VACCINE PROCUREMENT IN DEVELOPING COUNTRIES: A CASE STUDY OF THE REVOLVING FUND

Abstract

This thesis examines the Pan American Health Organization’s (PAHO) Revolving Fund as a case study of a regional vaccine procurement mechanism for countries in the Western Hemisphere. In the last thirty-eight years of its existence, the Fund has negotiated significantly discounted prices for vaccines by pooling vaccine demand and achieving economies of scale. These low prices have not only been instrumental in supporting regional efforts to stop the transmission of polio, measles and rubella but have also enabled participating countries to finance their national immunization programs with their own budgets. However, despite these successes, the rising cost of immunizing a child has highlighted the differential abilities of Member States to absorb the costs of new vaccines into their national health budget. With seventy percent of the world’s poorest people now living in middle-income countries, it is particularly relevant to reexamine PAHO’s Revolving Fund, which procures vaccines for several developing, upper-middle income countries. In this thesis, I evaluate if the Fund’s pricing policies are equitable, affordable and sustainable, given the greater costs of new vaccines. I achieved this by analyzing vaccination coverage in selected Latin American and Caribbean countries, comparing global vaccine prices and interviewing several experts in Washington D.C. and Lima, Peru. I conclude that the Fund’s singleprice policy is not affordable for all member countries and could therefore be made more equitable. Finally, I recommend that the Revolving Fund engage with other stakeholders as it continues to work towards achieving health for all.