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The strategic use and potential demand for an HIV vaccine in Southern Africa

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  • Desmond, Christopher
  • Greener, Robert
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    Abstract

    HIV prevalence in Southern Africa is the highest in the world and the impact of HIV/AIDS in the region are devastating at all levels of society, including the wider economy. Government response has lagged behind the pace of the epidemic, but programs are now beginning to focus on a broad range of interventions to combat its further spread and to mitigate its impact. The authors investigate the issues around the targeting of an eventual HIV vaccine. There is at present no vaccine against HIV. Although several candidates are in the trial stage, it is not likely that a vaccine effective against the sub-type of the virus prevalent in Southern Africa will be available for 10-15 years. When it is, it may be expensive, only partially effective, and confer immunity for a limited period only. Vaccination programs will need to make the best use of the vaccine that is available and effective targeting will be essential. The authors identify potential target groups for a vaccine, and estimate how many individuals would be in need of vaccination. They develop a method for estimating how many cases of HIV infection are likely to be avoided for each vaccinated individual. The cases avoided are of two kinds: primary-the individual case that might have occurred in people who are vaccinated, and secondary-the number of people that the vaccinated individual would otherwise have caused to become infected. Both ofthese depend on assumptions about the efficacy and duration of vaccine protection and the extent and nature of sexual risk behavior in the population groups. The authors distinguish between the HIV cases averted per vaccination and the cases averted per 100 recruits into a vaccination program. The cases averted per 100 recruits is used to develop a priority ranking of the identified population groups for vaccination. The authors discuss the issue of ease of access to those groups and how the differential costs would affect the vaccination strategy. They conclude that an expensive vaccine should be administered to commercial sex workers first, while an inexpensive vaccine would be better administered first to general population groups, in particular, schoolchildren. The authors conclude with a discussion of current levels of public and private expenditure on HIV prevention and treatment, and the implications for an assessment of the willingness to pay for an eventual HIV vaccine.

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    Bibliographic Info

    Paper provided by The World Bank in its series Policy Research Working Paper Series with number 2977.

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    Date of creation: 28 Feb 2003
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    Handle: RePEc:wbk:wbrwps:2977

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    Keywords: Disease Control&Prevention; Health Monitoring&Evaluation; HIV AIDS; Public Health Promotion; Early Child and Children's Health; Adolescent Health; Health Economics&Finance; HIV AIDS and Business; Health Monitoring&Evaluation; HIV AIDS;

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    1. Nichter, Mark, 1995. "Vaccinations in the third world: A consideration of community demand," Social Science & Medicine, Elsevier, vol. 41(5), pages 617-632, September.
    2. Cuddington, John T, 1993. "Further Results on the Macroeconomic Effects of AIDS: The Dualistic, Labor-Surplus Economy," World Bank Economic Review, World Bank Group, vol. 7(3), pages 403-17, September.
    3. Tangcharoensathien, Viroj & Phoolcharoen, Wiput & Pitayarangsarit, Siriwan & Kongsin, Sukhontha & Kasemsup, Vijj & Tantivess, Sripen & Suraratdecha, Chutima, 2001. "The potential demand for an AIDS vaccine in Thailand," Health Policy, Elsevier, vol. 57(2), pages 111-139, August.
    4. Cuddington, John T, 1993. "Modeling the Macroeconomic Effects of AIDS, with an Application to Tanzania," World Bank Economic Review, World Bank Group, vol. 7(2), pages 173-89, May.
    5. C Arndt & J D Lewis, 2000. "The Macro Implications of HIV/AIDS in South Africa: A Preliminary Assessment," South African Journal of Economics, Economic Society of South Africa, vol. 68(5), pages 380-392, December.
    6. David E. Bloom & Ajay S. Mahal, 1995. "Does the AIDS Epidemic Really Threaten Economic Growth?," NBER Working Papers 5148, National Bureau of Economic Research, Inc.
    7. Stover, John & Garnett, Geoff P. & Seitz, Steve & Forsythe, Steven, 2002. "The epidemiological impact of an HIV/AIDS vaccine in developing countries," Policy Research Working Paper Series 2811, The World Bank.
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