to pharmaceuticals (US$ 5 bn : US$ 300 bn)
Pharmaceuticals
Vaccines
Economic Value
So
cial
Val
ue
Rappuoli, Miller and Falkow, The Intangible Value of Vaccination, Science, vol. 297, 9 August 2002
Introduction of newer vaccines increases vaccination costs for infants, with vaccine costs increasing from 5% to 30% of the total
0
10
20
30
40
Routine Basic Routine Basic +HepB
Routine Basic +DTP-HepB
Routine Basic +DTP-HepB+Hib
$
Vaccine Op. Costs
LESS PUBLIC TRUST Publicly available information on
vaccines is confusing WHO, the USA and EU and vaccine
industry sometimes give different guidance and standards
Confusing information creates more public questioning
LESS PUBLIC TRUST 2
Politically, economically, ethnically and socially marginalised groups have less trust in government provided commodities/services - increasing rumours due to lack of trust in the provider (eg. OPV sterilizes, causes cancer and HIV/AIDS)
COUNTRIES IN TRANSITION
Immunization was previously imposed
by government as a “public good” for
the health of the public
There is new need for citizen demand
driven-services.
COUNTRIES IN TRANSITION 2
In many countries, immunization is a state-provided service - meaning it is also vulnerable to state budget cuts/constraints
Government health staff dedicated to immunization become de-motivated due to strained resources and lack of political support to immunization
COUNTRIES IN TRANSITION 3
Preventive services are less attractive
than specialized, treatment-oriented
professions that earn more money and
status
Previously government-provided
services such as public registries and
calls for immunization are less available
COUNTRIES IN TRANSITION 4
The health reform process is not followed by
adequate structural and behavior changes -
people not taking adequate individual
responsibility including responsibility for their
own health or the health of their own children.
Former state-provided services are changed
to privatized health care - mandatory and
“coercive” versus demand driven services
EUROPE OR DEVELOPING ECONOMY?
One of the issues facing the region is increasing questions as to whether countries should be procuring “European” or “African” vaccines
This vaccine divide has lead to increasing questions on quality - when everyone got the same vaccines there was a different level of trust
EUROPE OR DEVELOPING ECONOMY?
At the same time other products locally procured/produced are sometimes less questioned for quality and safety because they are local and therefore more trusted
Korean Samsung/Hyundai seen as a high-tech products and vaccines are not?
(RE-)branding immunization for “tomorrow’s society”
Re-establishing the value of immunization - a child right and a public good
Benefits (OVER risks) of immunization Immunization as an investment rather than
an expenditure Status of immunizer (as “local hero”)
vs. immunologist
(RE-)branding immunization for
Immunization service - public service - civic responsibility?
Democratization of demand through community based organizations and the media
Positioning Immunization in broader development context - ie. vaccines and national/global security
Vaccines - weapons of mass protection!