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Fifth GAVI Board Meeting, 21-22 June 2001, London, England
June 2001
NEW GAVI
Policy
User Fees
and Financing Essential Immunization Services
Beginning in
September 2002, countries that have received support from GAVI/The
Vaccine Fund will be submitting plans to the GAVI Board indicating how
they will assure the long-term financial sustainability of improved
immunization programs. These financial sustainability plans are to be
signed by the Minister of Finance in each country.
The GAVI
Financing Task Force is currently facilitating a process of drawing upon
partners and countries to develop financial sustainability guidelines
for consideration by the GAVI Board. In the interim, however, there are
indications that some countries are proposing immunization user fees as
a means to finance the introduction of new vaccines and improved
immunization programs as outlined in their applications to GAVI/The
Vaccine Fund.
In 2000, the
GAVI Financing Task Force undertook a major review of all information
and documentation on user fees for immunization and preventive health
services. Research findings, multilateral agreements and policies of the
World Bank and United Nations agencies all indicate that user fees
discourage people from seeking vaccination for themselves and their
children and are a disincentive to the utilization of preventive health
services, in general.
In addition
to the deleterious effect of user fees on people’s decision to use
appropriate preventive health services, user fees do not support
national and international goals for more effective immunization systems
and expanded vaccine coverage. This finding flows from the following:
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The
positive externalities of immunization to the wider community justify
public expenditure to promote widespread protection against disease
and to stop disease transmission. As such, immunization programs
should be a high priority for national government investment.
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One
principal and positive externality – protecting unvaccinated
individuals through decreased disease transmission – can only be
achieved with high levels of immunization coverage.
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There is
no national or regional data to demonstrate that user fees help
achieve high levels of routine immunization coverage.
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Vaccination is a preventive health intervention, and is more sensitive
than curative services to the discouraging effects of user fees.
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Policies
exempting the poor from user fees are difficult to administer.
Given the aforementioned concerns and the importance of conveying an
interim message to countries, the Financing Task Force requests the GAVI
Board to issue a policy statement to the following effect:
The
GAVI Board recognizes that countries are exploring a variety of
mechanisms to fund essential and routine immunization services. User
fees have been shown to be a disincentive to the utilization of
preventive health services including immunization, in particular. The
GAVI Board therefore recommends that in the absence of compelling
country or regional data unequivocally documenting their value, user
fees should not be levied in publicly financed national immunization
services.
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