Primarily because their intended target is the healthy population, the economics of vaccines are unlike those for other medicines.
- Most governments already factor in this difference and have specific policy guidelines and even laws to help fund mass immunizations campaigns.
- An international two-tier pricing structure ensures that vaccine costs in poorer countries are far lower than those in their wealthier counterparts (1, ).
- Vaccine cost is also fundamentally different between countries with a publicly funded national health care system, e.g., Canada (lower), versus countries that don’t, e.g., USA (higher).
- Difference between childhood and adult vaccination programs is another element that influences vaccine cost. While the former are the intense focus of governments and therefore have robust public-private partnerships to defray costs, adult vaccinations can be fee for service, i.e., a healthcare provider purchasing vaccines upfront and then getting reimbursed after administering them ( ).
Whether a future Zika vaccine will be available for free or ~free to everyone or not thus depends on whether Zika presents anor threat (circumstance #1) or not (circumstance #2), if and when such a vaccine becomes available.
Circumstance #1. When a vaccine becomes finally available, if Zika presented anor threat, affected governments would likely support mass immunizations campaigns, meaning vaccine cost would be heavily subsidized or even free. Though the particulars of how vaccines are funded differ in different countries, by and large most governments heavily subsidize costs of vaccination. For e.g., in the US, vaccine costs were brought under a common umbrella through the 1962 Vaccination Assistance Act (Section 317 of the Public Health Service Act) ( , , ). Section 317 has been continuously reauthorized since 1962. Thus, it’s now a mainstay of immunization support in the US ( ).
The US Vaccine Assistance Act ended up doing several things,
- One, it allowed the (CDC) to support mass immunizations through the National Immunization Program.
- Two, it provided financial assistance ‘in lieu of cash‘ to state and local health departments to in turn support mass immunization programs. Specifically Section 317 allows the US federal government to provide vaccines and personnel such as CDC Public Health Advisors and epidemiologists to assist local and state health departments in managing these programs.
- Three, through Section 317, the US federal government is able to negotiate down vaccine prices with manufacturers ( ; also see for price differences between CDC and private sector costs for pediatric and adult vaccines). Factors relevant to cost reduction include sales volume, limited distribution points, no-return policy, to name a few.
- Four, in addition, the US 1993 Vaccines for Children (VFC) Act ensures free vaccines to uninsured children, those on Medicaid or American Indian or Alaska Natives ( ).
Thus, in the US, most recommended vaccines are covered by either private health insurance plans or government subsidies.
Circumstance #2. If, on the other hand, Zika threat in a particular country is so low that it would not be cost-effective for its government to subsidize it, then an individual may have to pay for it out of pocket, similar to the way they do now for travel-related vaccines, i.e., not covered by health insurance. Intended to protect against a mosquito-borne viral disease like Zika, theis a helpful guide for the cost of a travel-related vaccine in the US (see figure below from ).
1. Batson, Amie, Sarah Glass, and Piers Whitehead. “Vaccine economics: from candidates to commercialized products in the developing world.” New Generation Vaccines (2004): 57-73.
2. Lieu, Tracy A., Thomas G. McGuire, and Alan R. Hinman. “Overcoming economic barriers to the optimal use of vaccines.” Health Affairs 24.3 (2005): 666-679.
3. Hinman, Alan R., Walter A. Orenstein, and Lance Rodewald. “Financing immunizations in the United States.” Clinical infectious diseases 38.10 (2004): 1440-1446.
5. Hinman, Alan R., et al. “Vaccine-preventable diseases, immunizations, and MMWR: 1961-2011.” MMWR Surveill Summ 60.Suppl 4 (2011): 49-57.
7. Robinson, Chester A., Stephen J. Sepe, and K. F. Lin. “The president’s child immunization initiative–a summary of the problem and the response.” Public Health Reports 108.4 (1993): 419.
8. Yellow Fever Vaccine Costs in the USA.