The Strategic Use and Potential Demand for an HIV Vaccine in Southern Africa

Desmond, Christopher ; Greener, Robert

World Bank, Washington, DC

关键词: HIV INFECTIONS;    HIV VIRUS TESTING;    HIV VIRUSES;    VACCINES;    VACCINATION;   

DOI  :  10.1596/1813-9450-2977
RP-ID  :  WPS2977

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

HIV prevalence in Southern Africa is thehighest in the world and the impact of HIV/AIDS in theregion are devastating at all levels of society, includingthe wider economy. Government response has lagged behind thepace of the epidemic, but programs are now beginning tofocus on a broad range of interventions to combat itsfurther spread and to mitigate its impact. The authorsinvestigate the issues around the targeting of an eventualHIV vaccine. There is at present no vaccine against HIV.Although several candidates are in the trial stage, it isnot likely that a vaccine effective against the sub-type ofthe virus prevalent in Southern Africa will be available for10-15 years. When it is, it may be expensive, only partiallyeffective, and confer immunity for a limited period only.Vaccination programs will need to make the best use of thevaccine that is available and effective targeting will beessential. The authors identify potential target groups fora vaccine, and estimate how many individuals would be inneed of vaccination. They develop a method for estimatinghow many cases of HIV infection are likely to be avoided foreach vaccinated individual. The cases avoided are of twokinds: primary-the individual case that might have occurredin people who are vaccinated, and secondary-the number ofpeople that the vaccinated individual would otherwise havecaused to become infected. Both of these depend onassumptions about the efficacy and duration of vaccineprotection and the extent and nature of sexual risk behaviorin the population groups. The authors distinguish betweenthe HIV cases averted per vaccination and the cases avertedper 100 recruits into a vaccination program. The casesaverted per 100 recruits is used to develop a priorityranking of the identified population groups for vaccination.The authors discuss the issue of ease of access to thosegroups and how the differential costs would affect thevaccination strategy. They conclude that an expensivevaccine should be administered to commercial sex workersfirst, while an inexpensive vaccine would be betteradministered first to general population groups, inparticular, schoolchildren. The authors conclude with adiscussion of current levels of public and privateexpenditure on HIV prevention and treatment, and theimplications for an assessment of the willingness to pay foran eventual HIV vaccine.