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Johns Hopkins Bloomberg School of Public Health


By Dr. Dagna Constenla and Samantha Clark

For many people throughout the world, the bite of a mosquito is nothing more than a common annoyance. But for individuals living in dengue endemic countries such an annoyance can quickly turn into a life threatening condition. Patients who get sick with dengue fever often experience excruciating headaches, skin rash, and debilitating muscle and joint pains. In severe cases, it can lead to circulatory failure, shock, coma, and death. Though early and effective treatment can ease symptoms, there is no specific cure available for dengue. Efforts to control dengue through preventing mosquito bites and breeding have proven to be largely ineffective due to the mosquito’s tendency to feed throughout the day and ability to breed in even small bits of stagnant water. 


The good news is a vaccine is forthcoming. After more than 60 years, the development of dengue vaccines has accelerated dramatically. Today, several vaccines are in various stages of advanced development, with clinical trials currently underway on five candidate vaccines. While it is difficult to predict the introduction date of a new dengue vaccine, it is expected that one will be available by 2017.

Unlike a new iteration of an existing vaccine, this is uncharted territory. Even if a dengue vaccine is successfully developed, a number of issues remain. How do we predict its use? Its costs? Its cost-effectiveness and affordability? How will countries introduce it?

Perhaps the greatest challenge facing countries will be how to finance the addition of a dengue vaccine to the national vaccine schedule. Vaccine price, availability of funding, and ability to negotiate pricing will all play a critical role in the ability of a country to finance a dengue vaccine. In the Americas, one of the regions where dengue is endemic, a key mechanism for introducing new vaccines has been PAHO’s Revolving Fund. This, along with other options such as pooled procurement, regional and domestic taxes, and low interest multilateral loans are all potential sources of funding.

These and other funding topics will be on the agenda at a workshop starting today and hosted by IVAC, a core partner in the Dengue Vaccine Initiative, in partnership with the International Vaccine Institute, the Sabin Vaccine Institute and the Pan-American Health Organization. The dengue finance workshop will bring together more than 30 experts from the Latin America and Caribbean region, including academics, representatives from bilateral organizations, international public health agencies, nonprofit organizations, international financial institutions, and government agencies. They will convene in Washington, D.C. on July 22-23, 2013 to discuss the challenge of vaccine finance in countries throughout the region.

This workshop will be critical to laying the groundwork for countries to establish a viable financing plan that can be immediately implemented following the introduction of a dengue vaccine. Stay tuned to the IVAC website for more information following the workshop.


Dagna Constenla, PhD, is the Director of Economics & Finance at IVAC. Samantha Clark is a Health Economist at IVAC.

Posted by Kelly Healy


Dr. Dagna Constenla & Samantha Clark
July 24, 2013 03:40:56 PM
The Dengue Financing Workshop was a great opportunity for experts from a variety of backgrounds to discuss the financing of dengue control and prevention in the Americas. The continued role that PAHO’s Revolving Fund will play in vaccine financing was evident from the start, as well as the need for coordination between financing sources. The open discussions on both days provided valuable insight into: the need for strengthened health systems, importance of vaccine legislation, key role of National Regulatory Agencies, and the need for integrated management systems. A recurring concern throughout the meeting was the lack of reliable disease burden and cost data, and the critical role that improving surveillance systems throughout the region and increasing the number of cohort studies conducted will play in addressing these gaps. From the manufacturer’s side, participants heard updates on the status of current vaccine development and future supply capacity. This workshop will only be the start of many such collaborative effects to generate financing solutions to the problem of dengue. We look forward to presenting a manuscript with an in-depth analysis of the issues brought forth and conclusions from the proceedings. In closing, we would like to thank our workshop partners PAHO, IVI, and The Sabin Institute. Feel free to leave any thoughts on the workshop or input on the topic here.

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