Hepatitis B vaccination or clean water? (2)
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Jacob, the rationale for preferring basic public health intervention
such as clean water and adequate sanitation in developing countries is
obscure (note that I am being very diplomatic). It remains one of the
mysteries of WHO. The economics of HB vaccination are bedeviled by all
sorts of problems and the answers are not as clear cut as WHO and the
vaccine's manufactures would like them to be.
You may wish to read the following systematic reviews of the economics
of HB vaccination:
JEFFERSON T O, DEMICHELI V. Is vaccination against Hepatitis B effi-
cient? A review of world literature. Health Economics 1994; 3:25-37.
Paper presented at the Fifth European Health Services Research Confer-
ence at Maastricht, (December 1993).
DEMICHELI V, JEFFERSON T O. An exploratory review of the economics of
recombinant vaccines against Hepatitis B (HB). In: Ronchi E (Editor)
Biotechnology and Medical innovation: Socio-economic assessment of the
technology, the potential and the products. OECD, Paris 1997 pages 105-
123.
And the following viewpoint article:
JEFFERSON T O, DEMICHELI V. Methodological quality of economic modeling
studies: a case study with hepatitis B vaccines. Pharmacoeconomics
1998; 14:251-7.
In summary these show that most of the economic evaluations of HB vac-
cines are not worth the paper they are written on. As you can imagine
we were not wildly popular with either WHO or the vaccine manufactur-
ers. Too bad.
Tom Jefferson
mailto:TOJ1@aol.com
P.S. Please do not ask me to post you or any of the other recipients of
this e-mail anything as my budget does not stretch to that.
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