Research Article: An Estimation of Private Household Costs to Receive Free Oral Cholera Vaccine in Odisha, India

Date Published: September 9, 2015

Publisher: Public Library of Science

Author(s): Vittal Mogasale, Shantanu K. Kar, Jong-Hoon Kim, Vijayalaxmi V. Mogasale, Anna S. Kerketta, Bikash Patnaik, Shyam Bandhu Rath, Mahesh K. Puri, Young Ae You, Hemant K. Khuntia, Brian Maskery, Thomas F. Wierzba, Binod Sah, Marleen Boelaert.

Abstract: BackgroundService provider costs for vaccine delivery have been well documented; however, vaccine recipients’ costs have drawn less attention. This research explores the private household out-of-pocket and opportunity costs incurred to receive free oral cholera vaccine during a mass vaccination campaign in rural Odisha, India.MethodsFollowing a government-driven oral cholera mass vaccination campaign targeting population over one year of age, a questionnaire-based cross-sectional survey was conducted to estimate private household costs among vaccine recipients. The questionnaire captured travel costs as well as time and wage loss for self and accompanying persons. The productivity loss was estimated using three methods: self-reported, government defined minimum daily wages and gross domestic product per capita in Odisha.FindingsOn average, families were located 282.7 (SD = 254.5) meters from the nearest vaccination booths. Most family members either walked or bicycled to the vaccination sites and spent on average 26.5 minutes on travel and 15.7 minutes on waiting. Depending upon the methodology, the estimated productivity loss due to potential foregone income ranged from $0.15 to $0.29 per dose of cholera vaccine received. The private household cost of receiving oral cholera vaccine constituted 24.6% to 38.0% of overall vaccine delivery costs.InterpretationThe private household costs resulting from productivity loss for receiving a free oral cholera vaccine is a substantial proportion of overall vaccine delivery cost and may influence vaccine uptake. Policy makers and program managers need to recognize the importance of private costs and consider how to balance programmatic delivery costs with private household costs to receive vaccines.

Partial Text: Several large cholera outbreaks in the sub Saharan Africa, Asia and Caribbean regions [1–3] have renewed interest in the use of oral cholera vaccines (OCV) in recent years. Considering the public health importance of cholera, the World Health Organization (WHO) recommends targeting OCVs to vulnerable populations living in high-risk areas in conjunction with other control measures [4]. The WHO prequalified OCV Shanchol is reported to confer 65% protective efficacy over five years against clinically-significant cholera [5].This vaccine has been used in several OCV mass campaigns worldwide in recent years [6–10] and available eligible countries through WHO stockpile [11].

Based on a cross sectional survey, we estimated the private household costs for receiving OCV during a mass vaccination campaign conducted in Orissa, India in 2011. These costs included direct costs or out-of pocket expenses and indirect costs such as income loss due to the time spent for vaccination by the recipients and their caretakers.

Among the 600 randomly selected households, five households could not be reached. Of the remaining households, the 337 households that reported one or more members received vaccine during the mass vaccination campaign were interviewed.

Our analysis shows that private cost, i.e., direct travel costs and indirect productivity losses during the Odisha mass campaign ranged from 0.16 to 0.30 USD per dose (0.62 to 1.18 USD per family). This is the marginal costs to vaccine recipients, despite the vaccination booths were organized close proximity to the households. Although the vaccine was provided for free during the campaign, vaccine recipients and those who accompanied them had to forego time and money. This indicates a need for operational approaches and robust planning to reduce private household costs in future OCV campaigns and potentially in other vaccination programs.



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