70 percent of the expected total mortality. A common-antigen vaccine, theoretically covering all pneumococcal serotypes, would avert some 510,000 deaths each year. If the price of the conjugate vaccine were $5 per dose and three doses were given, the cost per death averted would be between $6,000 and $7,000; the cost per death avoided with the common-antigen vaccine (also three doses, priced at $1 per dose) would be less than $800 (Table 4). As with Hib, these calculations take into account the projected additional expense resulting from side effects and the expected savings from reduced treatment costs.

TABLE 4 Cost-Effectiveness of Immunization with Pneumococcal Conjugate


Cost per Death Averted

Cost per Case Averted







Lederle-Praxis with herd immunity



Common antigen



NOTE:It is assumed that all vaccines are administered with DTP.

SOURCE: CDC, 1994.

Although direct purchase of conjugate Hib, pneumococcal, and meningococcal vaccines may be an option for some developing countries, for many those costs will be insurmountable. Other options will need to be explored. The purchase of bulk conjugate vaccine for combination with locally produced DTP is one such option. But for many poor nations, even the expense of bulk vaccine will be prohibitive.

Another alternative is to transfer conjugate vaccine production technology to the developing world. Indeed, given the potential size of the vaccine market in developing nations, it is highly unlikely that developed-country manufacturers alone could meet that need. Ultimately, indigenous production may be the only way poorer regions of the world will be able to afford to immunize their children.33 To produce these vaccines, developing countries must develop the


William Hubbard.

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