A Child Immunization Program

The objectives of this exercise are to evaluate alternative immunization strategies and design a program that will provide the maximum improvement in health for a given budget. The baseline alternative is to continue with the existing low level of immunization and treatment of morbidity for diphtheria, pertussis, and tetanus. The project entails the delivery of the Bacille Calmette Guerin  vaccine to prevent tuberculosis and the DPT  vaccine to children, and tetanus toxoid   to expectant women for a period of five years. For purposes of analysis, we assume that the program ends after five years   We want to know whether the package should include only DPT for the child and T for the mother, or whether BCG should be added for the child.

         

Under the project, health care practitioners would deliver DPT vaccinations in two visits during the first year of life, and T vaccinations to pregnant women. In addition or instead, BCG vaccinations would be given to children entering and leaving school. First, we use economic analysis to determine whether it is more cost-effective to continue with the status quo, which relies primarily on treatment, or adopt a DPTT program, a BCG program, or a combined DPTT and BCG program. Second, we use the tools to decide whether it is worthwhile adding a BCG program to an existing DPTT program and vice versa. Third, we assess the economic returns to the immunization program.

Displacement of Existing Activities

The immunization program is expected to displace private sector activity; therefore, the gains are gross, not net. Without a government immunization program, 8 percent of the population purchases immunization services from private health care providers. Analysts estimated that after the government introduces a free program, half of the children who would have received private immunizations would now use the government program. The net coverage of the population would not be the 80 percent coverage provided by the public immunization program, but 80 percent less 4 percent. Thus, the actual effects would be 19/20.

Is a Life Saved Today as Valuable as a Life Saved Tomorrow?

T constructed under the assumption that a premature death prevented today is more valuable than a premature death prevented tomorrow. This peculiar result stems from standard economic theory. Life is valuable because we enjoy it. Enjoyment today is more valuable than enjoyment tomorrow. We place more value on an activity that prolongs today’s enjoyment than on an activity that prolongs future enjoyment at the expense of enjoyment in the present. We discount the benefits the health effect generates, not the health effect itself.

Another reason for valuing the prolongation of life in the future less than the prolongation of life in the present is as follows. Suppose that a program costs US$1,000 and will avert premature deaths at US$10 per person. We have two options. First, we can spend US$1,000 this year and avert 100 deaths,