Towards increased uptake and impact assessment of ITM vaccine: A research agenda

Towards increased uptake and impact assessment of ITM vaccine

A research agenda

James Rao

Workshop on the distribution, delivery and improvement of the

Infection and Treatment Method vaccine for East Coast fever

Nairobi, 19-20 August 2014

Outline

1. Introduction

2. Reliable and consistent supply of vaccine

3. Demand Issues

4. Quality control and assurance

5. Favourable policy environment

6. Monitoring impacts

Introduction

What are the key incentives for increased uptake of ITM

• From a farmer perspective

• From a business perspective

• From a policy maker perspective

What are the disincentives impeding uptake of ITM?

What institutional innovations would improve uptake?

What are the full range of impacts of ITM vaccine – beyond what we know?

Reliable and Consistent Supply of Vaccine

Towards efficient production of vaccine – which way?

Public sector based production; but ……..

• Public sector incapable of responding efficiently and sustainably to

demand

• Public sector also lack incentives (and probably capacity) to ensure

quality control

Private sector based production

• Theoretically … private sector is more efficient … but only

– In the absence of externalities

– In the absence of informational failures

– When the good/product is not a public good

Reliable and Consistent Supply of Vaccine

Moreover, private sector may be discouraged by:

• High cost in establishing an efficient vaccine value chain

– Acquiring production technology

– Developing production capacity

– Establishing & maintaining a reliable distribution infrastructure

• Unpredictable & irregular demand projections - disincentive for

private producers

• If production require specialized facilities, what happens to

established facilities when demand declines?

Research questions

Is a pure private venture a feasible production alternative?

What preconditions would such a venture require?

How can these pre-conditions be realized?

Reliable and Consistent Supply of Vaccine

Towards efficient vaccine distribution: preferred distributor or open

access?

• Preferred distributors

– Due to the irregular nature of the market

– Distributors may need protection guarantee to recoup investment

– However, ills of a preferential treatment are a concern

» Non responsive to client demand; inefficient pricing; market

segmentation and a segment preference leading to exclusion of

some users

• Open access market

– Competition: - price wars, low margins; incentives for quality

compromises

Research questions

Which approach can ensure efficient and wider coverage/reach?

What institutional innovations if any, are needed to achieve the efficient outcome?

Demand issues

Fears of irregular demand pattern

• Initial mass immunization (large markets)

• But protection lasts at least 3 years – only calves and new cattle stock may

require immunization on a regular basis

• Hence fear of a shrinking market and potential for increasing idle capacity

• Making the product unattractive for private sector players

Demand may be limited by current high prices of vaccine per dose

Limited access to the technology especially in marginal areas that are

fraught with limited penetration of commercial delivery systems

Demand issues

Misperception/misinformation about the vaccine driven by interest

groups benefiting from status quo

• Less use of acaricides and ECF clinical drugs – a threat to pharmaceuticals

• Reduced/elimination of clinical treatment of ECF – a threat to business for

those engaged in clinical treatment (veterinarians/AHAs)

Research questions

Can we project long term demand – given possible changes in herd structure?

What is the optimum/efficient price of the vaccine per dose?

How does this vary by: country and/or system of production?

From equity perspective – is the current price increasing inter-household disparity

Are subsidised vaccine delivery to farmers sustainable; if so how best can we target

subsidy?

Will vaccination crowd in/crowd out veterinary services to the benefit/detriment of the

animal health service providers?

Quality control and assurance

Quality control at various levels of the cold chain is a concern

• Unreliable state of cold chains

• At the point of administration

– Poor handling techniques by personnel

– Intentional tampering with vaccines

Public agencies expected to enforce standards but they lack incentives

to ensure adequate quality control

Research questions

Is there a possibility for self-regulation?

Can the fear (risk) of loosing reputation and hence business losses enhance compliance?

Can the drive towards compliance lead to investment by actors (vaccine producers and

distributors) in quality control at all levels of the vaccine chain)?

If so, what form would this investment take – training of own AHAs and para-vets etc.?

Favourable policy environment

Country-specific versus regional policies

• Country-specific policies

– May fragment the market - different products needed in different sub-regions

– Requires multiple licensing and product registration procedures

• Regional policies

– Larger market – attractive for private players

– However,

» May require regional policies and oversight agencies

» Larger parasite stock on which to establish a vaccine

» Different sets of vaccines – an impediment to harmonization

» Inconsistent or lack of appropriate veterinary policies to enhance widespread

uptake and use of the vaccine

Research Question

What are the trade offs between regional and country-specific approach to policy issues?

Monitoring impacts

Inadequate capacity (facilities, tools and personnel) to:

• Monitor impacts

• Monitor Vaccine failures/parasite breakthroughs

• Respond accordingly

Insufficient knowledge of full range of impacts

• Effects on full range of productivity

• Effects on herd structure

• Effects on the life of current crop of OTCs

Monitoring impacts

Monitoring impacts

Possible impacts on productivity

• Most studies evaluate impacts under pastoral systems

• Clear impacts on mortality and morbidity

• Reduced losses in milk (due to morbidity and possible mortality)

• Downward shift in marginal cost of production

• Changes in herd structure

• Higher calf survival;

– incentive to keep fewer breeding stock; for shorter period resulting into smaller and

probably younger breeding stock

• Reduced fear of keeping exotic/cross bred cattle leading to increased stocking of

cross/exotic breeds in non-traditional dairy areas

• What could this imply for

– Demand for animal healthcare services

– Cattle population

– Further demand (for ITM vaccines) projections

Monitoring impacts

Are there changes in tick control regimes (less spraying/dipping)

• Do farmers really change their tick control regimes?

• Does this affect prevalence of other tick borne diseases?

• What complementary interventions are needed to realize the full benefits of

ITM?

What other constraints limit adoptability of ITM?

Conclusion

Resolving outstanding technical issues could accelerate uptake of ITM

Further uptake can be sustained via suitable institutional innovations/business

models that:

Are more adapted to peculiarities of the ITM vaccine and its final users (farmers)

Have an efficient pricing mechanism

Encourage efficient self-regulatory & monitoring mechanism

Need for comprehensive impact assessment to generate evidence that can

justify public sector funding

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