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Amanda glassman Amanda glassman Presentation Transcript

  • Global Health and the New Bottom Billion Input into thinking about policy implications for adult vaccination in middle-income countries Amanda Glassman Director of Global Health Policy Center for Global Development September 2013
  • Most of the world’s poorest people live in middle-income countries Global Distribution of World Poverty • In 1990, over 90% of the world’s poor lived in lowincome countries (LIC) • Now, more than 70% of the world’s poorest people live in middle-income countries (MIC) • % of World’s Poor, $1.25/Day Most of the “new bottom billion” live in stable, nonfragile MIC Source: PoVCal Source: Sumner, 2011 2
  • Even more of the world’s poor will live in MIC over time Number of LIC & MIC, 2000-2025E • Moss and Leo (2011) project that there will be only 20 LIC in 2025 Sources: Moss and Leo, 2011; World Bank, 2011 *If China is excluded 63 92 2003 61 93 2008 43 101 2009 40 104 2010 35 110 2025 (estimate) Although the number of LIC continues to fall, global poverty, defined as total number of people living under US$1.25 or $2 per day remains around 1 bn to 2 bn, respectively* MIC (Countries) 2000 • LIC (Countries) 20 130 3
  • Total burden of disease has also shifted to MIC Total Burden of Disease (DALY), All Causes (MMs), 2010 2,000 1,724 1,800 1,600 DALYs (MMs) 1,400 1,112 1,200 1,000 800 600 462 400 346 266 284 200 0 Low income Lower middle income (net of PINCI) PINCI Source: Institute for Health Metrics and Evaluation – GBD 2010 Data Upper middle income Total MIC High income 4
  • MIC as a group has the greatest disease burden associated with tuberculosis Number of Cases of Tuberculosis (MMs), 1990-2009 Number of Cases (MMs) 15 1990 10 5 7.75 2.06 3.50 1.58 2009 10.80 9.93 7.00 1.74 1.47 1.20 0.41 0.19 0 Low income Lower middle income (net of PINCI) PINCI Upper middle income Total MIC High income Burden of Disease Associated with Tuberculosis (DALY) (‘000), 2010 36,479 40,000 27,913 DALYs (‘000) 30,000 20,000 12,746 5,016 10,000 3,550 500 0 Low income Lower middle income (net of PINCI) PINCI Upper middle income Total MIC Source: World Health Organization Statistical Information System (WHOSIS), 2011; IHME – GBD 2010 Data High income 5
  • Disease burden related to measles is concentrated among the PINCI, while that of HIV / AIDS is equally concentrated among PINCI and upper MIC DALYs (‘000) Burden of Disease Associated with Measles (DALY) (‘000), 2010 10,000 8,000 6,000 4,000 2,000 0 7,910 6,976 2,495 793 Low income Lower middle income (net of PINCI) 141 PINCI Upper middle income 10 Total MIC High income DALYs (‘000) Burden of Disease Associated with HIV / AIDS (DALY) (‘000), 2010 60,000 50,000 40,000 30,000 20,000 10,000 0 51,025 29,271 20,881 10,906 19,238 1,127 Low income Source: IHME – GBD 2010 Data Lower middle income (net of PINCI) PINCI Upper middle income Total MIC High income 6
  • In the case of vaccine-preventable diseases, MIC, particularly PINCI, have a much higher burden than LIC Total Burden of Disease Associated with Vaccine-Preventable Diseases (DALY) (‘000), 2010* 18,000 15,595 16,000 13,652 14,000 DALYs (‘000) 12,000 10,000 8,000 6,695 6,000 4,000 1,631 2,000 312 50 0 Low income Lower middle income (net of PINCI) PINCI Upper middle income Total MIC High income Source: IHME – GBD 2010 Data; World Health Organization Global Disease Burden Database, 2008 Note: Vaccine preventable diseases includes pertussis, poliomyelitis, diphtheria, measles, and tetanus; *poliomyelitis data is from the WHO and is 2004 data 7
  • The shift of disease burden to MIC is driven by population size, but also by lagging effort on public health prevention programs Number of DTP3 Unvaccinated Children (‘000), 2010 20,000 18,135 Number of People (‘000) 18,000 PINCI have the largest number of DTP3 unvaccinated children 16,000 14,000 12,000 14,440 10,000 8,000 6,000 5,477 4,000 2,434 1,262 2,000 652 0 Low income Lower middle income (net of PINCI) PINCI Upper middle income Total MIC High income Source: World Health Organization Statistical Information System (WHOSIS), 2011 Note: DTP-3 vaccination rate pertains to 1 year olds, calculated by multiplying the crude birth rate, life table survivors at the age of one, and the total population, divided by 100. The period is 2005-2010 8
  • Many MIC have relatively poor vaccination performance DTP3 Vaccination Coverage and GDP per Capita in LIC and Lower-MIC 6000 Maldives Colombia 5000 Dominican Republic Azerbaijan Namibia Jordan GDP per Capita 4000 3000 Morocco Armenia Swaziland Egypt Congo Indonesia 2000 Honduras Bolivia (Plurinational State of) Philippines Republic of Moldova Nigeria Pakistan 1000 Ghana India Senegal Zambia Kenya Haiti Timor-Leste Bangladesh Rwanda Zimbabwe Guinea Ethiopia Nepal Niger Sierra Leone Liberia Uganda 0 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % DTP3 Vaccination Coverage Source: World Health Organization Statistical Information System (WHOSIS), 2011 Note: Line represents the income per capita threshold between LIC and MIC, which is $1,006 according to the most recent World Bank definition 9
  • Over the past 20 years, PINCI have done relatively poorly on different dimensions of quality and coverage of DTP3 vaccination Spatial Distribution of Own Vaccination Performance Range nd 59 - 69 < 38 69 - 79 38 - 49 79 - 90 49 - 59 > 90 Source: Own calculations on OECD, WHO and WDI data. Graphic: Glassman, et al. / Vaccine 31S (2013) 10
  • Although most LIC and MIC governments spend less on their own vaccination programs, some mostly self-finance Spatial Distribution of Own Vaccine Financing and Management Range nd 43 - 57 < 14 57 - 71 14 - 29 71 - 86 29 - 43 > 86 Source: Own calculations on OECD, WHO and WDI data. Graphic: Glassman, et al. / Vaccine 31S (2013) 11
  • However, judging from existing levels of spend and projected costs, many MIC will face challenges in self-financing their immunization programs Vaccine Spending per Child by Income Group Vaccine Spending per Child Spending versus estimated cost of a full package of WHO recommended routine immunization schedule Estimated cost of a full package of WHO recommended routine immunization schedule $80 $69 $70 $62 $60 $50 $38 $40 $30 $25 $20 $8 $10 $1 $0 Low income Lower middle income Upper middle Medecins sans income Frontieres Saxenian and Hecht High income Source: LIC/LMIC/UMIC/HIC spending based on own calculations from WHOSIS; cost of a WHO-recommended load of vaccines based on Medecins Sans Frontieres (2012) report includes 1 BCG, 3 oral polio vaccine, 3 DRP, 2 measles, Hep B, Hib, PCV, rotavirus and rubella. The Saxenian and Hecht (SH) figure of $62 includes new vaccines in addition to the WHOrecommended load: HPV, Japanese encephalitis, pentavelent, pneumo, yellow fever and typohoid 12
  • A new, tailored MIC strategy needs to be developed • Eliminating income thresholds as an across-the-board eligibility criteria – Working in poorer regions in populous MIC • Setting up regional pooled procurement schemes as at PAHO, or creating a MIC window at GAVI • Building evidence-based priority-setting institutions in MIC • Establishing better measurement and accountability mechanisms • Providing technical support to MIC 13
  • Sources • Glassman A., Duran, D., and Sumner, A., “Global Health and the New Bottom Billion: What Do Shifts in Global Poverty and the Global Disease Burden Mean for GAVI and the Global Fund?” CGD Working Paper 270 (Washington: Center for Global Development, 2011). http://www.cgdev.org/publication/global-health-and-new-bottom-billionwhat-do-shifts-global-poverty-and-global-disease • Sumner A. (2010) Global Poverty and the New Bottom Billion. IDS Working Paper. • Edward P., and Sumner A., “The Future of Global Poverty in a Multi-Speed World: New Estimates of Scale and Location, 2010-2030” CGD Working Paper 327 (Washington: Center for Global Development, 2013). http://www.cgdev.org/sites/default/files/future-of-global-poverty_1.pdf 14
  • Contact • Amanda Glassman – aglassman@cgdev.org – @glassmanamanda – www.cgdev.org 15
  • APPENDIX 16
  • Total MIC fare worse than LIC on ARV coverage of HIV positive people Number of People Infected with HIV and not receiving ARV Treatment (‘000), 2008 18,000 16,829 Number of People (‘000) 16,000 14,000 12,000 10,000 8,138 8,000 6,315 7,171 6,000 3,343 4,000 1,315 2,000 0 Low income Lower middle income (net of PINCI) PINCI Upper middle income Source: World Health Organization Statistical Information System (WHOSIS), 2011 Total MIC High income 17