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Lancet. 1998 May 16;351(9114):1446-7.

Getting Hib vaccine to those who need it.

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  • 1Department of Paediatrics, St Mary's Hospital, London, UK.



Despite the availability of an effective vaccine, Haemophilus influenzae type b (Hib) accounts for more than 3 million cases of serious illness and 700,000 deaths annually, mostly in developing countries where the cost of the vaccine is prohibitive. The World Health Organization has recommended that Hib conjugate vaccines be included in infant immunization programs, especially in countries with high disease rates. In light of evidence from a study by Rosanna Lagos et al., that 3 fractional doses or 2 full doses of vaccine may be as effective as the standard 3-dose infant regimen, research into the efficacy of a single dose in resource-poor settings would be valuable. However, it is unlikely that vaccine manufacturers will reformulate their vaccines to produce substantially cheaper products because a 66.7% reduction in antigen content is estimated to reduce costs by only 10%. Reformulation would also necessitate reapplication for a product license, which is an expensive undertaking. While there is a dearth of published material available on dose-ranging immunogenicity studies with Hib conjugate vaccines, selection of a dose reflects the inferior field vs. trial delivery conditions, and the fact that some recipients will be less immunocompetent than trial participants. The most cost-saving implication of the Lagos study may be found in the temptation to substitute a single dose for a multi-dose of the vaccine. This practice, however, would raise concerns about preservation, contamination, and vaccine failure. New competitors in the Hib market may lower the price within reach, but policymakers should understand that even a high-priced vaccine can be cost-effective as a medical intervention.

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