London School of Hygiene & Tropical Medicine

Manufacturers of the human papillomavirus (HPV) vaccine could reduce prices for low- and middle-income countries and still retain most profits, according to a new study published in the journal Health Affairs.

Researchers from the London School of Hygiene & Tropical Medicine and the World Health Organization created an economic model to assess the financial benefits of vaccinating 80% of the world's 12-year old females against HPV, which is a cause of cervical cancer. They found that this could generate economic returns worth up to $12.5 billion a year.

Manufacturers were estimated to have received economic returns worth five times their original investment in HPV vaccine development. Furthermore, vaccinating an individual in a high-income country returned economic benefits five times greater than in a low-income country - this is a result of savings on health costs, such as cervical cancer treatment, as well as averting larger economic losses when women become ill or die from cancer.

The researchers also believe non-transparent pricing schemes that fail to consider the economic and health benefits of vaccination, are dissuading lower-income countries from buying the HPV vaccine.

Dr Mark Jit, Reader in Vaccine Epidemiology at the School who led the study, said: "Vaccinating females against HPV prior to the debut of sexual activity is touted as a global health success story, with good reason. The vaccine is highly effective at preventing HPV infection that can lead to cancer. However, although most developed countries have already incorporated HPV vaccines into their national immunisation schedules, cervical cancer still kills more than 250,000 women annually around the world - 90% of these deaths occur in low- and middle-income countries, and many of these nations can't afford the vaccine."

In this study the researchers analysed the economic surplus-the sum of all health and economic benefits minus the costs of development, production and distribution-for HPV vaccination of 12-year-old females. They also analysed the consumer surplus, calculating the difference between improved health and reduced cervical cancer treatment costs resulting from vaccination, and the cost of purchasing and delivering the vaccine.

Dr Jit said: "Both vaccine manufacturers and high-income countries have received large economic surpluses from the development of HPV vaccines. Developing countries have the potential to do the same. Alternative pricing schemes that explicitly and transparently take into account the health and economic value of HPV vaccination in different countries, instead of relying on market forces alone, could increase vaccine pick-up in these settings.

"Such schemes would still enable high-income countries to reap the benefits and manufacturers to generate the profits they need. While some countries benefit from vaccine purchasing schemes, such as those organised by Gavi, the Vaccine Alliance, many others do not. In the interim, providing countries with accurate and comprehensive information on vaccine prices and values, could improve the bargaining position of countries that are not currently part of pooled procurement schemes.

"One thing is clear though - it's time for higher-income countries and manufacturers to put their hands deeper into their pockets. Further subsidising vaccine prices in poorer countries will increase vaccine uptake, and in the long-term save more lives."

The researchers note that the model did not take into account indirect immunity and that some countries vaccinate older females and males. Reduced cancer screenings and treatment of precancerous neoplasias or genital warts was not considered, and the model assumed that manufacturers captured the entire producer surplus, but part of this may actually go to distributors.

Publication

• Niamh Herlihy, Raymond Hutubessy, and Mark Jit. Current Global Pricing For Human Papillomavirus Vaccines Brings The Greatest Economic Benefits To Rich Countries. Health Affairs. DOI: 10.1377/hlthaff.2015.1411