, Volume 19, Issue 9, pp 937–946 | Cite as

The Economics of HIV Vaccines

Projecting the Impact of HIV Vaccination of Infants in Sub-Saharan Africa
Original Research Article


Objectives: (i) To project vaccine parameters, economic consequences and market size associated with HIV-1 vaccination of infants in sub-Saharan Africa through the Expanded Program on Immunisation (EPI); and (ii) to assess threshold values for price and effectiveness.

Study design and methods: Cost-effectiveness analysis using a decision-analysis model linking epidemiological data with economic information. Epidemiological data on the burden of disease of HIVwere obtained from theWorld Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS. The decision analysis model was constructed using estimates of lifetime chances of HIV infection. To assess threshold values for price and effectiveness, a maximum value for cost effectiveness in developing countries of $US100 was used in the base case. One-way and multivariate sensitivity analysis was performed on relevant parameters, assessing the impact of these parameters on the results of our analysis. In the base case, health benefits and consequences were discounted at a rate of 3%.

Study perspective: Societal.

Results: According to our model, introduction of an HIV-1 vaccine in the EPI would result in the vaccination of 8 717 112 infants in sub-Saharan Africa per year. This corresponds to the prevention of 1 839 355 cases of HIV per year, gaining 16 461 800 disability-adjusted life years (DALYs). The cost-effectiveness ratio of the intervention would be $US3.4 per DALY gained (1998 values) at a vaccine price in the base case of $US5. At the same price the estimated size of the market would be approximately $US44 536 111 per year.

Conclusion: If technological and financial problems associated with the development of an HIV vaccine can be solved,HIVvaccination in Africa could be both cost effective and potentially profitable.


  1. 1.
    The World Bank Africa Region. Intensifying action against HIV/AIDS in Africa: responding to a development crisis. Washington (DC): The World Bank, 1999Google Scholar
  2. 2.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global HIV/AIDS epidemic. Geneva: UNAIDS, 2000 JunGoogle Scholar
  3. 3.
    International Labour Organisation. The impact of HIV/AIDS on the productive labour force in Africa. Addis Abeba: Eastern Africa Multidisciplinary Advisory Team (EAMAT), 1995: EAMAt working paper No.1Google Scholar
  4. 4.
    International AIDS Vaccine Initiative (IAVI). Scientific blueprint 2000: accelerating global efforts in AIDS vaccine development. New York (NY): IAVI, 2000 JulGoogle Scholar
  5. 5.
    Jackson H, Kerkhoven R, Lindsey D, et al. HIV/AIDS in southern Africa: the threat to development. London: Russell Press UK for The Catholic Institute for International Relations (CIIR), 1999Google Scholar
  6. 6.
    World Bank Task Force on the Development of an HIV/AIDS Vaccine for Developing Countries. HIV vaccine industry study Oct–Dec 1998, Draft 20 Mar 2000 [online]. Available from URL: [Accessed 2000 Oct 20]Google Scholar
  7. 7.
    Kremer M. Creating markets for new vaccines: part I: rationale. Harvard Centre for International Development Project on Vaccines (Harvard, MA), Draft: Apr 13, 2000 [online]. Available from URL: [Accessed 2000 Oct 20]Google Scholar
  8. 8.
    Mahoney MT, Ramachandran S, Zhi-Yi X. The introduction of new vaccines into developing countries II: vaccine financing. Vaccine 2000; 18: 2625–35PubMedCrossRefGoogle Scholar
  9. 9.
    International AIDS Vaccine Initiative (IAVI). AIDS vaccines for the world: Preparing now to assure access. New York: IAVI, 2000 JulGoogle Scholar
  10. 10.
    Schweitzer SO. Pharmaceutical economics and policy. New York (NY): Oxford University Press, 1997Google Scholar
  11. 11.
    Smith R. Vaccines and medicines for the world’s poorest: public-private partnerships seem to be essential. BMJ 2000; 320: 952–3PubMedCrossRefGoogle Scholar
  12. 12.
    Kremer M. Creating markets for new vaccines: part II: design issues. Harvard Centre for International Development Project on Vaccines (Harvard, MA), Draft: Apr 13, 2000 [online]. Available from URL: [Accessed 2000 Oct 20]Google Scholar
  13. 13.
    Markowitz D. Infection with the human immunodeficiency virus type 2. Ann Intern Med 1993; 118: 211–8Google Scholar
  14. 14.
    DeVita Jr VT, Hellman S, Rosenberg SA, et al., editors. AIDS: etiology, diagnosis, treatment and prevention. Philadelphia (PA): Lippincott-Raven Publishers, 1997Google Scholar
  15. 15.
    Essex M. Human immunodeficiency viruses in the developing world. Adv Virus Res 1999; 53: 71–88PubMedCrossRefGoogle Scholar
  16. 16.
    Watts C, Kumaranayake L. Thinking big: scaling up HIV-1 interventions in sub-Saharan Africa. Lancet 1999; 354: 1492PubMedCrossRefGoogle Scholar
  17. 17.
    Forsythe S. Potential barriers to demand for an AIDS/HIV vaccine in developing countries [online]. Available from URL: [Accessed 2000 Oct 20]Google Scholar
  18. 18.
    World Health Organisation. United Nations Children’s Fund. State of the world’s vaccines and immunisation. Geneva: World Health Organization, 1996 [online]. Available from URL [Accessed 2000 Oct 29]Google Scholar
  19. 19.
    World Health Organization, Department of Vaccines and Biologicals. Vaccines, immunisations and biologicals: 2000–2003 strategy. Geneva: World Health Organization, 2000Google Scholar
  20. 20.
    Gold MR, Russel LB, Siegel JE, et al., editors. Cost-effectiveness in health and medicine. New York (NY): Oxford University Press, 1996Google Scholar
  21. 21.
    World Bank. World development report 1993: investing in health. New York (NY): Oxford University Press for the World Bank, 1993Google Scholar
  22. 22.
    Joint United Nations Programme on HIV/AIDS (UNAIDS)/ World Health Organization Working Group on Global HIV/ AIDS and STI Surveillance. Epidemiological Fact Sheet on HIV/AIDS and sexually transmitted infections: 2000 Update [online]. Available from URL: [Accessed 2000 Oct 26]Google Scholar
  23. 23.
    Population Division Department of Economic and Social Affairs, United Nations. World population prospects: the 2000 revision highlights, Draft. New York (NY): United Nations Population Division, 2001 Feb 28Google Scholar
  24. 24.
    World Health Organisation Department of Vaccines and Biologicals. WHO vaccine preventable diseases:monitoring system. Geneva: World Health Organisation, 2000Google Scholar
  25. 25.
    Sweat M, Gregorich S, Sangiwa G, et al. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. Lancet 2000; 356: 113–21PubMedCrossRefGoogle Scholar
  26. 26.
    Marseille E, Kahn JG, Mmiro F, et al. Cost-effectiveness of single dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa. Lancet 1998; 354: 803–9Google Scholar
  27. 27.
    Whyte B. UNAIDS estimates that half the teenagers in some African countries will die of AIDS. Bull World Health Organ 2000; 78 (7): 946PubMedGoogle Scholar
  28. 28.
    Joint United Nations Programme on HIV/AIDS (UNAIDS)/ World Health Organisation. AIDS epidemic update. Geneva: UNAIDS/ WHO, 2000 DecGoogle Scholar
  29. 29.
    Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge (MA): Harvard School of Public Health, 1996Google Scholar
  30. 30.
    Dalgleish A, Weiss R, editors. HIV and the new viruses. San Diego (CA): Academic Press, 1999Google Scholar
  31. 31.
    Blower SM, McLean AR. Prophylactic vaccines, risk behaviour change and the probability of eradicating HIV in San Francisco. Science 1994; 265 (5177): 1451–4PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Groningen University Institute for Drug Exploration/Groningen Research Institute for Pharmacy (GUIDE/GRIP)GroningenThe Netherlands

Personalised recommendations