Financing And Funding Gap For 16 Vaccines Across 94 Low- And Middle-Income Countries, 2011-30.

We estimated immunization program costs, financing, and funding gaps for sixteen vaccines among ninety-four low- and middle-income countries during the period 2011-30. Inputs were obtained from the Institute for Health Metrics and Evaluation, the 2020 Decade of Vaccine Economics costing analysis, the World Health Organization, Gavi, and the United Nations Children's Fund. We found a total funding gap of $38.4 billion between 2011 and 2030, with the cost of immunization delivery being the main driver (86 percent) of the funding gap. On average, government financing of vaccination programs steadily rises throughout the period. However, the decline in both Gavi and development assistance for health (DAH) financing anticipated between 2011 and 2030 outpaces the forecasted increases in domestic government immunization spending. Probabilistic sensitivity analysis was applied to both the costing and the scenario analyses to address uncertainty in the financing of vaccines and vaccine delivery. The results highlight a narrowing gap for vaccine acquisition but a growing gap for vaccine delivery, which emphasizes the critical need for resource mobilization and sustainable financial strategies for immunization programs at national and global levels, as well as a need to address the COVID-19 pandemic's potential effects on government financing for vaccines between 2021 and 2030.

COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts.

BACKGROUND: Restrictions to curb the first wave of COVID-19 in India resulted in a decline in facility-based HIV testing rates, likely contributing to increased HIV transmission and disease progression. The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown. METHODS: Retrospective programmatic and costing data were analyzed under a US government-supported program to assess the pandemic's impact on the programmatic outcomes and cost of index testing implemented in two Indian states (Maharashtra and Andhra Pradesh). We compared index testing continuum outcomes during lockdown (April-June 2020) and post-lockdown (July-Sept 2020) relative to pre-lockdown (January-March 2020) by estimating adjusted rate ratios (aRRs) using negative binomial regression. Startup and recurrent programmatic costs were estimated across geographies using a micro-costing approach. Per unit costs were calculated for each index testing continuum outcome. RESULTS: Pre-lockdown, 2431 index clients were offered services, 3858 contacts were elicited, 3191 contacts completed HIV testing, 858 contacts tested positive, and 695 contacts initiated ART. Compared to pre-lockdown, the number of contacts elicited decreased during lockdown (aRR = 0.13; 95% CI: 0.11-0.16) and post-lockdown (aRR = 0.49; 95% CI: 0.43-0.56); and the total contacts newly diagnosed with HIV also decreased during lockdown (aRR = 0.22; 95% CI: 0.18-0.26) and post-lockdown (aRR = 0.52; 95% CI: 0.45-0.59). HIV positivity increased from 27% pre-lockdown to 40% during lockdown and decreased to 26% post-lockdown. Further, ART initiation improved from 81% pre-lockdown to 88% during lockdown and post-lockdown. The overall cost to operate index testing was $193,457 pre-lockdown and decreased during lockdown to $132,177 (32%) and $126,155 (35%) post-lockdown. Post-lockdown unit cost of case identification rose in facility sites ($372) compared to pre-lockdown ($205), however it decreased in community-based sites from pre-lockdown ($277) to post-lockdown ($166). CONCLUSIONS: There was a dramatic decline in the number of index testing clients in the wake of COVID-19 restrictions that resulted in higher unit costs to deliver services; yet, improved linkage to ART suggests that decongesting centres could improve efficiency. Training index testing staff to provide support across services including non-facility-based HIV testing mechanisms (i.e., telemedicine, HIV self-testing, community-based approaches) may help optimize resources during public health emergencies.

An Innovative Pilot Program Addressing Food Insecurity in the Pediatric Primary Care Setting

Background: Food insecurity has long been established as a social determinant of health. Food insecurity in children is correlated with adverse health outcomes including poor overall health, obesity, asthma, allergies, anxiety and depression. Traditional interventions for food insecurity in the pediatric primary care setting have included referral to food banks, food vouchers and assistance programs. Limited research has been done examining the impact of meal delivery or of the feasibility of integrating food assistance directly into the pediatric practice. The objective of this pilot study is to determine if a medical home centered meal delivery program is acceptable, feasible and effective in reducing food insecurity and stress in families with children ages 0-5. Methods: The Division of Community Pediatrics (DCP) provides healthcare to vulnerable children in an urban area. DCP partnered with Share Our Strength's No Kid Hungry, and the Power of 10, a restaurant industry non-profit, to design and implement a pilot program to address food insecurity for families with young children during the COVID-19 pandemic. Ready to heat and serve healthy meals were delivered to the household twice a week to provide one meal per day per family member for 10 weeks. Surveys were conducted before and after receipt of 10 weeks of meal delivery during the pandemic among an adult caregiver. Survey questions were adapted from existing survey tools that examine meal delivery program implementation effectiveness, program acceptability, food insecurity and caregiver stress. Results: 43 families with at least one child age 0-5 enrolled and received meals. The majority (83%) stayed in the program until the conclusion. 31 families completed both the pre-test and the post-test. The average household size of participants was 5.6 members with an average of 2 children under age 5. Most (84%) participants were already receiving food assistance like WIC and/or SNAP benefits. The number of families who experienced food insecurity decreased with program participation (Table 1). Satisfaction and acceptability with the program was high (Table 2). Most (77.4%) said they and their children ate more fruits and vegetables than normal. Of those worried about food before the intervention, 66.7% were no longer worried at the end of the program (p=0.0001). Of those who ran out of food before the intervention, 71% reported no longer running out of food at the end of the intervention (p=0.0001). Conclusion: This innovative pilot program demonstrated that meal delivery through the primary care setting is feasible and effective in reducing food insecurity. It improved the quality of food consumed. Participants were satisfied with the program and there was a high retention rate. There was less reported worry about food running out by the conclusion of the program.

Vaccinations or Non-Pharmaceutical Interventions:Safe Reopening of Schools in England (preprint)

With high levels of the Delta variant of COVID-19 circulating in England during September 2021, schools are set to reopen with few school-based non-pharmaceutical interventions (NPIs). In this paper, we present simulation results obtained from the individual-based model, JO_SCPLOWUNEC_SCPLOW, for English school opening after a prior vaccination campaign using an optimistic set of assumptions about vaccine efficacy and the likelihood of prior-reinfection. We take a scenario-based approach to modelling potential interventions to assess relative changes rather than real-world forecasts. Specifically, we assess the effects of vaccinating those aged 16-17, those aged 12-17, and not vaccinating children at all relative to only vaccinating the adult population, addressing what might have happened had the UK began teenage vaccinations earlier. Vaccinating children in the 12-15 age group would have had a significant impact on the course of the epidemic, saving thousands of lives overall in these simulations. In the absence of such a vaccination campaign our simulations show there could still be a significant positive impact on the epidemic (fewer cases, fewer deaths) by continuing NPI strategies in schools. Our analysis suggests that the best results in terms of lives saved are likely derived from a combination of the now planned vaccination campaign and NPIs in schools.