Immunization sustainability study

is beginning to question the wisdom of urging universal coverage or 80% coverage on countries that cannot afford the recurrent costs of maintaining these coverage levels. To address this issue, a 50- country study was undertaken, focusing on the costs and affordability of Expanded Programs of Immunizations (EPI). major conclusions are given below. (1) Wide differences exist among developing countries concerning the share of national resources required to meet the goals of EPI. (2) Sustainability is beyond the reach of many countries, particularly those in Africa and Asia. However, the sample group excludes some of the poorest nations due to lack of available economic data. If all countries had been included, sustainability would be unattainable for some Latin American countries as well. Even using the high economic growth assumptions, 8 of the 14 Child Survival Emphasis countries would require a commitment greater than 0.1% of their GDP to reach 80% coverage by the year 2000. (3) For many countries, the level of resources sufficient to immunize 80% of the projected 1990 target population would take decades to reach, even using high economic growth estimates. (4) Reducing the costs of immunization can have a significant impact on the potential of a country to "afford" the coverage targets. For nearly 15% of the countries, however, even a cost per fully immunized child of one-third of the $15.00 figure would be insufficient to produce 80% coverage with a commitment of 0.1% of GDP using the base growth assumptions. (5) Donor policy should focus on initiatives to reduce the economic burden of EPI and to establish country-donor partnerships. Efforts to reduce the economic burden of EPI must concentrate on reducing the average cost per fully immunized child and supporting population and other development activities that increase the economic capacity of each country. Country- donor partnerships reflect the conviction that universal coverage of immunization is a shared goal and that an effective response thereto requires a continuous relationship between the country and the donor(s). (Author abstract)