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April 2000 - Demand for AIDS vaccines varies by level of risk and by national wealth. At-risk individuals in poor countries suffer on both counts. Providing funds to develop and distribute AIDS vaccines should be a global concern. Bishai, Lin, and Kiyonga delineate two different algorithms for the purchase of AIDS vaccines, to show how differences in policy objectives can greatly affect projections of the number of courses of vaccine that will be needed. They consider a hypothetical vaccine costing USD 10 to produce, and offering 60 percent, 75 percent, and 90 percent reductions in the risk of HIV for 10 years. For each of the world's 10 major geographic divisions, they use published estimates of the risk of AIDS, the value of medical costs averted, and the value of potential productivity losses. Under the health sector algorithm - in which purchases are made to minimize the impact of AIDS/HIV on government health spending - 766 million courses of vaccine would be purchased. Under the societal algorithm - in which purchases are made to minimize the impact of AIDS/HIV on health spending and GDP - more than 3.7 billion courses of vaccine would be purchased. Under an equity model - allocating vaccines to everyone in the world at high risk as if they had the financial resources of Western Europeans - vaccine would be offered to 4.7 billion people. For a Western European man, reducing the risk of HIV/AIDS would be a USD 789 concern; in Africa, the comparable risk would be a USD 48,577 crisis. The authors conclude that financing AIDS vaccines solely on the fixed budget of a ministry of health means large vulnerable populations wouldn't receive the vaccine. Allocating the vaccine based on society's ability to pay would still exclude many poor infants who would probably be immunized if they were born in more developed regions. Policymakers concerned about equity in health care must redouble efforts to making the financing of development and distribution of AIDS vaccines a global, not a regional, concern. This paper was commissioned by the World Bank AIDS Vaccine Task Force, co-chaired by Poverty and Human Resources, Development Research Group and the Health, Nutrition, and Population Team, Human Development Network. David Bishai may be contacted at dbishai@jhsph.edu.

AIDS HIV --- Bereavement --- Children --- Disease Control and Prevention --- Drug Users --- Epidemiology --- Families --- Health Care --- Health Monitoring and Evaluation --- Health, Nutrition and Population --- Hepatitis B --- Hygiene --- Influenza --- Morbidity --- Patient --- Patients --- People --- Public Health --- Risk Groups --- Sex Workers --- Strategy --- Vaccination --- Victims --- Workers